Training and Maintenance of Skills for Professionals Responsible for Resuscitation of Babies at Birth

Royal College of Paediatrics and Child Health/RCOG/Royal College of Midwives - Joint statement

Background

1 - The Royal Colleges have published the recommendation that all professionals present at the time of birth are proficient in resuscitation of the newborn^1,2,3,4,5. This recommendation has been incorporated into Changing Childbirth - the Report of the Expert Maternity Group ⁶ , the National Service Framework for Children, Young People and Maternity Services in England ⁷ and in Wales ⁸ , Implementing a Framework for Maternity Services in Scotland - the Report of the Expert Group on Acute Maternity Services ⁹ and Care of the Critically Ill Child in Irish Hospitals ¹⁰.

Wherever the birth takes place, the professionals present must be trained and experienced in the systematic application of resuscitation techniques.

It is the responsibility of managers, supervisors and supervisors of midwives to assess the training needs of new and existing staff, and the duty of professionals to ensure that they have been trained appropriately before taking on their duties (NMC 2004) ¹¹. Staff should be given supervised opportunities to gain the competencies appropriate to their area of practice, and to maintain their skills.

This document is an overview of the process by which assessment can be made and training provided.

2 - The professional staff concerned span a wide spectrum of experience, including paediatric consultants and other non training grades, doctors in training, midwives, advanced nurse practitioners, neonatal nurses, obstetricians, anaesthetists, general practitioners and ambulance paramedics.

3 - All individuals who are appointed to a post in which resuscitation skills are a fundamental requirement should be fully competent, at the appropriate level, before they are expected to take up responsibility for this procedure. New staff have a professional duty to ensure they have had opportunity to achieve the necessary competence. A specific training plan, agreed with their supervisor, should form part of their induction programme. Managers have a responsibility to provide the resources to make this possible.

4 - Responsibility lies with the Maternity Services to ensure that all professional staff who are present at the time of birth are competent in basic neonatal life support. The Maternity Services must show compliance with appropriate standards set by any Clinical Negligence Scheme for Trusts that is in operation. There must be opportunity and funding available for appropriate members of staff to be trained in advanced neonatal life support.

5 - The following should be considered as examples from which individual training needs can be adapted.

5.1 - Those requiring training in neonatal basic life support
All staff involved in the newborn at the time of birth and who are not competent in neonatal basic life support

• Background reading is essential and should be readily available 2
• Attendance at training sessions using simulators and manikins
• Training in basic neonatal life support, which includes
  • An understanding of the physiology and biochemistry of the adaptation to extra-uterine life
  • Thermal care of the newborn
  • Assessment of the newborn who needs resuscitation
  • Effective airway positioning
  • Use of bag-, valve-, mask-ventilation
  • External chest compression
• Observation of resuscitation by trained instructors
• Undertake resuscitation of babies under direct supervision
• Knowledge of unit protocols and guidelines
• An understanding of the importance of good record keeping and communication with fellow professionals and with the parents.
• 5.2 Those trained in neonatal basic life support
  This is all professionals who attend delivery of a baby
• Revision and reinforcing of all skills previously acquired
• Regular audit of skills and training and dissemination of information

After achieving competency in neonatal basic life support, it is expected that the Maternity Services will support a continuous programme of updating of skills. There should also be resources and opportunity for those who wish to develop advanced neonatal life support skills

5.3 - Those trained in neonatal advanced life support
Paediatric, and other, staff with a responsibility for resuscitation of the newborn. Other professionals who wish to extend their skills.

• Regular revision of skills
• Training in tracheal intubation with practice and supervision
• Training in umbilical venous catheterisation
• Training in appropriate drug therapy
• Supervision of those in training
• Participation in teaching and training courses
• Responsibility for organisation and audit of skills and training.

It is expected that staff involved in neonatal advanced life support attend a recognised course, such as NLS ¹² or appropriate equivalent. Managers have a responsibility to provide the resources to make this possible.

Maternity Services providing high risk obstetric care will be expected to have staff trained to the level of advanced neonatal life support available on site at all times. In all other situations there must be a clear referral pathway for a baby who needs neonatal advanced life support.

References

1. British Paediatric Association (1993).Neonatal Resuscitation . London. Available from the Royal College of Paediatrics and Child Health, 50 Hallam Street, London W1W 6DE.
2. Royal College of Paediatrics and Child Health and Royal College of Obstetricians and Gynaecologists (1997).Resuscitation of Babies at Birth . London. BMJ Publishing Group.
3. Royal College of Obstetricians and Gynaecologists (2005).Minimum Standards for Care on the Labour Ward .
4. Royal College of Midwives (RCM) (2002). Position paper 26.Refocusing the role of the Midwife . London: RCM
5. Royal College of Midwives (RCM) (2003). Home birth handbook: Volume 2: Practising home birth . London: RCM
6. Department of Health (DoH) (1993). Changing Childbirth. Report of the Expert Maternity Group. HMSO.
7. Department of Health. (DoH) (2004). Maternity Standard, National Service Framework for Children, Young People and Maternity Services. HMSO.
8. National Service Framework for Children, Young people and Maternity Services in Wales (2004). Children and Families Directorate, Welsh Assembly Government, Cardiff.
9. Scottish Executive (2002). Implementing a Framework for Maternity Services in Scotland. Expert Group on Acute Maternity Services - Reference Report.
10. Care of the critically ill child in Irish Hospitals (2005). Recommendations of the faculty of Paediatrics, RCPI and the Irish Standing Committee, Association of Anaesthetists of Great Britain and Ireland.
11. Nursing & Midwifery Council (NMC) (2004). Midwives rules and standards. London: NMC
12. Resuscitation Council (UK) (2001). Resuscitation at birth: The Newborn Life Support Provider Course Manual. London: Resuscitation Council (UK).