This time I’m going to discuss EINC or Essential Intrapartum and Newborn Care.

So, what
exactly is EINC? EINC are series of time-bound and evidence-based interventions that play
significant roles in improving maternal and newborn health. For newborns, it is important
especially in the first hours of life because this is the time that the they will adopt to a new
environment.

Actually, there are 4 time-bound interventions in this protocol, and these are:
- immediate drying
- skin to skin contact,
- followed by clamping of the cord,
- non-separation of baby from mother,
- and lastly, breastfeeding initiation

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So, when the baby is born, under the second stage of labor, the first intervention is

Immediate thorough drying (at least 30seconds). This is done to stimulate breathing. If there is
stimulation of breathing, there’ll be independent life wherein the baby will cry. Drying also
prevents hypothermia which is crucial as it can lead to further complications such as infection,
acidosis, brain hemorrhage and so on.

Upon drying, we should

- wipe gently without including the vernix (as it helps the baby to keep warm)
Then, we’re going to remove wet cloth, and then replace it with dry one.

It is important to note that we should not ventilate unless the baby is floppy or not breathing.
Additionally, we should not suction unless mouth or nose is blocked by secretions

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Secondly, after drying, we’re going to expose both the mother and baby skin to skin (30seconds
– 90 minutes) so that there’ll be mother and baby bonding. Other benefits include:
Breastfeeding success
Lymphoid system stimulation (or the stimulation of baby’s immune function as it starts
to receive the immunological effects of colostrum )
Exposure to maternal skin flora (which increases colonization of protective maternal
bacteria to the baby thereby establishing immunity)
Sugar (for protection from hypoglycemia), and of course
Thermoregulation (to prevent hypothermia)

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If the baby is already breathing or crying, we’re going to position the baby prone on mother’s
abdomen with the head tuned to the side to let the baby see mother’s nipple for breastfeeding
initiation. Then, check for temperature.
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After skin to skin, it will be followed by clamping of the cord when pulsation stops, between 1
to three minutes. The reason behind delaying clamping until the pulsation stops is that it allows
as much as 100 mL of blood to pass from the placenta into the fetus; and this helps ensure an
adequate RBC count in the newborn. So, properly clamping the cord on time decreases anemia
and prevents brain hemorrhage. The skin to skin will also promote faster slacking off, healing,
and necrotization of the cord (3-7 days it will dry).
Preterm-1min
Term-3mins
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Lastly, after 20-60mins or within 90mins of birth, the newborn is ready to breastfeed. We’re
going look for signs of good attachment and suckling such as:
– Mouth wide open
– Lower lip turned outwards
– Baby’s chin touching breast

It is important to initiate breastfeeding within the first hour of life as this again, prevents
neonatal deaths and during breastfeeding, the hormone oxytocin is released, thereby
stimulating uterine contraction or the return of the uterus to its prepregnant state.

Early Breastfeeding (latch/latching on)

IC