title: Effect of a two-component intervention to change hospital practice from early to delayed umbilical cord clamping in the Peruvian Amazon.
abstract: OBJECTIVE
  To investigate the effect of a two-component intervention to change hospital practice with regard to the timing of umbilical cord clamping.
  
  
  METHODS
  A pre-/post-study design was used to measure the effect of a two-component intervention on mean time to clamp the umbilical cord. The study took place at Hospital Iquitos "César Garayar García" in Iquitos, Peru. A total of 224 women were recruited from the hospital labor room: 112 pre-intervention, from 18 May-3 June 2009, and 112 post-intervention, from 6-20 July 2009. The intervention consisted of 1) a "best practice" three-day training workshop on birthing, and 2) a hospital directive. All deliveries were observed and the time between delivery of the first shoulder and clamping of the umbilical cord was measured with a digital stopwatch.
  
  
  RESULTS
  The mean time between delivery and cord clamping before the intervention was 56.8 seconds (95% confidence interval [CI]: 51.0, 62.7). This increased to 169.8 seconds (95% CI: 153.8, 185.8) following the intervention. The difference in mean time to clamp remained significant in multivariate analyses (β adjusted = 113.2 seconds, 95% CI: 96.6, 129.9).
  
  
  CONCLUSIONS
  Hospital policy and practice can be successfully changed from early to delayed umbilical cord clamping using a simple, two-component intervention.
authors.affiliation: Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.
authors.forename: Brittany
authors.initials: B
authors.lastname: Blouin
authors.forename: Mary E
authors.initials: ME
authors.lastname: Penny
authors.forename: Martin
authors.initials: M
authors.lastname: Casapia
authors.forename: Eder
authors.initials: E
authors.lastname: Aguilar
authors.forename: Hermánn
authors.initials: H
authors.lastname: Silva
authors.forename: Serene A
authors.initials: SA
authors.lastname: Joseph
authors.forename: Hilary M
authors.initials: HM
authors.lastname: Creed-Kanashiro
authors.forename: Mathieu
authors.initials: M
authors.lastname: Maheu-Giroux
authors.forename: Theresa W
authors.initials: TW
authors.lastname: Gyorkos
mesh_terms: D003250:Constriction; D036861:Delivery, Obstetric / Q000193:education* / Q000592:standards*; D005260:Female; D006801:Humans; D008880:Midwifery / Q000193:education*; D010568:Peru; D057184:Practice Patterns, Nurses'; D011247:Pregnancy; D013997:Time Factors; D014470:Umbilical Cord; D055815:Young Adult