Thank you for so clearly raising and documenting a very real problem.
For the last 5 years in KZN, South Africa we have been advocating for and implementing a policy of identifying and monitoring at risk newborns, skin to skin, with their mothers in the postnatal ward. We have not designated a separate area but instead are advocating for appropriate observation/assessment and care for every newborn in the postnatal ward including increased frequency and basic interventions eg phototherapy for those at increased risk.
It has met with resistance due to severe staff shortages in the post natal ward and their primary focus on delivering maternal care.
This is exacerbated by the fact that there are no allocated inpatient beds for well or at risk newborns in the postnatal beds. This means that there is no budgetary or staffing allocation for these babies.
In our provincial efforts to strengthen this aspect of newborn care we have:
1. Developed a clear guideline for the care of well and at risk babies and strict admission criteria for the neonatal unit
2. Developed staffing norms for the postnatal and neonatal units
3. Developed infrastructure norms for a well baby area in the postnatal ward where well babies, with sick/absent mothers, can be safely monitored
4. Developed standardised clinical records that support the classification and appropriate observation of and care for newborns
5. Are advocating with the National DoH, that the allocated/designated bed numbers for postnatal wards should be reviewed and increased to include neonatal not just maternal beds (even though they are cared for as a mother baby pair in the skin to skin position)
6. Are in the process of adapting the AAP/WHO Essential newborn Care 1 & 2 courses to suit our context. We are proposing a year long inservicetraining course to be completed by all midwives/nurses and doctors in the maternity unit. It is broken into 2 components: well and at risk, and sick and small. It consists of 22 modules. Each module will be covered over 2 weeks and includes reading material, a narrated powerpoint, video/s, clinical observation, facilitated group discussion, a practical exercise and knowledge check. It will be offered at facility level (all materials downloaded onto a facility computer), with facility based facilitation.
God bless
Ruth Davidge RN RM RPN, Cert. Neon Intensive Care, *f*ANSA
KZN Neonatal Coordinator
CHIFA profile: Ruth Davidge is Neonatal Coordinator at PMB Metro, Hospitals Complex Western, Kwa-Zulu Natal, South Africa. She is President of the Neonatal Nurses Association of Southern Africa, NNASA. She is a Registered Nurse and on the board of the Council of International Neonatal Nurses, COINN. ruth.davidge AT kznhealth.gov.za www.nnasa.org.za
