Background

The risk of neonatal respiratory distress increases in planned cesarean section (CS), due to elevated lung liquid resulting from the absence of labor. The knee-to-chest flexion (KCF) maneuver is a novel, low-resource technique intended to mimic the uterine contraction by flexing the newborn’s legs against the chest to aid lung fluid expulsion. Although the maneuver has shown to be feasible and safe, its acceptability among healthcare providers is unknown. The study aimed to understand how healthcare providers perceive and accept the KCF intervention for preventing neonatal respiratory distress following planned CS.

Methods

The study used an exploratory qualitative approach, with semi-structured interviews at a tertiary referral hospital in Moshi, Tanzania. Fifteen interviews were conducted with obstetricians and resident doctors who had observed and/or performed the maneuver as part of an ongoing clinical trial which aims to test effectiveness of KCF maneuver in reducing newborn respiratory distress (ClinicalTrials.gov: NCT06270823). The data was first analyzed thematically using the Theoretical Framework of Acceptability as guidance, and later by inductive coding.

Results

The KCF maneuver was generally viewed as acceptable, supported by its simplicity, compatibility with routine workflows, and observed clinical benefits, such as visible lung fluid expulsion. Its physiological rationale further contributed to clinicians’ confidence in the procedure. However, acceptability remains closely tied to perceptions of effectiveness, with several providers awaiting trial results before they would endorse its use.

Conclusion

This study suggests that the KCF maneuver could be an acceptable intervention for improving newborn outcomes following planned CS, provided that efficacy is confirmed.