Midwifery postnatal home visit with a feeding problem
NMC OSCE practice station

The task

You are a community midwife making a postnatal home visit on day 5. Sana Iqbal, aged 29, had a normal birth five days ago and is breastfeeding her baby Zayan. Her partner is present. She says feeding is going badly. Introduce yourself, assess Sana and Zayan, with a focus on feeding, and decide what needs to happen today. Record your findings, calculation of the baby's weight change and your plan on the form provided. Say aloud what you are checking and why, and explain your plan to the parents.

What this station tests

• Calculate weight change as a percentage of birth weight: loss of around 10 percent needs action.
• Weight loss, jaundice, sleepiness and few wet nappies together are a red flag, not a reason for reassurance.
• Watch a whole feed; attachment and swallowing tell you more than a history.
• Check the mother as well as the baby, including mood and nipple damage.
• Escalate the same day and give parents a clear safety net.
• Do not judge jaundice by looking alone; a baby over 24 hours old with visible jaundice needs bilirubin measured within 6 hours.

Sources for the clinical content

• NICE NG194: Postnatal care
• NICE CG98: Jaundice in newborn babies under 28 days
• NICE CG192: Antenatal and postnatal mental health
• NMC: The Code

An original practice scenario with invented patients. Not an exam question.

Practise next

• Breathless older patient with a chest infection
• Worsening abdominal pain after bowel surgery
• Confused patient after a fall with a head injury
• Children's nursing assessment of a child with a high fever
• Midwifery assessment of reduced baby movements