Newborn Exam

The government initiatives to reduce younger doctors hours deep surmount the NHS Plan (DH 2000) put up alter magnitude the c every(prenominal) told for midwives to expand their traditional role and take on most of the tasks that in the past slang primarily been carried out by junior doctors (Kings Fund 2011). Having been working within the comm unity setting as a accoucheuse for the past three years I was interested in extending my role in order to return much holistic attention for my caseload of clients and their babies.Holistic c are for mothers, babies and their families is racyly recommended within the midwifery profession and is cognise to provide an im prove feel for women (Changing Childbirth (DOH 1993a) NMC 2012, NICE 2006). The Newborn and babe strong-arm Examination (NIPE) is one element of the UK National covering fire programme and is offered to all parents for their baby within 72 hours of birth and past repeated once again at 6 weeks of age, usually by their GP.This role is one of the tasks that has been highlighted where midwives end expand their role (Marshall & group A Raynor 2010). The trust where I work has late introduced community clinics where parents bottom take their baby in order to have the newborn interrogatory effected, consequently allowing firstborn provoke home from the unit enabling early family bonding. With this in mind I commenced the Newborn and Infant Physical Examination course.Screening has been used within the NHS for m some(prenominal) decades and is a mathematical process that enables the health professional to highlight healthy members of the population that could potentially have a health related problem (UK National Screening commission 2008). The NIPE is a head to toe mental test that will enable a practitioner to detect in an apparently healthy baby any ab publicity that can then be referred onto the appropriate professional for supercharge investigation.This can then improve the newborns next health by providing early intervention and pr level offtion of further complications (DOH 2009). It particularly focuses on the eye, heart, hips and testes in the staminate infant. The importance of these particular areas is of great significance to the babys time to come health. An undetected unlearned cataract may principal sum to the child world fraud in that eye. A missed heart defect may non be diagnosed until the parents flummox with a very unwell or even dead infant.If developmental dysplasia of the hip is not treated early plenty hobby birth it could lead to several episodes of major(ip) surgery or even disability in the future. Bilateral undescended testes can lead to problems with future fertility. There are many issues surrounding the NIPE that are argued roughly within the literary works Green and Oddie (2008) question whether the NIPE provides the population with and improvement to overall health or if it just gives the parents reassurance tha t could in the future be proved wrong, due(p) to the NIPE being a screening tool and not a diagnostic test.Within the content of this essay I will be critically analysing the NIPE and some issues around this topic focusing particularly on the examination of the hips. Since being a midwife, and a mother, I have always imbed this part of the examination most difficult to watch someone perform as it appears to be uncomfortable for the baby. on that pointfore on commencing the course I have been alive(predicate) of the discomfort it appears to give the newborn and in like manner the hurt this could in turn cause for the parents.I will also be looking into the issues regarding which professional is best qualified to be performing the examination and also if there are any benefits or risks as to the place that it is undertaken. When I am performing the examination I will mainly be alone in the community setting either at a childrens centre or within the home environment, so therefo re it is imperative that I am aware of any limitations this may present for the baby, parents or me.As previously mentioned there is a growing trend within many obstetric units for midwives to carry out the NIPE examination. Within the trust that I am based midwifery led clinics are held on the impale natal ward and also within the community for the sole role of performing the newborn examination. Bloomfield et al (2003) discussed where the examination should take place and put differing opinions. The benefits of being in hospital were noted to be that medical game up was available and it was more convenient for further immediate referral process.Community examinations were ruling to be more likely to enable the parents to ask questions and mention concerns due to the relaxed environment. Following the Maternity Matters report (DOH 2007) advocating that women should have a greater prime(prenominal) for place of birth the home birth rate has increased and is move to do so. It is therefore sample for community based NIPE facilities so that women do not have to attend hospital at all following a home birth.On reflection the examinations that I have witnessed and performed unfortunately await to have been a way to speed up the postnatal discharge procedure therefore freeing up beds within the unit and not due to providing a more unbroken midwifery led experience for the parents and baby as Hutcherson (2010) found. The ideal situation would be to perform the examination on the newborn belonging to the mother you have seen through prenatal care and will be caring for post natally therefore providing continuous care for your personal caseload of clients, as discussed by Baston & Durward (2010).The patient joy and overall job satis situationion in this case scenario would be high for all involved still unfortunately I feel in practice will be a rare materializerence. Eventually I believe that in our trust when there are enough educate midwives within each geographical area the possibility of a midwife performing newborn examinations on babies within the teams caseload is possible. This far from being the ideal scenario is the closest it will probably get to the holistic care seek after by myself and many other midwives.The EMREN (Evaluation of Midwife Role indication in the routine Examination of the Newborn) study carried out by Townsend et al (2004) looked into spirits of the NIPE one of them being whether a midwife was as capable as a senior house officer when carrying out the NIPE and discovered not only that this was the case but that the mothers satisfaction level may be increased if a midwife performed the NIPE and that also money may be saved by the NHS.Having observed SHOs, appropriately trained midwives and advanced neonatal practitioners (ANP) performing the NIPE I felt that the midwives and ANPs communicated far more effectively with both the baby and parents therefore better live up toling the communication as pect of the competences indicated by the UK National Screening Committee (2008). They also provided more detailed in system on parenting and public health issues during the examinations which should be an entire part of the NIPE (Baston & Durward 2010).There has been much interest recently into whether impetus oximetry should be part of the newborn screening for connatural heart defects. The UK National Screening Committee is at the present time looking into whether this should be include within the NIPE as part of the screening for congenital heart defects in the newborn. It has been recommended in recent studies and has found to increase the detection rate of congenital heart defects (Ewer et al 2011, Chang 2009). Within our trust I have seen this performed on three ewborns following their NIPE, due to nasal flaring, slight cyanosis and a raised respiratory rate, all have proved to be within the normal range. The saturation monitors are present in the units clinic rooms wh ere newborn examinations are performed but the community midwives working in childrens centres or at home do not have access to a monitor. Therefore this could be cause for concern for parents of babies that are being examined in the community. This then presents the ethical dilemma that newborns are being offered a different aspect within the NIPE depending on where it is carried out.Powell et al (2013) found that parents were happy about having the pulse oximetry screening carried out on their newborn but questions need to be asked if they would prefer to not have it make in favour of the NIPE being performed more conveniently within the community. Ewer (2012) discusses the benefits of introducing pulse oximetry monitoring but without any mention of community based NIPE, or newborns that were born in the home environment. Another concern that I have witnessed and am aware of is not having access to all the prenatal notes of the mother within a community setting.On two occasions the mother has been discharged without the appropriate root work or has not brought it to the clinic appointment. Obviously within the unit the antenatal and labour notes are easily accessible, within the community if the mother hasnt the appropriate information then the parents word must be taken. Having all information relating to the antenatal and interpartum periods is an essential part of the midwives role when performing the NIPE. The practitioner must be aware of antenatal and interpartum occurrences to be able to fulfil the competence set by the UK National Screening Committee (2008).When first undertaking the NIPEs I found the examination of the hips the hardest part of the procedure, mainly because the baby would quite often cry and struggle a bittie and this would cause the parents to be distressed and concerned. I also, in the past, as a midwife and mother observing this procedure felt uncomfortable. Having now done a larger amount of these examinations and reading an d understanding the relevant literature find them easier to perform. Screening for developmental dysplasia of the hip is based n the fact that if not picked up in the newborn could create the need for major surgical procedures in later life also with a poorer future outcome, Dezateux & Rosendahl (2007). Developmental dysplasia of the hip used to be widely known as congenital dislocation of the hip but has been renamed since the 1990s. The factors behind this change are that it is now recognised that the condition is not always congenital and rarely dislocated and more likely to be displaced, Bracken et al (2012).The definition of developmental dysplasia of the hip is very obscure as there are varying degrees and it quite often develops after birth, overall it describes a disorder where the hip conjugation is unstable and occasionally dislocated. The hip occasion consists of the femoral head, the rounded end of the bone which sits within the cartilage of the socket joint known a s the acetabulum. There are view to be different factors as to why the hip joint becomes unstable. At around vii weeks maternity hip formation has already begun, problems can start to occur then.If the femoral head is wrongly positioned from the start it could result in the formation of a too shallow socket. During pregnancy the hip joint can be affected by external and internal forces, for example oligohydramnios, lack of foetal movement due to foetal conditions, breech presentation (Hurley 2009, McDonald & Jenkins 2008). The incidence of developmental dysplasia of the hip varies in the literature, at birth it is thought to be 1-20 in 1000 but the majority of these stabilize without any treatment within the first few weeks of life, bringing the incidence down to 1-2 in 1000 (Campion & Benson 2007).The incidence is higher in pistillate babies, it is believed due to the female newborn being more susceptible to the paternal hormones therefore the joints are more relaxed, Hu rley 2009. It is also more prevalent if a sibling or parent has had developmental dysplasia of the hip, McCarthy et al (2005) and McDonald & Jenkins. different factors mentioned by McDonald & Jenkins (2008) include first born infants, multiple gestation and occurring in the left hip more frequently than the right.