A recommendation to avoid umbilical cord prolapse: Lying down after rupture of membranes [Hinlegen und liegendtransport nach blasensprung]

Prolapse of the umbilical cord is a rare but serious complication after rupture of membranes. To avoid cord prolapse Austrian midwives and obstetricians recommend pregnant women to lie down after rupture of membranes at home and stay in a lying position until a caregiver has confirmed that the presenting fetal part is fixed in the maternal pelvis. This recommendation has disadvantages and there is no scientific evidence to support the belief in its effectiveness. This study aimed to gather information on the recommendation to serve as a basis for putting it into debate and for research on its effectiveness. It was conducted as a descriptive survey with three parts: ▶ An international e-mail / postal questionnaire survey contacting an opportunity sample of national midwifery associations and international midwives to find out if this recommendation is also given outside Austria. ▶ A national postal questionnaire census of the 1636 midwives and e-mail survey of approximately 600 obstetricians practising in Austria to find out how widespread the practice is in Austria and what practitioners in maternity care think of it. ▶ Standardised interviews with an opportunity sample of 25 women in Austria having recently experienced rupture of membranes at home to find out childbearing women's experience and compliance with the recommendation. Data were analysed with descriptive statistics and by content analysis. The results show that the recommendation is not known in all countries. If it is, it is mostly used in a less strict sense or not at all. In Austria, caregivers do not apply it in a uniform way. About half of them do not believe in the effectiveness of the recommendation but nevertheless give it for forensic reasons and because it is standard. Midwives also stated a lack of autonomy and "protecting women" as their reasons to use it. Most women knew the recommendation but few complied. After discussing the results in the wider context of the recommendation, it is concluded that it does not seem justified to use the recommendation as a routine measure. If at all, it could be applied according to the individual clinical situation. The best feasible design to determine its effectiveness is that of a case-control study. © Georg Thieme Verlag KG Stuttgart.