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Exam standard · Discharge · Nursing

A newborn with jaundice, and a mother with low mood

This case practises: A clear timeline · Leaving out what the reader doesn't need · Including every key fact

Writing task

Today's date: 30 November 2026. You are the registered midwife on the Maternity Ward, Southbank Hospital. Write a letter to Ms Rebecca Tan, Child and Family Health Nurse, Southbank Child and Family Health Service, 120 River Road, Southbank, who will visit Mrs Hussain and her baby at home after their discharge today. Write in full sentences, not note form, using letter format. Aim for a body of about 180–200 words.

Case notes

In the test you get 5 minutes to read, then 40 minutes to write.

Mother
- Mrs Sana Hussain, DOB 18/03/1997 (29 y.o.)
- 7/42 Canal Street, Southbank
- First baby; admitted in labour 24/11/2026; discharge 30/11/2026
- Husband works as an accountant; returns to work 07/12
- Her parents visiting from Hyderabad until January
- Works as a dental receptionist; maternity leave until July 2027
- Blood group A positive; rubella immune
- Low-risk pregnancy; attended all antenatal appointments
- Family planning trip to India with baby in April 2027
- 14-hour labour, epidural; normal vaginal birth 25/11/2026
- Blood loss 350 mL; Hb 112 g/L
- Day 4 (28/11): tearful, sleeping poorly, worried about feeding
  - EPDS score 13 (question 10 - thoughts of self-harm: scored 0)
  - Seen by perinatal mental health liaison 29/11 - appointment booked 10/12/2026

Baby
- Baby Zara Hussain, born 25/11/2026 at 39+2 weeks, birth weight 3.20 kg
- Vitamin K given; hearing screen passed; hip check normal
- Day 3 (27/11): visibly jaundiced; SBR above treatment line
  - Phototherapy 24 h
  - Rebound SBR 29/11: below treatment line - no further treatment
- Breastfeeding: poor latch; weight day 3 = 2.91 kg (9% loss)
  - Lactation consultant 28/11: latch improved
  - Plan: breastfeed 3-hourly + expressed breast milk top-ups 30 mL after feeds
- Weight day 5 (30/11) = 2.96 kg
- Wet nappies 6/day; stools changing to yellow

Discharge plan
- Home visit within 48 h of discharge
- Weigh baby: aim to regain birth weight by day 14 (09/12/2026)
- Check jaundice and feeding; support breastfeeding and top-ups
- Repeat EPDS at visit; ensure perinatal mental health appointment 10/12 is kept
- Advise parents to seek urgent review if baby feeds poorly, is drowsy or jaundice increases

Write your letter

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Model answer Try writing your own letter first
Ms Rebecca Tan
Child and Family Health Nurse
Southbank Child and Family Health Service
120 River Road
Southbank

30 November 2026

Dear Ms Tan,

Re: Mrs Sana Hussain (DOB 18/03/1997) and Baby Zara Hussain (born 25/11/2026)

I am writing to hand over the care of Mrs Hussain and her first baby, Zara, who are going home today, and to request a home visit within 48 hours to monitor Zara's weight, feeding and jaundice and Mrs Hussain's mood.

Zara was born at 39+2 weeks, weighing 3.20 kg. On day 3 she needed 24 hours of phototherapy for jaundice, and her rebound bilirubin level was below the treatment line. Because of a poor latch, she had lost 9% of her birth weight by day 3. After lactation support, her latch has improved, and she now weighs 2.96 kg. She is breastfed three-hourly with 30 mL expressed milk top-ups and has six wet nappies a day.

On day 4, Mrs Hussain was tearful and sleeping poorly, and her EPDS score was 13, with no thoughts of self-harm. She has a perinatal mental health appointment on 10 December.

I would be grateful if you could weigh Zara, aiming for her to regain her birth weight by 9 December, check her jaundice and feeding, repeat Mrs Hussain's EPDS and make sure she attends her appointment.

Yours sincerely,

Registered Midwife
Maternity Ward
Southbank Hospital

What the reader needs

  • Baby treated with 24 hours of phototherapy for jaundice; rebound bilirubin below the treatment line
  • Breastfeeding difficulty: 9% weight loss on day 3; now 2.96 kg on day 5 (birth weight 3.20 kg)
  • Feeding plan: breastfeed 3-hourly with 30 mL expressed milk top-ups
  • Home visit within 48 hours; aim to regain birth weight by 9 December
  • Mother's EPDS score 13 with no thoughts of self-harm
  • Perinatal mental health appointment on 10 December; repeat EPDS at visit

Details to leave out

  • Husband's job and return to work
  • Grandparents visiting from Hyderabad
  • Labour length and epidural
  • Blood loss and haemoglobin
  • Vitamin K, hearing screen and hip check
  • Mother's job and maternity leave
  • Blood group and rubella status
  • Low-risk pregnancy history
  • Planned trip to India

One good way to write this letter, not the only one. Written by Kurippu; awaiting nurse review.