The Evolution of Individual Maternity Care Providers to Delayed Cord Clamping: Is It the Evidence?

INTRODUCTION: Studies of organizational strategies to incorporate evidence into practice and change provider behavior have shown limited success. The majority of existing research centers on influencing participants to change practice versus understanding what occurs when providers have successfully shifted to an evidence-based practice on their own. This study sought to explore the dynamics involved when individual midwives and physicians transitioned from a practice less based on the evidence to one with more scientific support. Delayed cord clamping was selected as the exemplar practice for the study.

METHODS: A qualitative grounded theory approach was used. Seventeen providers were interviewed throughout the United States. This included 5 physicians and 12 midwives from a variety of practice configurations and birth settings including the home, birth center, and hospital.

RESULTS: Five themes arose from the stories of the participants: 1) trusting colleagues, 2) believing the evidence, 3) honoring mothers and families, 4) knowing personal certainty, and 5) protecting the integrity of the mother and the baby. The themes served as drivers of change for the providers in what emerged as an evolution toward change rather than a decision to change. From the themes, the model for individual evolution to evidence-based practice was developed.

DISCUSSION: Important findings included the significant role that colleagues play in an individual's journey toward a new practice, the fact that the evidence alone was never a sole driver of change, and the emergence of a discourse: Who owns the baby? The model developed as a result of this study provides a new framework for both future research and potential strategies to support the incorporation of evidence into practice.