When a baby is delivered, the midwife's initial physical assessment provides the first opportunity to detect structural malformations. A systematic head-to-toe examination is essential immediately after ensuring the newborn is breathing and stable. Look closely for visible anomalies such as an open neural tube defect along the spine, an abdominal wall defect where intestines protrude, or facial clefts. Do not delay initial warmth and airway checks, but fold structural screening into your routine transition assessment.
Commonly missed defects include imperforate anus, which is why checking the anal opening with a digital or visual thermometer check during admission is standard practice in many Nigerian delivery suites. Document every visible abnormality clearly in the birth register and clinical notes, noting size, location, and whether the skin is broken or intact over the lesion.
Some congenital anomalies directly compromise newborn breathing and circulation from the first breath. Midwives must follow standard neonatal resuscitation guidelines while modifying techniques to protect fragile anatomical defects.
Once the newborn is stable, preventing infection, fluid loss, and tissue damage becomes the primary focus of midwifery care. Exposed tissues require immediate protection to prevent bacterial colonization and sepsis.
| Defect Type | Immediate Protective Measure |
|---|---|
| Exomphalos / Gastroschisis | Cover exposed bowel with warm, sterile saline-soaked gauze wrapped in cling film or a sterile bowel bag. |
| Spina Bifida / Myelomeningocele | Cover the neural sac with a sterile, non-adherent saline dressing to keep it moist and clean. |
| Cleft Lip and Palate | Use specialized feeding techniques, such as an elongated teat or cup feeding, to prevent aspiration and starvation. |
Keep the newborn warm using skin-to-skin contact where anatomical defects permit, or nurse them under a pre-warmed radiant warmer. Hypothermia complicates metabolic acidosis and increases mortality in surgically vulnerable neonates.
Discovering that a newborn has a congenital anomaly often plunges parents into intense shock, grief, and guilt. Midwives carry the responsibility of breaking this news with deep empathy, clarity, and cultural sensitivity. Choose a quiet, private space for conversation, and invite both parents if they are available. Use simple, non-judgmental language, avoiding heavy medical jargon that can heighten their anxiety.
Allow parents time to express their emotions and ask questions without rushing them. Reassure them that congenital anomalies are common and usually not caused by anything they did during pregnancy. Avoid false promises about complete cures, but offer realistic hope regarding specialized surgical interventions available at tertiary referral centers.
Timely transfer to a tertiary health facility with pediatric surgical services can save a newborn's life, but transport itself carries physical risks. Midwives must stabilize the infant thoroughly before dispatch. Ensure the airway is secure, intravenous access is established for fluid maintenance, and thermoregulation is maintained throughout the journey.
Accompany the referral with a detailed, legible referral letter stating the clinical findings, stabilization steps taken, and medications administered. Send copies of the mother's antenatal records along with the baby. Whenever possible, arrange for a trained nurse or midwife to accompany the transport vehicle to monitor breathing and warmth en route, ensuring continuous clinical handover upon arrival at the receiving hospital.