Maidstone and Tunbridge Wells Nhs Trust

MAIDSTONE AND TUNBRIDGE WELLS NHS TRUST

Immediate Care of the Newborn

Requested/

Required by: Women’s and Children’s Directorate

Main author: Midwife (TC)

Other contributors: Consultant Paediatrician (RG)

CNST Maternity Co-Ordinator (AC)

Document lead: CNST Maternity Co-Ordinator (AC)

Contact Details: ext 33514

Supersedes: Immediate Care of the Newborn (Version 2.0: November 2009)

Approved by: Clinical Risk Management Group Date: 6th October 2011

Ratified by: Clinical Risk Management Group Date: 6th October 2011

Review date: October 2014

Disclaimer:Printed copies of this document may not be the most recent version.

The master copy is held on Q-Pulse Document Management System

This copy – REV3.0

Document History

Policy Statement for

Immediate Care of the Newborn

Immediate Care of the Newborn

Contents

1.0 Introduction and Scope of Procedural Document

This guideline applies to all staff caring for women and their babies following birth.

It will ensure that the immediate care of the newborn is appropriate to the individual baby’s needs and that all professionals involved in providing care are aware of procedures to be followed in routine care and a range of special circumstances.

Any information is given to and discussed with women by a relevant professional at the appropriate time, as clinically indicated. This should be clearly documented in the appropriate place in the medical records, to enable continuity of care and good communication.

The Maternity Service provided to women by Maidstone & Tunbridge Wells NHS Trust was reconfigured in September 2011. Inpatient services for high risk women were transferred to the Tunbridge Wells Hospital at Pembury (TWH) with the Neonatal Unit also based at TWH.

Women are offered the following:

·  Low risk women may choose to give birth at TWH, at home or the new midwife-led Birth Centre at Maidstone

·  A range of outpatient maternity services including Antenatal Clinics, Obstetric Ultrasound and a Maternity Day Unit, continue to be offered at both TWH and Maidstone Hospital. These will be accessed, as appropriate, by both high and low risk pregnant women in each geographical area.

Clinical Risk Assessment (antenatal and intrapartum) is integral to planning the most appropriate place of birth for mother and her newborn.

Refer to MTW Guidelines: (referenced at pages 2 and 3)

● Antenatal Clinical Risk Assessment

● Care of Women in Labour including Clinical Risk Assessment in Labour

2.0 Definitions

Hypothermia: Temperature below 36.5 deg Celsius

Hypoglycaemia: Capillary Blood Glucose (CBG) below 2.6 mmol/l

Low Risk – women who are identified by risk assessment as suitable for midwifery led care during their pregnancy. Low Risk women may choose to give birth at home, at the Maidstone Birth Centre, or at TWH.

High Risk – women who are identified by risk assessment as having a condition or problem that require them to have additional care during their pregnancy. It is recommended that High Risk women receive care that is led by an Obstetric Consultant and give birth at TWH.

MTW – Maidstone & Tunbridge Wells NHS Trust

TWH – Tunbridge Wells Hospital at Pembury

3.0 Duties and Record Keeping requirements

It is the registered professional’s responsibility to deliver care that it based on current evidence, always acting in the mother’s and baby’s best interests.

All health care staff involved in maternal and neonatal health will adhere to this policy for continuity of care.

Any deviation from this guideline must be justified and recorded in the mother’s and/or baby’s notes.

Complete, accurate and timely documentation of care is integral to good practice. The mother’s health record and that of her baby should inform any clinician who has a responsibility for their care of all the relevant information, which might influence the proposed management. These records should also provide a contemporaneous and complete record of the mother’s or baby’s treatment and related features. In addition to ensuring good care maintaining these record keeping standards allows a clear picture of events to be obtained, which is imperative for managing claims and complaints.

Refer to MTW Guidelines: (referenced on page 3)

·  Record Keeping and the Management of Maternity Records

·  Handover of Care (onsite)

4.0 Training / Competency Requirements

Registered Midwives and Medical staff caring for obstetric/paediatric clients have a professional responsibility to maintain their competence. All professionals have a duty to keep their knowledge base up-to-date and this should be reflected in their annual appraisal.

Aspects included in this guideline will be updated in the care group annual mandatory multidisciplinary updates.

Refer to MTW Guideline: (referenced on page 3)

● Maternity Training Strategy & Training Needs Analysis Matrix

5.0 Procedure for Immediate Care of the Newborn

5.1 Background:

Childbirth is a unique and special experience. All those providing care to families at this time will endeavour, where mother and baby are healthy, to create a calm and unhurried environment in which parents may begin to establish a bond with their newborn as s/he adapts to extrauterine life. Biological nurturing, with all the benefits of skin-to-skin contact and the initiation of feeding will be encouraged. Should either mother or baby be unwell, or require medical intervention, every effort will be made to provide care in such a way that will promote the family’s bond as circumstances allow.

5.1.1 Routine Care of the Newborn, following delivery

·  All staff handling babies are advised to wear gloves, at all times, for protection against potentially contaminated fluids

·  If parents wish delayed cord-clamping refer to MTW guideline Care of Women in Labour.

·  Following delivery, the baby should be dried and if there are any concerns, weighed. The baby should be returned to the mother’s abdomen adopting a biological nurturing position for a period of uninterrupted skin-to-skin contact. If not weighed following birth, then the baby can be weighed following the first hour of skin-to-skin contact and completion of the first feed. Ensure baby is covered with a dry wrap, especially the head

·  In order to prevent and detect hypothermia in the newborn, the baby’s temperature should be recorded and documented within 30 minutes of birth.

·  Whilst baby is on mother’s abdomen, the midwife should examine the baby, take the temperature, measure the head circumference, check the cord clamp and complete the documentation. Baby labels (Mother’s surname, hospital number, baby’s date of birth, time of birth, hospital number and ward destination, and if plain labels are used then state baby girl or boy) should be checked with parents and applied to the baby’s ankles.