Midwives have been successfully examining babies as an additional aspect
of their role since the first post-qualifying course was established in
1995 (Michaelides, 1995). It is clear that midwives are in a pivotal
position to perform the newborn examination as part of the holistic care
they provide to mother and infant (Lumsden, 2005). There is now an
established body of experience with examination-of-the-newborn skills
and, with the core role of the midwife expanding in response to service
development (Masterson, 2010), it is now timely to introduce this to
undergraduate, pre-registration student training.
Newborn and infant physical examination (NIPE)
launched its guidelines in 2008, rolling this out to educators and
practitioners in 2010 (National Screening Committee (NSC), 2008). Alongside this,
Midwifery 2020
states that all newly qualified midwives will be expected to be
proficient in examination of the newborn, prescribing, suturing and
intravenous cannulation, and expects curricular changes (Department of
Health (DH), 2010). At the University of Wolverhampton, the
pre-registration curriculum was due for revalidation in 2011, making it
an ideal time to look at incorporating the NIPE guidelines into the
programme. A collaborative approach to curriculum development followed
(DH, 2010), with partners from local service providers, students,
service users, midwives and advanced neonatal nurse practitioners (ANNP)
participating in the venture. All agreed that this would be not only a
unique feature of the course but that, ultimately, the additional skills
gained by students would benefit mothers and their babies.
The midwife has always made a general assessment of
the baby at birth. Student midwives at this institution are also trained
to make this immediate assessment (Lumsden, 2008). Initially, this
comprises colour, tone, breathing and heart rate. The midwife can then
judge whether the baby requires any resuscitation and call for help and
follow the Resuscitation Council (UK) (2011) and hospital guidelines for
resuscitation of the newborn. The value of the Apgar score has come
under question and, where trusts are still insisting that this is
recorded, midwives should record not only the numerical score, but also a
detailed description of the baby (Resuscitation Council, 2011) as part
of their initial assessment.
Most parents will want confirmation that their baby
is perfect as soon as it is born (Lumsden, 2010). It is part of the
midwife’s role to identify any major anomalies following delivery. This,
essentially, is the beginning of the child health surveillance
programme and is of utmost importance (Hall and Elliman, 2006).
Following on from the immediate assessment, a
further, more in-depth examination takes place – usually before the
mother and baby are discharged home. In some instances, this may be six
hours after delivery. The standard set by the NSC (2008) states that all
babies should be examined within 72 hours of birth by a trained
healthcare professional. This is because the turbulence of the blood
flow in the lungs and heart will have settled and full transition to
extra-uterine life will be more or less complete. However, many mothers
go home before this and the value of the assessment at such an early
stage is questionable, although it avoids the problem of getting the
baby examined at a later stage. The NSC guidelines (2008) state that
babies should be examined for less obvious problems, such as congenital
heart defects, developmental dysplasia of the hips and undescended
testes, as well as the general physical examination.
Simulation will play an important role in the way
student midwives are taught to examine babies. Midwifery education is
based on 50% clinical practice (NMC, 2009). Simulation will not replace
the valuable experience students will gain in clinical practice (Cioffi,
2001), but it will help prepare them for the examination. Dow (2008)
suggests that clinical simulation is based on experiential learning and
can develop skills by providing a safe, controlled situation. Haigh’s
(2007) study concluded that simulated practice is beneficial, as busy,
stressful clinical environments are not always conducive to learning.
The university setting also allows time for students to become familiar
with skills in a non-threatening, supportive atmosphere. This
institution already makes good use of the neonatal high fidelity
simulator for teaching neonatal emergencies, newborn resuscitation, as
well as playing a major part in objective simulated clinical examination
(OSCE) for third-year student midwives.
It is envisaged that this simulator will allow
students to listen to a variety of heart murmurs and respiratory sounds
in preparation for auscultating hearts and lungs in newborn babies in
clinical practice.
Supportive midwife mentors will be essential to the
success of this venture. Steele (2007) and McDonald (2008) suggest that
many midwives who are trained to examine babies do not fully use their
skills – unfortunate as they have the overriding advantage of providing
continuity of care (Hutcherson, 2009). However, it will be essential
that those midwives who are willing and confident in their practice
mentor students to examine newborn babies. Mentors who act as positive
role models encourage students to reflect and develop their analytical
skills (Fowler, 2008), as well as helping them to engage in clinical
situations that will enhance their skills. Mentors, in turn, will need
additional support from the university’s midwife lecturers (Finnerty et
al, 2006) to teach and assess students in these additional skills. Other
professionals groups have expressed an interest in facilitating
students’ clinical practice of newborn examination and this will create a
more inter-professional approach to teaching and learning (Lait et al,
2011).
For future midwives to deliver true holistic care,
their role should encompass examination of the healthy newborn. If
introduced early in midwifery education, the skills can be taught and
developed throughout the programme, enabling the student to become
familiar and confident with physical assessment skills, resulting in
confident, fully family-centred care.
Hilary Lumsden is senior lecturer – midwifery and newborn, at the School of Health and Wellbeing, University of Wolverhampton
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