ESSENTIAL INTRAPARTUM

NEWBORN CARE (EINC)

Prepared by: Rona Grace L. Ulitin, RN, MAN
 ESSENTIAL INTRAPARTUM AND NEWBORN
CARE (EINC, OR “UNANG YAKAP”)
• That first embrace of the mother is the first step to a healthy
happy baby. This in gist is what UNANG YAKAP, a
Department of Health (DOH) project backed by the World
Health Organization, is all about.
 ESSENTIAL INTRAPARTUM AND NEWBORN
CARE (EINC, OR “UNANG YAKAP”)
• The program for ESSENTIAL INTRAPARTUM NEWBORN
CARE (EINC) is described as a “simple cost-effective
newborn care intervention” intended to enable improved
neonatal and maternal care. By changing childbirth practices,
maternal and newborn deaths can be reduced significantly.
 ESSENTIAL INTRAPARTUM AND NEWBORN
CARE (EINC, OR “UNANG YAKAP”)
• The UNANG YAKAP protocol was first mandated in public
and private hospitals in the Philippines in 2009, under an
administrative order of the DOH. Administrative Order
2009-0025 provided specific details on care during birth
until first 6 hours of life, as a guide for healthcare workers as
well as clarify the importance of public health units in the
implementation of the protocol.
 ESSENTIAL INTRAPARTUM AND NEWBORN
CARE (EINC, OR “UNANG YAKAP”)
• The initial results of UNANG YAKAP were encouraging, with
lower numbers in cases of neonatal sepsis, lower admissions
to neonatal intensive care units, and decreases in maternal
and newborn deaths. Ten years after, the EINC program
continues to spread the lessons of better childbirth practices
and the wonders of that first embrace.
 ESSENTIAL INTRAPARTUM AND NEWBORN
CARE (EINC, OR “UNANG YAKAP”)
• A campaign that seeks to engage national and local sectors,
public and private health sectors, individuals and
organizations, mothers, fathers and families, to embrace the
Essential Newborn Care Protocol to ensure a bright and
healthy future for our newborns.
 ESSENTIAL INTRAPARTUM AND NEWBORN
CARE (EINC, OR “UNANG YAKAP”)
• a simple, cost-effective newborn care intervention that can improve neonatal as well as
maternal care.
• an evidence-based intervention that:
 emphasizes a core sequence of actions, performed methodically (step-by-step)
 is organized so that essential time bound interventions are not interrupted
 fills a gap for a package of bundled interventions in a guideline format
• a series of time bound, chronologically-ordered, standard procedures that a baby receives at
birth
 TIME BAND: AT PERINEAL BULGING
INTERVENTION: PREPARE FOR THE DELIVERY
•Check temperature of the delivery room
25-28C
Free if air drafts
•Notify appropriate staff
•Arrange needed supplies in a linear fashion
•Check resuscitation equipment
•Wash hands with clean water and soap
•Double glove just before delivery
 FOUR CORE STEPS OF ESSENTIAL
NEWBORN CARE
•Immediate and thorough drying
•Early skin to skin contact
•Properly timed cord clamping
•Non-separation of the newborn and mother for early initiation of
breastfeeding
 TIME BAND: WITHIN THE 1ST 30 SECONDS
INTERVENTION: IMMEDIATE AND THOROUGH DRYING

•Call out time of birth

•Dry the newborn thoroughly for at least 30seconds
 wipe the eyes, face, head, front and back, arms and legs

•Remove the wet cloth

 WITHIN THE 1ST 30 SECONDS:
IMMEDIATE AND THOROUGH DRYING
•Do a quick check of breathing while drying
• **Do not ventilate unless the baby is floppy/limp and not breathing.
• **Do not suction unless the mouth/ nose are blocked with secretions or
other material
 IF AFTER 30 SECONDS OF DRYING, NEWBORN
IS NOT BREATHING OR IS GASPING
•Intervention: Reposition, suction and ventilate
•Action:
Clamp and cut cord immediately
Call for help
Transfer to a warm, firm surface

Inform the mother that the newborn has difficulty breathing and that you will help
the baby breathe
Start resuscitation protocol
 TIME BAND: AFTER 30 SECONDS OF DRYING
INTERVENTION: EARLY SKIN TO SKIN CONTACT

•If newborn is breathing or crying:

 Position the newborn prone on the mother’s abdomen or chest
 Cover the newborn’s back with a dry blanket
 Cover the newborn’s head with a bonnet
 Place identification band on ankle (not wrist)
 TIME BAND: AFTER 30 SECONDS OF DRYING
INTERVENTION: EARLY SKIN TO SKIN CONTACT

•Do not separate the newborn from mother

•Do not put the newborn on a cold or wet surface.
•Do not wipe off vernix if present.
•Do not bathe the newborn earlier than 6hours of life.
•If the newborn must be separated from his/her mother, put him/her on
a warm surface, in a safe place close to the mother
 TIME BAND: 1-3 MINS PROPERLY TIMED
CORD CLAMPING
•Remove the first set of gloves
•After the umbilical pulsations have stopped, clamp the cord using a
sterile plastic clamp or tie at 2 cm from the umbilical base
•Clamp again at 5 cm from the base
•Cut the cord close to the plastic clamp
 NOTES

• Do not milk the cord towards the baby; After the first clamp- you may
strip the cord of blood before applying the 2nd clamp
• Cut the cord close to the plastic clamp so that there is no need for a 2nd
trim
• Do not apply any substance to the cord
 TIME BAND: WITH 90 MINS NON SEPARATION OF
NEWBORN FROM MOTHER FOR EARLY BREASTFEEDING

•Leave the newborn in skin to skin contact

•Observe for feeding cues, including tonguing, licking, rooting
•Point out these to the mother and encourage her to nudge the newborn
towards the breast
 TIME BAND: WITH 90 MINS NON SEPARATION OF
NEWBORN FROM MOTHER FOR EARLY
BREASTFEEDING
•Counsel on positioning
 Newborn’s neck is not flexed nor twisted
 Newborn is facing the breast
 Newborns body is close to mother’s body
 Newborns whole body is supported
 TIME BAND: WITH 90 MINS NON SEPARATION OF
NEWBORN FROM MOTHER FOR EARLY
BREASTFEEDING
•Counsel on attachment and suckling
 Mouth wide open
 Lower lip turned outwards
 Baby’s chin touching the breast
 Suckling is slow, deep with some pauses
 NOTES
• Minimize handling by health workers

• Do not give sugar water, formula or other prelacteals

• Do not give bottles or pacifiers

• Do not throw away colostrum

 ESSENTIAL NEWBORN CARE FROM 90
MINS TO 6 HOURS OF LIFE
• Carry out eyecare and immunization procedures
• Practice Rooming in
• Exclusive breastfeeding for 6 months
 CARE PRIOR TO DISCHARGE
• INTERVENTION: Support unrestricted, per demand breastfeeding, day and night
• ACTION: Keep the newborn in the room with his/her mother, in her bed or within easy
reach. Do not separate them (rooming-in). Support exclusive breastfeeding on demand day
and night.
 CARE PRIOR TO DISCHARGE
• INTERVENTION: Ensure warmth of the baby
• ACTION: Ensure the room is warm (> 25o C and draft - free). Explain to the
mother that keeping baby warm is important for the baby to remain healthy
• Keep the baby in skin-to-skin contact with the mother as much as possible.
Dress the baby or wrap in soft dry clean cloth. Cover the head with a cap for
the first few days, especially if baby is small.
 CARE PRIOR TO DISCHARGE
• INTERVENTION: Washing and bathing (Hygiene)
• ACTION: Wash your hands. Wipe the face, neck and underarms with a damp cloth daily.
Wash the buttocks when soiled. Dry thoroughly. Bathe when necessary, ensuring that the
room is warm and draft-free, using warm water for bathing and thoroughly drying the baby,
then dressing and covering after the bath. If the baby is small, ensure that the room is
warmer when changing, wiping or bathing
UNANG YAKAP – YAKAP NG INA, YAKAP
NG BUHAY