From knowledge to action: understanding midwives’ challenges in implementing delayed cord clamping in Northern Ghana

Abstract Background Delayed cord clamping (DCC) is a cost-effective neonatal care intervention that has been proven to enhance iron stores, increase hemoglobin levels, and improve long-term infant health. Despite its inclusion in national guidelines, adherence to DCC protocols in Ghana remains inconsistent. This study assessed midwives’ knowledge, practices, and barriers to the implementation of DCC in the Tamale Metropolis to inform targeted interventions to improve neonatal outcomes. Methods A sequential explanatory mixed-methods study was conducted among 105 practicing midwives in the Tamale Metropolis. Quantitative data were analyzed using chi-square tests and multivariable logistic regression to identify factors independently associated with routine DCC practice. Routine delayed cord clamping practice was operationalized as clamping performed within 1–3 min after birth in accordance with WHO recommendations. Results Awareness of delayed cord clamping was high (94%), yet 57% perceived it as potentially harmful. Although 73% reported routinely practicing delayed cord clamping, only 51% adhered to the WHO-recommended 1–3-minute delay. After adjustment for age, years of experience, education level, and facility type, midwives who had received formal delayed cord clamping training were significantly more likely to adhere to recommended timing (AOR = 4.76, 95% CI: 1.78–12.72). Recent training (< 1 year) (AOR = 5.63, 95% CI: 1.42–22.21) and the presence of a facility protocol (AOR = 2.94, 95% CI: 1.12–7.68) were also independently associated with practice. Conclusion Despite widespread awareness, persistent misconceptions, inadequate training, and institutional barriers hinder optimal delayed cord clamping implementation in Northern Ghana. Regular professional development, standardized institutional protocols, and strengthened supervision are critical to bridging the knowledge–practice gap and ensuring consistent, evidence-based neonatal care. Clinical trial number Not applicable.