The neonatal examination involves a detailed examination of the newborn baby within 72 hours of birth (Williamson et al 2005). For the past decade midwives who wish to acquire these skills have undertaken post-registration study. Over 20 universities now offer post-registration courses aimed at providing practitioners with the necessary knowledge and skills to detect less obvious adverse conditions or abnormalities in the neonate (Lanlehin et al 2011). The Newborn and Infant Physical Examination programme (NIPE) (UK National Screening Committee) includes a competency document (available from http://www.screening.nhs.uk/) which aims to standardise neonatal examination training for all health care professionals. The increase in the number of midwives trained in neonatal examination is in part due to the implementation of the European Union (EU) Working Time Directive to reduce junior doctors’ hours from 58 hours (by 2007) to 48 hours (by 2009) (European Parliament and Council 2000).
A number of studies have explored the role of midwives and neonatal nurses in relation to holistic assessment of the newborn (Wolke et al 2002, Rogers et al 2003). Williamson et al (2005) devised an audit tool to measure the clinical effectiveness of midwives who had been trained in neonatal examination. Although a relatively small study, the authors found that over an 18 month period, midwives who were trained in neonatal examination detected 75% of early cardiac abnormalities.
Is it time to have a rethink? Should neonatal examination of the newborn be part of pre-registration midwifery degree programmes? As far as I am aware no midwifery degrees include this in their programmes, partly because it is not an NMC requirement. As Hall and Elliman (2006:337) point out the ‘professional qualification of the person… is less important than the quality of their initial and continuing education’. Midwifery is now recognised as a graduate profession and I would argue that the knowledge and skills required for neonatal examination are consummate with degree study. The Midwifery 2020 (2010:8) report states that education of midwives should enable them to ‘fulfil the lead practitioner role’. The inclusion of neonatal health assessment in pre-registration programmes would produce midwives better able to meet the demands of a modern maternity service and more able to take on the role of lead professional in normal pregnancies and births. The idea of a highly skilled midwifery workforce providing holistic care is congruent with health policy: Standards for better health (DH 2004), Skills for health (2004) and Midwifery 2020 (2010).
One of the problems in the past has been the lack of opportunity for midwives to practise neonatal examination in their place of work (Townsend et al 2004, Lanlehin et al 2011 (conducted in 2005)). I believe the reasons for this are twofold: firstly that at the time neonatal health was not viewed as essential to midwifery practice; secondly the effects of the EU Working Time Directive and difficulties with recruitment of medical staff to obstetrics and paediatrics have only recently started to be felt. Anecdotally, the demand for midwives trained in neonatal examination is increasing in both hospital and community settings. What is clear is neonatal examination is now viewed by many as essential to continuity of midwifery care and part of the skills set of a qualified midwife (Lanlehin et al 2011).
If my assertions are correct then midwifery educators and the Nursing and Midwifery Council (NMC) should consider making neonatal examination a mandatory part of pre-registration midwifery programmes. As a profession we need to respond to the changing climate of health care and recognise that the future of midwifery rests on the provision of quality care.
- Department of Health (2004). Standards for better health. London: The Stationery Office.
- European Parliament and Council (2000). Directive 2000/34/EC. Official Journal of the European Community L195:41-5.
- Hall DMB (1999). The role of the routine neonatal examination. BMJ 318(7184):619-20.
- Hall DMB, Elliman D (2006). Health for all children. 3rd ed. Oxford: Oxford University Press.
- Lanlehin R, Noble H, McCourt C (2011). How well do midwives use the skills and knowledge in examining newborns? British Journal of Midwifery 19(11):687-91.
- Midwifery 2020 (2010). Midwifery 2020. Delivering expectations. Cambridge: Jill Rogers Associates. Available from [Accessed 25 September 2012].
- Rogers C, Bloomfield L, Townsend J (2003). A qualitative study exploring midwives’ perceptions and views of extending their role to the examination of the newborn baby. Midwifery 19(1):55-62.
- Skills for Health (2004). Children’s national workforce competence framework guide. Bristol: Skills for Health.
- Townsend J, Wolke D, Hayes J et al (2004). Routine examination of the newborn: the EMREN study. Evaluation of an extension of the midwife role including a randomised controlled trial of appropriately trained midwives and paediatric house officers. Health Technology Assessment 8(14):112 pages.
- Williamson A, Mullet J, Bunting M et al (2005). Neonatal examination: are midwives clinically effective? RCM Midwives 8(3):116-18.
- Wolke D, Dave S, Hayes J et al (2002). Routine examination of the newborn and maternal satisfaction: a randomised controlled trial. Archives of Disease in Childhood: Fetal and Neonatal Edition 86(3):155-60.
Contributor: Kim Russell, Senior Lecturer, Midwifery & Women’s Health, University of Worcester.
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