The Neonate is Being Noticed

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Today the RMC neonatal working group met to discuss respectful neonatal care. The RMC working group consists of several governmental and nongovernmental organizations that are working on
maternal and neonatal issues. The RMC maternal working group was responsible for writing the WHO
Respectful Maternal Care document. During the process of writing the document it became evident that
neonates would need their own statements and standards. Emma Sacks one of the primary drivers of
the neonatal document states that neonates are unique because they need an advocate (Sacks, 2017).
Anyone who cares for neonates are to be an advocate. Excerpts from the Sacks article related to the WHO domains and quality standards for mothers, newborns and families of stillborn infants.

Standard 4: Communication with women and their families is effective and responds to their needs and
preferences. Within this domain is: no unnecessary separation of mother and newborn, education on
proper essential newborn care, supportive breastfeeding.
Standard 5: Women and newborns receive care with respect and preservation of dignity. Within this
domain: newborns handled gently and safely, cared for by adults at all times, competent providers and
staff, home-born infants receive same quality of services as facility born, avoid painful procedures, still
born infants are given respect and allow family to grieve.
Standard 6: Every woman and her family are provided with emotional support that is sensitive to their
needs and strengthens the woman’s capability. Within the domain: warm safe are for newborn,
promotion of skin to skin and immediate breastfeeding and on demand, dry warm clothes, prompt
removal of soiled clothing, provision of care for women and children with HIV and disabilities,
acceptance of all kinds of family types, maternal groups, postnatal care.
Standard 7: For every woman and newborn, competent, motivated staff are consistently available to
provide routine care and manage complications. Within domain: provider competent in essential
newborn care, staff able to care for critical ill infant, staff care with compassion,
Standard 8: The health facility has an appropriate physical environment, with adequate water, sanitation
and energy supplies, medicines, supplies and equipment for routine maternal and newborn care and management of complications. Within domain: area for delivery and newborn kept clean and warm,
equipment ready and clean for low birth weight, preterm or sick infants, separate postpartum area for
parent of still born infants.
These standards are important for all infants. What is not addressed is the special vulnerabilities that a
neonate encounters in neonatal units. They deserve specialized trained nurses and doctors; their own
bed; their own space; their own equipment not shared with another infant; equipment available when
they need it. They need appropriate nurse staffing which allows the nurse the time to respond to the
neonates if their condition changes. They need doctors trained in neonatal diagnosis and care to round
or tour on them every day and to come if their condition worsens. They need their families available to
them at all times. The family needs space to hear about their infant without everyone in the room
hearing the diagnosis, problems and plans. The need the appropriate laboratory studies and that the
test is available to them. As the team discussed just a few of these needs it became obvious that we
needed more literature, more research and more discussion surrounding the special needs of the
vulnerable neonate. COINN is involved in these discussions and working with this group to keep the
neonate and the nurses/midwives that care for them at the forefront.
Reference:
Sacks, E. (2017). Defining disrespect and abuse of the newborn: a review of the evidence andexpanded
typology of respectful maternity care. Reproductive Health, 14:66. https://doi.org/10.1186/s12978-
017-0326-1