*3.1.3 Care of the child*

The newborn is susceptible without skilled midwifery care, preventing and reducing neonatal and infant mortality. The midwife is the surest person to provide the utmost neonatal care for the neonate. The three essential needs of the neonate after establishing respiration are the need for warmth, protection from infection and nutrition. As early and sustained skin-to-skin contact provides warmth, the mother's body temperature helps regulate the neonate's temperature. Bonding begins early, comforting the newborn and initiating breastfeeding [48, 49].

#### *3.1.4 Nutrition*

Both mother and baby benefit from early breastfeeding. To the mother, suckling stimulates the release of endogenous oxytocin and uterine contraction thereby reducing the third stage of labour duration and regulating the neonates' temperature, leaving the resuscitaire for use by preterm and critically ill neonates. Additionally, it helps to reduce postpartum hemorrhage and increases uterine involution. This also

helps the development of mammary glands for milk secretion, helps breast emptying and prevents inflammation of the breast (Mastitis) [50, 51].

Correspondingly, initiating breastfeeding early can save millions of neonates, their gut gets colonized with good microbiota, which promotes the immune development of the child. It also promotes growth and prevents stunting. Therefore, the midwife must ensure the mother initiates breastfeeding within the first hour of birth [52, 53].

Equally important is the care of the cord. Being a key area for introducing infection to the child, asepsis must be maintained around the cord. Regulatory bodies recommend dry cord care until its detachment which is faster compared to the use of antibiotic gels. However, chlorhexidine gel is recommended for prevention in situations where strict sterility cannot be maintained, thus chlorhexidine provides the advantage of antibiotic cover. Handwashing is the single most effective means to prevent the spread of infection to both the mother and the child. The midwife must instruct the mother and all managing the baby on the importance of hand hygiene. Endeavor to wash hands before and after taking care of the infant, after a diaper change [54].

#### **3.2 A guided approach to assessing the newborn**

Midwives perform a newborn examination at birth detect abnormality early and institute treatment quickly. Mothers are gratified to know how well their baby is doing and might need to learn how to examine their babies It is thus expedient that the midwife conducts the following examination of the baby beginning from head to toe.

The head: most babies are born headfirst and so the head is subject to injury as it navigates the birth canal. The risk of caput succedaneum and cephalhematoma with bruises and sometimes scalpel injuries from cesarean section. Show the position of the sutures. And the time they close. The posterior fontanels close at 18 months. and the posterior fontanel fuses at six weeks. When the anterior fontanel is sunken Adequate feeding will prevent dehydration.

The eyes: check the appearance of the eyes and their movement. Teach mothers to look at the baby's eyes while feeding. The newborn begins to follow objects at six meters and can see up to 12 meters.

The mouth: for tongue tie and false tooth which can fall off while feeding to prevent asphyxiation of the infant. The presence of cleft lip and palate and micrognathia [55]. For many mothers, it is a frightening experience. Therefore, they require the support of the midwife, family, and significant others. Following the examination, breastfeeding must begin within the first hour of birth. It provides nourishment and bonding between mother and baby [56].

Midwives concentrate on meeting the physiologic as well as the emotional and psychological needs of mothers, especially mothers of preterm and extreme preterm neonates. The distress of physical and emotional separation of mothers from their babies is traumatizing, contributing to emotional instability and depression [57].

Attention must be given to mothers of sick neonates to avoid losing them. Supported and informed mothers contribute better to the care of their newborns, and their well-being encourages lactation and the treatment of the neonate.

Note that the midwife conducts a complete physical examination of the child, and notifies the mother and results are recorded in the delivery notes [58].
