Scotland’s Local Supervising Authorities
STATUTORYSUPERVISION OF MIDWIVES
PRACTISING IN NEONATAL UNITS
Midwifery practice can be described as activities which involve the application
of midwifery expertise and knowledge and meeting statutory requirements.
Rule 3 of the Midwives rules and standards (NMC 2012) states:“If a midwife intends either to be in attendance upon a woman or baby during
childbirth….. or (b) to hold a post for which a midwifery qualification is required
she must give notice of that intention in accordance with this rule”
In view of this, it is of vital importance that midwives are able to relate midwifery
knowledge to neonatal knowledge and vice versa. This is instrumental in narrowing
the perceived gap between what is ‘midwifery’ and what ‘neonatal’ care is and will
contribute towards holistic care of neonate and mother rather than
compartmentalising the care.
The midwife possesses qualities which are of special benefit in caring for sick and
preterm neonates, their parents and families, and she receives a unique programme
of education to prepare her for a role in caring for newborn babies (further
information is included in paragraph 1 of the appendix to this guidance). A midwife
practising in the neonatal unit should be encouraged to undertake professional
education relevant to her work.
Supervisors of Midwives need the vision to help midwives encompass a wider
definition of what constitutes ‘practice’. Not all midwives possess all midwifery
skills, but still function effectively and safely as midwives, providing high standards of
care and a quality of service wherever they choose to practise. The emphasis of
good midwifery care has moved away from doing things to women and has taken on
a more supportive and enabling approach to care. Communication and listening
skills are of vital importance. Education, support and clear information giving may
contribute towards the woman and her family feeling reassured.
South East and West Region Supervisors Quality Improvement Group (SQIG)
Document Number: 7
Implemented Oct 2007
Reviewed December 2015
Review December 2018
Page 1 of 11
There are many ways in which a midwife practising in a neonatal unit can maintain
and update her midwifery skills, consideration should be given to the following:a)
b)
c)
d)
e)
f)
g)
h)
Clinical practice - knowledge, skills competence.
Care of the newborn - recognising the normal and deviations from this.
Updating in resuscitation of the newborn.
Parent and family education - family centred care.
Postnatal care of mothers.
Breastfeeding - safe expression and storage of breast milk. Encouraging
lactation - often for many months before breastfeeding is established.
Practical and emotional support to the whole family for an extended period.
Training - passing on their specialist skills and knowledge to nurses (RN and
RSCN) and other midwives. Mentoring student midwives and other learners.
Allocation to other clinical areas for lengthy periods of time is not always necessary.
Paragraph 3 of the appendix to this guidance contains ideas and suggestions for
ways in which other midwifery skills and knowledge may be updated.
Neonatal midwives have an important part to play in antenatal preparation of parents
and families; in the event of admission to the neonatal unit preparation is invaluable.
This preparation and the neonatal midwife’s involvement may be required during an
unexpected preterm labour, for intranatal care. The skills outlined would strongly
support the requirements for updating neonatal midwives; these are very different
than those of general midwives.
To meet NMC requirements, mothers and their babies require midwifery input for at
least ten days after the birth and this care may continue for as long as is required.
Therefore if mother and baby go home during this time the mother will need
postnatal care; it is advantageous for continuity to be provided by the most
appropriate person. If the neonatal team can provide this care, fragmentation and
duplication are avoided, as is conflicting advice. Paragraph 5 of the appendix to this
guidance gives further information.
Midwives play a vital role in the support and ongoing education of student midwives
during their clinical placement to the neonatal unit; ways in which midwives can
support student midwives are included in paragraph 4 of the appendix to this
guidance.
Midwives must be encouraged to reflect upon their experiences/activities and be
able to discuss with their supervisors how their practice has benefited. A suggested
self review form for midwives practising in a neonatal unit is attached as Appendix
2.14 of this guidance.
South East and West Region Supervisors Quality Improvement Group (SQIG)
Document Number: 7
Implemented Oct 2007
Reviewed December 2015
Review December 2018
Page 2 of 11
Scotland’s Local Supervising Authorities
LIST OF APPENDICES
Appendix 1
Appendix 2
Appendices to Guidelines for the supervision of
midwives practising in Neonatal Units
Self review form for midwives practising in Neonatal
Units
South East and West Region Supervisors Quality Improvement Group (SQIG)
Document Number: 7
Implemented Oct 2007
Reviewed December 2015
Review December 2018
Page 3 of 11
Amended with permission of the original authors North West LSA England
APPENDIX
Scotland’s Local Supervising Authorities
APPENDIX TO GUIDELINES FOR THE SUPERVISION
OF MIDWIVES PRACTISING IN NEONATAL UNITS
The following appendices are intended to be non-prescriptive suggestions to
aid Supervisors and midwives in exploring options for updating practice and
knowledge.
1.
The Midwife has an in depth knowledge and understanding of: The development of the fetus.
 The attachment and bonding process for the parents and family.
 The emotional and psychological impact that pregnancy, labour, delivery
and outcome can have on the parents and family.
 The skills and understanding to encourage, often for many months, the
establishment of successful breastfeeding - supporting the mother and
helping to keep her morale intact.
 Skilled and safe resuscitation of the newborn.
2.
Midwives and Nurses: a joint workforce
Children admitted to hospital are established as part of a family and have
formed a special close relationship with their family members, most especially
their mother. Babies admitted to neonatal units have not had this opportunity.
The midwife is the ideal person to understand and facilitate this process,
supporting the mother/father and encouraging family involvement from the
beginning.
The survival of lower gestation babies means that the stay of some babies in
neonatal units is prolonged, some of these babies developing chronic lung
disease. The nurse who has undergone children’s training is invaluable in this
situation, encouraging the family to become involved in stimulation and
development of their child, encouraging normal patterns of family involvement.
South East and West Region Supervisors Quality Improvement Group (SQIG)
Document Number: 7
Implemented Oct 2007
Reviewed December 2015
Review December 2018
Page 4 of 11
APPENDIX 1
3.
Updating of Midwives
The release of midwives for updating may require some degree of funding
depending upon the route chosen by the midwives concerned. How this is
achieved will depend upon the politics and/or directorate structure of each
individual unit and should be agreed locally. It must be stressed that the
following list of activities will reduce the need for lengthy periods of time spent
off the neonatal unit. This may be a useful tool when completing the self
review form (Appendix 2).
GENERAL
Read/subscribe to relevant journals e.g. MIDIRS
Journal clubs
Study days/courses
Inservice training - e.g. CTG workshops etc.
Perinatal mortality meetings
Feeding advice at all stages of pregnancy/post delivery
Resuscitation workshops
ANTENATAL
Drug liaison e.g. clinics/case conferences
Advice to mothers antenatally who may have babies requiring admission to NNU
Antenatal examinations on clinic/community/labour ward/wards
Booking clinic either on community/at home/clinic
Observe ultrasound scans/amniocentesis
Update on screening tests used
Mentor student midwives
Attend midwifery updating sessions
Discussions with other midwives on topics
Involvement with groups about midwifery matters
DELIVERY
Attend deliveries requiring admission to NNU
Normal delivery
Resuscitating baby at CS if requiring admission to NNU
POSTNATAL
Parent Education
Postnatal care on visiting mothers to NNU
Postnatal care on wards
Breastfeeding advice and support, especially on NNU
Input into transitional care
Parent support groups
Family planning advice/clinics
6 week postnatal check
South East and West Region Supervisors Quality Improvement Group (SQIG)
Document Number: 7
Implemented Oct 2007
Reviewed December 2015
Review December 2018
Page 5 of 11
COMMUNITY
Community neonatal care
Antenatal examinations
Booking clinics
Postnatal checks
Parent Education
Feeding advice and support
This list is by no means exhaustive.
4.
Student Midwives’ Education: neonatal midwives involvement in:Breastfeeding
Information and guidance on breastfeeding small and sick babies
Encouraging reluctant feeders
The importance and relevance of weight gain
Related Midwifery Knowledge
Nasogastric tube feeding
Cup feeding
Recognising illness in the neonate
Physical and psychological development of the premature neonate
Assessing gestational age
IUGR
Jaundice
Drugs - uses and contraindications
Bonding and attachment
Psychological care of families and parents
Mentorship and Support
One midwife should be allocated to discuss the student’s progress and
competencies. The student could work with a variety of different midwives over
the period of the allocation.
Midwives are able to put neonatal care issues into clinical context and can
address clinical issues that relate to midwifery knowledge. They can offer
support and constructive advice, not only to do with neonatal care issues, but
also on wider aspects of the course.
5.
Midwives in the community neonatal team: the advantages are that they
can provide:

Postnatal care to mother
Postnatal advice
South East and West Region Supervisors Quality Improvement Group (SQIG)
Document Number: 7
Implemented Oct 2007
Reviewed December 2015
Review December 2018
Page 6 of 11






Parenthood education teaching
Breastfeeding advice
Contraceptive advice
Knowledge of fetal development, therefore better understanding of many
abnormalities
Understanding of the birth process, therefore better insight into deviations
from the normal
Health education for baby and mother and wider family
South East and West Region Supervisors Quality Improvement Group (SQIG)
Document Number: 7
Implemented Oct 2007
Reviewed December 2015
Review December 2018
Page 7 of 11
South East and West Region
APPENDIX 2
South East and West of Scotland Local Supervising Authorities
SELF REVIEW FORM FOR MIDWIVES PRACTISING IN NEONATAL UNITS
Dear
This Self Review Form has been designed to help you to look at your practice as a
midwife.
As you are aware, the NMC Midwives rules and standards state, in Rule 5:
“you must be capable of meeting the competencies and essential skills clusters set
out in standard 17 of Standards for pre registration midwifery education (NMC 2009)
that are within your scope of practice”
It would be useful if you could prepare brief reflective notes to help demonstrate the
use of your midwifery skills over the past year.
It is hoped that this form will enable you to review all aspects of your practice and
professional development, and will form the basis of our discussions.
Yours sincerely
Supervisor of Midwives
NAME: …………………………………… CURRENT POST: …………………………………
REGISTRATION (RM) DATE: …………… RENEWAL DATE: ……………………………….
LENGTH OF MIDWIFERY PRACTICE: …………………………
Do you possess the following NMC booklets?
1)
2)
3)
4)
Midwives rules and standards (2012)
The Code (2015)
Standards for Medicine Management (2007)
Record keeping guidance (2009)
Yes/No
Yes/No
Yes/No
Yes/No
South East and West Region Supervisors Quality Improvement Group (SQIG)
Document Number: 7
Implemented Oct 2007
Reviewed December 2015
Review December 2018
Page 8 of 11
South East and West Region
APPENDIX 2
MIDWIFERY EXPERIENCE
Please identify the areas in which you have gained experience in the last two years. Please
comment on any skills, in addition to those stated, which you feel you have achieved or are
particularly interested in acquiring.
ANTENATAL CARE
Awareness of pre-conception care
and genetic counselling
Range and availability of antenatal
services
Knowledge of antenatal screening
Knowledge of tertiary referral
system
Venepuncture/Intravenous additives
Knowledge of current methods of
induction of labour
INTRAPARTUM CARE
Updated knowledge/care of women
in labour
Updated knowledge of methods of
fetal monitoring and interpretation of
results
Updated knowledge regarding pain
relief in labour
Taking baby/or attendance at
caesarean section
Updated knowledge/attendance at
instrumental deliveries
Updated knowledge of fetal blood
sampling
Resuscitation of the newborn
South East and West Region Supervisors Quality Improvement Group (SQIG)
Document Number: 7
Implemented Oct 2007
Reviewed December 2015
Review December 2018
Page 9 of 11
South East and West Region
APPENDIX 2
MIDWIFERY EXPERIENCE – Continued
COMMUNITY CARE - Updated knowledge / experience of:Systems of Midwifery Care
Parent Education/Aquanatal
Home Birth
Specialist support available e.g.
Drug Liaison Midwife
Child Protection Professionals
POSTNATAL CARE - Updated knowledge / experience of:Postnatal Care
Transitional Care
COMMUNICATIONS - Updated knowledge / experience of current communication
systems including the following:Maternity Computer Systems
Midwifery Records
Availability of information for
Parents
CLINICALTEACHING IN MIDWIFERY
Mentorship/assessment of Learners
Preceptorship and Induction of staff
South East and West Region Supervisors Quality Improvement Group (SQIG)
Document Number: 7
Implemented Oct 2007
Reviewed December 2015
Review December 2018
Page 10 of 11
South East and West Region
APPENDIX 2
INTENTIONS FOR PREP:
RELEVANT STUDY SESSIONS ATTENDED IN PAST YEAR:
ANY OTHER ISSUES FOR DISCUSSION:
SIGNATURE: MIDWIFE: ………………………………………………………………..
SUPERVISOR OF MIDWIVES: ….……………………………………
DATE: …………………………………………
South East and West Region Supervisors Quality Improvement Group (SQIG)
Document Number: 7
Implemented Oct 2007
Reviewed December 2015
Review December 2018
Page 11 of 11