Legal and ethical considerations for midwives performing the neonatal infant physical examination
The newborn and infant physical examination (NIPE) is part of a national screening programme in the UK that involves the first full physical assessment of the newborn. The examination aims to identify conditions and diseases early in order for prompt intervention and treatment to be arranged. Historically, the examination has lain solely in the paediatrician's remit; however, the more recent shift in midwifery care provision has led to a focus on midwifery-led care, continuity of carer and seamless care, which has brought the NIPE into the midwife's sphere of practice. There has been increasing evidence demonstrating that the midwife is the most suitable practitioner to conduct the NIPE following appropriate training; however, this has not been evaluated in recent years. Midwives are supported professionally, legally and ethically to conduct this examination, provided that they work within their sphere of practice and professional guidelines.
The newborn and infant physical examination (NIPE) is a national screening programme in the UK that involves a full physical assessment, history-taking, health promotion and education (Baker, 2010). The aim of the programme is early identification of conditions and diseases in newborn babies (Baker, 2010), and Public Health England (2016) recommends that the examination is carried out within the first 72 hours of life to ensure that prompt and appropriate treatment is commenced if required.
The examination has been a vital part of the child health surveillance programme in the UK since the 1960s (Hayes et al, 2003) and was conducted by neonatal senior house officers within the hospital setting before discharge (Mckinnon, 2017). However, in more recent times, there has been a shift towards midwifery-led care, which has increased rates of homebirth and births in standalone midwife-led units (Chief Nursing Officers of England, Northern Ireland, Scotland and Wales, 2010; National Maternity Review, 2016). There is also increasing workload and pressure on junior doctors, which has caused constraints on the amount of clinical time available to complete the NIPE. This has become one of the main drivers behind training midwives to complete the NIPE (Baker, 2010). There is a demand for expanding services to include more outpatient provision, including at home or in standalone birth centres, for services such as the NIPE, which can be satisfied by training midwives to complete the examination. This is also an opportunity for multidisciplinary working between junior neonatal doctors and midwives and a chance for midwives to widen their scope of practice (Baker, 2010). It is therefore important to consider the legal, ethical and professional issues surrounding the role of the midwife in conducting the NIPE.
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