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A national review of neonatal resuscitation programmes for midwives
  1. M G GNANALINGHAM,
  2. C ROBINSON,
  3. N A MIR
  1. Neonatal Department, Warrington General Hospital
  2. Lovely Lane, Warrington WA5 1QG, UK
  3. molingham{at}hotmail.com

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    Editor—A considerable number of babies with no obstetric or neonatal at risk factors require help in establishing respiration at birth. This may range from tactile stimulation to bag and mask ventilation to endotracheal intubation. Midwives in the United Kingdom are primarily involved in the initial resuscitation of newborn babies in delivery units and at home. There is a national lack of neonatal resuscitation training in the United Kingdom, with inadequate provision of neonatal life support skills remaining an acknowledged contributory factor to perinatal death.1 2 There are no directives from governing bodies for midwives to attend mandatory neonatal life support updates. Moreover, the national availability of specific neonatal resuscitation programmes for midwives is not known.

    A standardised written and telephone questionnaire survey of all national maternity units (n = 245) was undertaken. The questionnaire primarily examined duration, structure, and assessment strategies of the resuscitation programmes for midwives.

    All 245 maternity units were surveyed by written and telephone questionnaires; 196 responded (80%). Of these, 172 (88%) have some form of resuscitation programme available for midwives. The resuscitation programmes have been in existence for a mean (SD) of 3.7 (2.6) years (range 0.5–20). The programmes involve on average 1.9 main trainers (range 1–5), including senior midwives, paediatricians, and resuscitation training officers. There are pronounced structural differences between the available resuscitation programmes. Those in 100 (58%) units closely follow the Neonatal Life Support course guidelines (UK Resuscitation Council). The programmes in the remaining 72 (42%) units are variably incomplete in their evaluation of neonatal basic life support. Of the units currently not following standard guidelines, 61 (84%) expressed a desire to change. Of the units with resuscitation programmes, 116 (67%) have no standards of achievement set for resuscitation training. Standards were characterised by competence in basic life support, clinical scenarios, and theoretical knowledge of neonatal resuscitation. Resuscitation training was compulsory for midwives in 132 (72%) units. Midwives are reassessed on average every 9.2 (5.8) months (range 6–24), with 148 (86%) units holding a logbook of attendance. There are regional differences in the availability of resuscitation programmes (range 77–100%), existence of standards of achievement (range 1–50%), and existence of compulsory resuscitation programmes (range 50–92%). Overall, North West hospitals have high scores in the above three categories stated. Currently, no individual region has the highest scores for all the categories stated.

    This is the first national survey examining neonatal resuscitation programmes for midwives. Most (88%) of the 196 maternity units that responded have some form of resuscitation programme available for midwives. However, the programme in 42% of these units does not directly follow the Neonatal Life Support Course guidelines recommended by the UK Resuscitation Council. Moreover, 67% of programmes have no established standards. The average period of reassessment in these units is nine months. This interval may be too long because skill retention has been shown to be lost within six months of a neonatal resuscitation programme.3

    The specific needs of UK midwives to provide basic neonatal life support have not been objectively evaluated, in contrast with the United States and Canada.4 In addition, there is a collective call for consistent skills attainment, nationally and internationally.5 The availability of resources and personnel may contribute to regional differences in resuscitation programmes. Continued structural differences in neonatal resuscitation programmes will further exaggerate differences in local and national practices. Hence, the need to establish uniform standards in neonatal resuscitation and for mandatory hospital trust support not only in organising suitable resuscitation programmes, but also in ensuring compulsory attendance by midwives at these essential training sessions. Encouragingly, 84% of units currently not following the UK Resuscitation Council guidelines expressed a desire to change accordingly.

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