"EFFECTIVENESS OF PROFESSIONAL TRAINING PROGRAMS ON IMPROVING EVIDENCE-BASED MATERNAL AND NEONATAL CARE PRACTICES: A META-ANALYSIS WITH FOCUS ON UMBILICAL CORD CLAMPING."

Seema Rani, Prof. (Dr.) Vikas Choudhary

Abstract

Background:
Delayed umbilical cord clamping (DCC) is recognized as a beneficial practice for improving neonatal outcomes, including enhanced hematologic status and neurodevelopment, without increasing maternal or neonatal complications. However, its implementation remains inconsistent across healthcare settings, often due to gaps in provider training and systemic barriers.

Objective:
To evaluate the effectiveness of professional training programs on improving evidence-based maternal and neonatal care practices, with a specific focus on delayed umbilical cord clamping, by synthesizing evidence from experimental studies conducted across diverse populations and settings.

Methods:
A meta-analysis was conducted including six experimental studies that compared the effects of DCC, early cord clamping (ECC), or umbilical cord milking (UCM) on maternal and neonatal outcomes. Studies included randomized controlled trials and quasi-experimental designs involving healthcare providers and mothers in both high- and low-resource settings. Data were extracted on neonatal hematologic outcomes, neurodevelopment, and maternal safety parameters.

Results:
The study by Armstrong-Buisseret et al. (2020) showed a significant reduction in death or adverse neurodevelopmental outcomes in preterm infants with deferred clamping (RR 0.61, 95% CI 0.39–0.96). Chawanpaiboon et al. (2025) reported higher hemoglobin and hematocrit levels in the DCC group among term infants, with no increase in neonatal complications. Al-Tawil et al. (2012) found improved iron stores at 3–5 months of age in infants receiving DCC. Lushindiho et al. (2020) highlighted the need for structured provider training to promote DCC practices. Ofojebe et al. (2021) confirmed higher neonatal hemoglobin levels at 48 hours without significant differences in bilirubin levels or maternal outcomes. Wang et al. (2025) found no increased risk of neonatal respiratory distress or maternal adverse events with DCC. Overall, DCC was associated with improved neonatal hematologic outcomes and was well-tolerated, though implementation barriers persist.

Conclusion:
Delayed umbilical cord clamping is a safe and effective intervention that enhances neonatal health outcomes without increasing risks. Structured training programs for healthcare providers are essential to improving adherence to evidence-based practices. Policy initiatives and educational interventions tailored to local contexts are necessary to ensure widespread implementation and sustained practice change.