SSENTIAL NTRAPARTUM AND EWBORN ARE
Procedures and their Rationale:
1. Perform Proper Handwashing
➢ This is to prevent cross-contamination of
microorganisms and even prevent
infection.
2. Double Gloving
➢ Purpose of Double Gloving
- Reduces infection risk
- Provides a high level of protection
3. Place the mother in a lithotomy position
- Lithotomy Position involves lying on
your back with your legs flexed 90
degrees at your hips. Your knees will
be bent at 70 to 90 degrees, and
padded foot rests attached to the table
will support your legs.
➢ The lithotomy position was the standard
birthing position used by many hospitals.
It was often used during the second stage
of labor, when you start pushing. Some
doctors prefer it because it gives them
better access to both mother and baby.
But hospitals are now moving away from
this position.
➢ Cons of Lithotomy Position during
childbirth:
- A 2016 study comparing different
birthing positions noted that the
lithotomy position lowers blood
pressure, which can make
contractions more painful and draw
out the birthing process.
- A study in 2012 similarly found a
higher risk of perineal tears in the
lithotomy position.
- Another study linked the lithotomy
position with an increased risk of
injury to the perineum when
compared with squatting lying on
your side.
4. Drape the mother to maintain privacy.
➢ Draping or covering the mother helps in
providing privacy.
5. Perform Perineal Prep to the mother
➢ Perineal Preparation is performed
because it helps the mother to learn how
to relax into the natural opening of the
vagina during childbirth and how to
become accustomed to these sensations.
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It also provides cleanliness, prevent
infections, and gives comfort
6. Advise the mother about pushing or bearing
down
➢ It will encourage or urge the mother to
push when the cervix is fully dilated.
Moreover, it will help the mother to
know the different methods of
pushing/bearing down that is suitable or
will help her to deliver the baby easily.
➢ Do not perform routine episiotomy
- Take note that episiotomy should be
considered only in the case of (1)
Complicated vaginal delivery, (2)
Scarring of the female genitalia or
poorly healed third of fourth-degree
tears, and/or (3) Fetal distress.
7. Take vital signs of the mother
➢ Taking and monitoring the mother’s vital
signs are essential because it will allow
the medical team to know any early
detection of complications that might
harm her and the baby.
8. Delivery of the Newborn
9. Call out time of birth
10. Dry baby thoroughly while observing
breathing
➢ Within the first 30 seconds of birth,
provide the newborn with warmth to
prevent hypothermia by drying the baby
with a clean, dry cloth thoroughly. Wipe
the baby from the eyes, to the face, head,
front and back, arms and legs in a
cephalocaudal (head-to-toe) direction.
This way, heat loss by evaporation is
prevented.
➢ Do a quick check of newborn’s breathing
while drying. Normal breathing is quiet,
nasal, abdominal, synchronized,
shallow, and rapid with the rate of 30 to
60 bpm.
11. Remove all wet linen
➢ The presence of wet clothing against the
newborn’s skin causes loss of heat by
conduction and evaporation.
12. Do not suction unless airway is obstructed
➢ You can only suction if the mouth/nose
is blocked with secretions or other
materials.
 SSENTIAL NTRAPARTUM AND
➢ If the newborn is breathing well and
crying vigorously, there is no reason for
suctioning.
13. Place prone on mother’s abdomen or chest
➢ This will promote skin-to-skin contact
(SSC)
➢ Prone position helps draining of
secretions and clearing of air passages.
➢ Take note:_________________________
- The top priority in the immediate
care is AIRWAY.
- As soon as the baby is securely
positioned on the mother, palpate the
abdomen to exclude a second baby,
or multiple births.
14. Cover with warm blanket and bonnet
➢ Covering the baby will keep him/her
warm. Note that you should not separate
the baby from the mother, but if the
newborn must be separated due to
conditions, place him/her in a safe and
warm place close to the mother.
15. Remove first set of gloves
16. Do not clamp cord until umbilical
pulsations stop
➢ Delay cord clamping or implement non-
immediate cord clamping to reduce the
incidence of anemia in term newborns
and intraventricular hemorrhage (IVH)
in pre-term newborns.
➢ Clamp and cut the cord only if the cord
pulsations have stopped.
17. Clamp the cord at 2 cm and 5 cm from the
baby’s abdomen then cut
➢ Take note:_________________________
- The longer is left of the cord stump,
the longer is drying and dropping off
time. This implies more risk to local
bacterial infection of the cord called
omphalitis.
- Cut between ties with sterile
instrument to prevent tetanus
neonatorum
- Examine the cord, there should be
three vessels; one umbilical vein
(left), and two smaller umbilical
arteries (right and left). Incomplete
cord vessels require referral for
further thorough assessment for
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EWBORN ARE ROTOCOL
congenial defects of the
kidneys/renal.
18. Do not apply anything (e.g. alcohol,
povidone-iodine) to the stump
➢ The use of alcohol keeps the stump moist
so avoid applying it to the stump
19. Deliver the placenta
20. Instruct the mother to hold in one hand
their newborn and the other hand to
massage her uterus
21. Take vital signs of the mother
22. Inject oxytocin 10 units IM, to the mother’s
arm or thigh after excluding a 2nd baby
➢ Explain to the mother that you will be
injecting her with oxytocin to make her
uterus contract and protect her from
excessive bleeding.
➢ Oxytocin increases availability of
intracellular calcium thereby increasing
myometrial contraction.
➢ Take note:_________________________
- (If IV) Monitor the rate of IV
oxytocin flow accurately. Too rapid
infusion of the drug may cause
tachycardia, hypertension or
hypotension, and antidiuretic effect
which may be manifested in oliguria,
water intoxication, fluid overload,
headache, nausea, and vomiting.
23. Keep on uninterrupted skin-to-skin contact
for at least 90 minutes even when
transferring to the RR
➢ Importance of SSC
- Promotes bonding between the
mother and the baby.
- Keeps the baby warm
- Increases chances of overall success
of Breastfeeding/Colostrum Feeding
- Allows colonization with good
bacteria (Maternal Skin Flora)
24. Aid the physician in episiorrhaphy
25. Provide perineal care
26. Put an adult diaper to the mother
➢ This is for the bleeding that may take
place after giving birth.
➢ Lochia is the vaginal discharge you have
after giving birth. It contains blood,
mucus, and uterine tissue. It has three
stages:
- First stage: Lochia Rubra
 SSENTIAL NTRAPARTUM AND
Expect the following:
• Dark or Bright Red Blood
• Lasts for 3-4 days
• Flows like a heavy period
• Small clots are normal
• Mid, period-like cramping
- Second stage: Lochia Serosa
Expect the following:
• Pinkish Brown discharge that’s less bloody
and watery.
• Lasts for 4-12 days
• Flow is moderate
• Less clotting or no clots
- Third stage: Lochia Alba
Expect the following:
• Yellowish White Discharge
• Little to no blood
• Light flow or spotting
• Lasts from about 12 days to 6 weeks
• No clots
27. Transfer mother to stretcher and wheel her
in the recovery room
28. Room in baby with the mother
29. Put oil in Sanitex then rub in a
cephalocaudal way
30. Perform Vitamin K, Hepa B, BCG, eye
prophylaxis, P.E. and anthropometrics
➢ Give 1 mg of Vitamin K Prophylaxis
IM. Offer oral vitamin k if parents
decline intramuscular injection
- Note that without adequate Vitamin
K, the newborn is at risk of
hemorrhagic conditions. Clotting
Factors II (prothrombin), VII
(proconvertin), IX (plasma
thromboplastin component), and X
(thrombokinase) are proteins that
need Vitamin K to convert them into
active clotting factors, thus they are
called Vitamin K-dependent
coagulation factors.
- Note that Vitamin K is given
prophylactically to prevent neonatal
hemorrhage (esp. for those who are at
greater risk of hemorrhage, those
with cephalhematoma, those born
pre-term, and those delivered
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EWBORN ARE ROTOCOL
precipitately or instrumentally with
forceps)
➢ Give Hepatitis B Vaccine
intramuscularly
- This is given to protect the infant
against hepatitis B viral infection.
- WHO recommends administering
the first Hepa B Vaccine or Dose less
than 24 hours after birth to prevent
perinatal HBV transmission.
- Dosage: 0.5 mL for newborns and
infants
➢ Inject BCG intradermally
- BCG Vaccination gives active
immunity against Pulmonary
Tuberculosis (PTB)
- Dosage: 0.05 mL for newborns and
infants
➢ Eye Prophylaxis is given in a newborn’s
eye after birth in order to protect the
baby from an unknown gonorrhea
infection in the mother’s body.
- Note that the passage of the baby
through the vagina predisposes
him/her to an infection of the eyes
called ophthalmia neonatorum.
- Vaginal infections like gonorrhea and
chlamydia can result in ophthalmia
neonatorum called gonorrheal and
chlamydial conjunctivitis.
31. Put diaper, baby’s clothes, and swaddle
32. Watch out for feeding cues at 20-90
minutes; encourage direct breastfeeding
once present
➢ Observe the newborn for feeding cues
such as:
- Opening of mouth
- Tonguing
- Licking
- Rooting
➢ If cues are present, suggest to the mother
to encourage the baby to move toward
the breast.
33. Minimize handling of the newborn
34. Do not bathe the baby for the first 6 hours
➢ Body Temperature and Blood Sugar –
Babies who gets bath right away may be
more likely to become cold and develop
hypothermia. It can also make some
 SSENTIAL NTRAPARTUM AND
babies more likely to have a drop in blood
sugar (hypoglycemia).
➢ Bonding and Breastfeeding – Taking
away the baby for a bath can interrupt
ssc, mother-child bonding, and early
breastfeeding success.
➢ Dry Skin – The Vernix; a waxy white
substance that coats a baby’s skin before
birth, acts as a natural moisturizer and
may have anti-bacterial properties.
According to the American Academy of
Pediatrics (AAP), it's best to leave vernix
on a newborns' skin for a while to help
prevent their delicate skin from drying
out.
35. Encourage breastfeeding per demand
➢ Provide support for early breastfeeding
by facilitating newborn’s early initiation
to breastfeeding and transfer of
colostrum.
36. Observe one breastfeeding for proper
positioning and attachment
➢ Counsel the mother on positioning and
attachment. If the attachment or suckling
is not good, advise mother to try again.
➢ Assess for signs of good attachment and
suckling:
- Mouth wide open
- Lower lip turned outwards
- Baby’s chin touching breast
- Slow, deep suckling with some
pauses
37. Do not give sugar water, formula or other
liquids
38. Do not use pacifiers or bottles
Summary of “Don’ts” in the Immediate Care of
the Newborn
1. Within first 30 seconds of life:
● Do not suction unless the mouth/nose is
blocked with secretions or other material.
● Do not ventilate unless the baby is
floppy/limp and not breathing.
● Do not place the newborn on a cold or wet
surface.
2. After 30 seconds of thorough drying, newborn
is breathing/crying:
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[BSN23] UDM CHS – A.Y. 2022-2023
EWBORN ARE ROTOCOL
● Do not separate newborn from the
mother as long as the newborn does not
exhibit danger signs of respiratory
distress such as severe chest in-drawing
or apnea, and the mother does not need
urgent medical stabilization (e.g.,
emergent hysterectomy). If newborn
must be separated from the mother, put
him/her on a warm and safe surface
close to the mother.
● Do not do foot printing to identify the
newborn; ankle band is sufficient.
● Do not wipe off vernix caseosa if present as
it prevents heat loss.
● Do not manipulate (e.g., routine
suctioning) if the newborn is crying and
breathing normally to prevent undue
trauma which can precipitate newborn
infection.
3. From 1 to 3 minutes:
● Do not milk the cord towards the
newborn.
4. Within 90 minutes:
● Do not touch the newborn while on
maternal abdomen unless there is a
medicalindication.
● Do not give glucose water, formula, or
other prelacteal feedings.
● Do not give bottle or pacifiers.
● Do not throw away colostrum.
● Do not wash away the eye antimicrobial.
5. From 90 minutes to 6 hours:
● Do not touch the stump unnecessarily.
● Do not apply any substances or medicine
on the stump.
● Do not bandage the stump or abdomen.
● Do not bathe the newborn at least 6 hours
after birth.