EINC

ESSENTIAL INTRAPARTUM
AND
NEWBORN CARE

by: Heidi C. Cabanatan, RN

 EINC (Essential Intrapartum and Newborn Care)

 The EINC practices are evidence -based standards for

safe and quality care of birthing mothers and their
newborns, within the 48 hours of Intrapartum period (labor
and delivery) and a week of life for the newborn.
EINC (Essential Intrapartum and Newborn Care)

Is a package of evidence-based practices recommended by the

Department of Health, PHIC, and the WHO as the standard of care in all
births by skilled attendants in all government and private settings.
EINC (Essential Intrapartum and Newborn Care)

It is a basic component of DOH’s Maternal, Newborn and Child

Health and Nutrition (MNCHN) strategy.
EINC (Essential Intrapartum and Newborn Care)
The EINC practices for newborn care constitute a series of time-bound,
chronologicallly-ordered, standard procedures that a baby receives at birth.

At the heart of the protocol are four time-bound interventions

1.Immediate drying
2.Skin-to-skin contact followed by
3.Clamping of the cord after 1-3 minutes
4.Non-separation of baby from mother and breastfeeding initiation
EINC (Essential Intrapartum and Newborn Care)

1. Immediate Drying

Using a clean, dry cloth, thoroughly dry the baby, wiping the
face, eyes, head, front and back, arms and legs.
 time bound : 30 seconds to 1 minute
EINC (Essential Intrapartum and Newborn Care)
2.Skin-to skin contact
 If a baby is crying and breathing normally, avoid any manipulation,
such as routine suctioning, that may cause trauma or introduce
infection.
 Place the newborn prone on the mother’s abdomen or chest skin-
to skin
 Cover newborn’s back with a blanket and head with a bonnet.
 Place identification band on ankle.
EINC (Essential Intrapartum and Newborn Care)
3. Proper cord clamping
 Clamp and cut the cord after cord pulsations have stopped (typically at 1-3
minutes)
 Put ties tightly around the cord at 2 cm and 5 cm from the newborn’s
abdomen.
 Cut between ties with sterile instrument.
 Observe for oozing blood
 Do not milk the cord towards the newborn
 After cord clamping, ensure oxytocin 10 iu IM is given to the mother.
This prevents:
 Anemia
protect against brain hemorrhage in premature newborn
EINC (Essential Intrapartum and Newborn Care)
4. Non-separation of baby from mother and breastfeeding
initiation

 time bound: 90 minutes of age

 continuous non separation for early breastfeeding which protects
the infants from infections
Initiation on Breastfeeding
Observe the newborn.
Only when the newborn shows feeding cues (e.g.
opening of mouth, tonguing, licking, rooting), make verbal
suggestions to the mother to encourage her newborn to
move toward the breast.
Counsel on positioning and attachment
When the baby is ready, advice the mother to:
a) Make sure the newborn’s neck is neither flexed nor twisted
b) Make sure the newborn is facing the breast, with the newborn is facing the
breast, with the newborn’s nose opposite her nipple and chin touching the
breast.
c) Hold the newborn’s body close to her body
d) Support the newborn’s whole body, not just the neck and shoulders.
e) Wait until her newborn’s mouth is opened wide
f) Move her newborn onto her breast, aiming the infant’s lower lip well below
the nipple
g) Look for signs of good attachment and suckling:
Signs of good attachment and suckling:
Mouth wide open
Lower lip turned outward
Baby’s chin touching breast
Suckling is slow, deep with some pauses
If the attachment or suckling is not good, try again and
reasess.
Notes:
Health workers should not touch the newborn unless
there is a medical indication
Do not give sugar water, formula or other prelacteals
Do not give bottles or pacifiers
Do not throw away colostrum
What has the government done to ensure implementation of the
Essential Newborn Care Protocol?
The signing of the Administrative Order 2009-0025 last Dec. 1,
2009 institutionalizes policies and guidelines for government and
private health facilities to adopt the essential newborn care
protocol.
Advocacy and dissemination have been done since its launch
Scale-up implementation in all facilities and social marketing are
both the pipeline to ensure that the policy is implemented all over
the country
What is the relationship of ENC Protocol with regard to the Maternal,
Newborn and Child Health Nutrition (MNCHN) Strategy?

 The Maternal, Newborn, Child Health and Nutrition Strategy is in line with the
DH Administrative Order 2008-0029 that seeks to rapidly reduce maternal
and newborn morbidity and mortality
 This is the provision of Basic and Comprehensive Emergency Obstetric and
Newborn Care (BEmONC and CEmONC) capability of health facilities to
meet the UN MDGs 4 and 5
 Newborn care has been incorporated in the provision these service
capabilities
 The Administrative Order 2009-0025 formalized the adoption of policies and
guidelines on essential newborn care
What is the relationship of the ENC Protocol with
regard to the Mother-Baby Friendly Hospital Initiative
(MBFHI), Infant and Young Child Feeding strategy, and
the Republic Act 10028?

• The ENC seeks to provide a firm foundation for an environment

that complies with the “Ten (10) Steps to Successful
Breastfeeding” of the Mother-Baby Friendly Hospital Initiative
(MBFHI) breastfeeding initiation crucial to the IYCF WHO global
strategy and in the implementation of R.A. 10028.
What newborn care practices in the delivery room should no longer be
continued?

• Manipulation such as routine suctioning of secretions if the baby is crying and breathing
normally.
• Putting the newborn on a cold or wet surface
• Wiping or removal of vernix caseosa if present
• Foot printing
• Bathing earlier than 6 hours of life
• Unnecessary separation of the newborn primarily for weighing, anthropometric
measurements, intramuscular administration of vitamin K, Hepatitis B vaccine and BCG
vaccine
• Transferring of the newborn to the nursery or neonatal intensive care unit without any
medication.
Who are involved in Essential Newborn care Protocol
Healthcare professionals (government or in private facilities)
Those who are involved in maternal and newborn care (not limited to
obstetrician-gynecologists, pediatricians/neonatologists, nurses, midwives,
but also the hospital administration officials, anesthesiologists, hospital
infection control officers, hospital PhilHealth/Quality officers, clinical
nutritionists, clinical pharmacists, nursing attendants, health promotion and
information officers.
At the community level:
The local government up to the barangay officials, together with their health
workers, nutrition scholars, community health teams and volunteers, mother’s
groups are likewise enjoined to ensure proper information is disseminated to
pregnant women and women of the reproductive age group.
Thank You!