This article explores jaundice in the newborn, seeking to present a strategy to improve the care of newborn babies and their families through a more seamless service. Two case studies, based upon real life situations, are presented, as a means of exploring how the integrated team can make a difference to the experience of babies, their mothers and families. The work of the NHS Improvement (NHSI) led project Atain (avoiding term admissions into neonatal units) is described and the potential for improving care for babies, their mothers and families is explored.
Jaundice in the newborn is a common condition, hence often detected by midwives. Physiological jaundice is estimated as affecting around 60–70% of babies, while pathological jaundice is less common (National Institute for Health and Care Excellence (NICE) 2016). However, although pathological jaundice is less common the effects can be significant and sometimes catastrophic. Jaundice may result in long-term morbidity including kernicterus, which is considered by some to be largely preventable and has been suggested as a ‘never event’ in the NHS (Ives 2011).
Midwives, and others providing maternity and newborn care, must be vigilant and aware of the causes, effects and management of jaundice. Practitioners need to ensure that mothers and families are well informed to reduce the likelihood of problems occurring and to protect babies from harm. There is a complex balance between seeing maternity care as a normal transition to motherhood and being acutely aware of potential problems and deviations from the norm. This is enhanced by a more individualised and personalised approach to care (NHS England 2016).
In this article, the issue of neonatal jaundice and the care that may be required is explored, using two case studies, and suggests the use of a care plan on which to base provision of care. This is set out within the context of the Atain project which provides an important opportunity to focus on, examine and improve care, providing tools and resources for service providers, and women and families of newborns.
Most mothers and babies remain healthy throughout the process of labour and birth. Many are transferred to the care of the community team after six hours and others within one or two days following birth. However, in recent years, the pressure on services has impacted on midwifery care in the community — this might mean that in some areas the mother no longer receives regular postnatal home visits from a midwife. Instead she may only have telephone contact with the midwife, be asked to attend a postnatal clinic with her baby, or be visited by a maternity support worker who then reports back to the midwife (Lewis 2009, RCM 2014). This is not necessarily what most women would choose, and some research suggests that in terms of infant health and improved maternal satisfaction, there are still benefits from home visiting (Yonemoto et al 2013).
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Michaelides, S. MIDIRS Midwifery Digest, Vol 27, no 2, June 2017, pp237-243
Original article. ©MIDIRS 2017