We are discussing a lot around how to organise the ”well baby checks”, ie the medical assessment of all infants discharged home from the delivery/maternity unit? 

How is this set up in your various contexts? Is it a doctor or midwife doing it? What exactly is included in the exam/assessment?

I am just wondering if you are referring to the neonatal check before discharge home? Or the six week baby check that is done by the GP?

 

@PHutchings I am referring to the first neonatal check before discharge home

In USA, it is common practice to see babies daily, since birth. If delivered Vaginally , these babies get discharged along with mother in 2 days and if c-section delivery then 3 days.

In Buenos Aires, babies discharged with their mothers, with low risk, are monitored at one week of age

We have started with midwife-examinations for early discharge (6-12h from birth), followed by a physician eaxmination within 2 days. For infants staying at the maternity ward they will be examined once by a physcian before discharge, unless there are indications for more exams (murmurs, tachypnea, hypotonus etc.). This would be at 12-36 hours of age. Indications for staying in the maternity ward could be first born child, risk of infection, maternal health or other, but many choose early discharge with their second child.

The midwives will do a basic exam but not listen to the hearth though, only do a pre-post-ductal saturation check, and they are not trained in finding more subtle finds associated with disease. I believe that for most babies it will be alright, but for some babies this could mean severe consecuenses, although they might be too few for it to be statistically significant upon review.

On the other end of the spectrum I spoke with a couple of collegeues visiting from a country in south east Europe where every infant stayed for at least 5 days, and 7 days if there was a c-section. All the babies were examined once daily, and the well baby check shifts could be pretty hard in the weekends.

Right now were are aiming at combining the maternity ward with our NICU at our smaller rural hospital, to be able to offer CPAP-care skin to skin and aiming at zero separation between mother and child. We have implemented this with some success at our post-op after c-sections and thereby been able to keep some newborns with TTN out of our intensive care unit.