Your thoughts: be better prepared with NIPE
Ruby Handley-Stone reflects on her role as a newborn infant and physical examination practitioner.
The thought of qualifying as a midwife sparked excitement and uncertainty. But I also had to prepare for the added responsibility of working as a newborn infant and physical examination (NIPE) practitioner, screening for congenital abnormalities in the newborn during the examination undertaken within 72 hours after birth (PHE, 2017).
I studied at Birmingham City University, one of the few UK universities offering both theory and practice competency components of NIPE training as part of the midwifery programme (Yearly et al, 2017).
As a student training to screen for conditions relating to the heart, hips, eyes and testes, I detected some of the more common abnormalities such as cryptorchidism, the failure of one or both testes to descend into the scrotum, present in 4.5% of newborn males (Khatwa and Menon, 2000), but not less common conditions, such as genetic and chromosomal defects, so I still felt I lacked experience.
It took four further months after qualifying to encounter conditions such as congenital cataracts, occurring in up to two or three per 10,000 births (Lomax, 2015). I was surprised, however, at how confident I felt in safely detecting, referring and then communicating with parents in these situations, and felt increasingly confident in my NIPE skills.
On the delivery suite, I was able to facilitate earlier discharges for women by performing the examination myself as the only NIPE practitioner available. Similarly, on the postnatal ward, when midwives were inundated with paperwork and the new mothers are eager to return home, I was able to offer the examination instead of waiting for an available paediatrician. I couldn’t help thinking that the lack of qualified NIPE practitioners was a recurring barrier against women gaining their independence through early discharges.
Being able to perform the examination brings increased autonomy, empowerment and an improved service. Despite this, there remains a shortage of NIPE-trained midwives – currently only 13.7% of UK midwives (Council of Deans of Health, 2017) – which could be due to a lack of emphasis on the value of this role by hospitals and education facilities.
NQMs often feel emotionally vulnerable, but I believe that being provided with these additional skills instils greater confidence, and enables a smoother transitional period and a quicker sense of belonging within the multidisciplinary team.
I feel strongly that it should be a requirement of the NMC that all higher education institutions offer the NIPE course pre-registration, followed by a preceptorship programme offering more protected time for development as part of rotation. Undergoing training alongside paediatricians may help to better prepare NQMs, building a closer relationship between the paediatrician and the examining midwife, and offering the opportunity to share skills and expertise.
Undergraduates may not fully grasp the need for this additional qualification, but there is no better feeling than knowing you are well prepared for the start of a long and rewarding career.
The NIPE exam includes
- Eyes: position, symmetry, size and colour, and presence of red reflex
- Heart: observation, palpation and auscultation
- Hips: the Ortolani and Barlow manoeuvres to screen for dislocated or dislocatable hips
- Testes: palpation of scrotal sac and/or inguinal canal to determine location.
Ruby Handley-Stone is an NQM at University Hospitals Birmingham NHS Foundation Trust.
Council of Deans of Health. (2017) Educating the future midwife: discussion paper on the key future outcomes for registered midwife education. See: councilofdeans.org.uk/wp-content/uploads/2017/11/Educating-the-Future-Midwife-FINAL-Nov-17.pdf (accessed 10 July 2018).
Khatwa UA, Menon PSN. (2000) Management of undescended testis. Indian Journal of Paediatrics 67(6): 449-54.
Lomax A. (2015) Examination of the newborn: an evidence-based guide (2nd edition). Wiley Blackwell: Hoboken.
Norris S. (2018) Sink or swim. Midwives 21(2): 62-5.
Public Health England. (2018) Newborn and infant physical examination screening programme handbook. See: gov.uk/government/publications/newborn-and-infant-physical-examination-programme-handbook/newborn-and-infant-physical-examination-screening-programme-handbook (accessed 12 July 2018).
Public Health England. (2017) Newborn and infant physical examination: standards 2016/2017. See: assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/692020/NIPE_Programme_Standards_2016_to_2017.pdf(accessed 9 July 2018).
Yearly C, Rogers C, Jay A. (2017) Including the newborn physical examination in the pre-registration midwifery curriculum: National survey. British Journal of Midwifery 25(1): 26-32.