PAPER

Evidence Based on Newborns and Journal Studies

(Proposed to fulfill one of the tasks of the Maternity and Newborn Midwifery
Care Course for the Midwifery Professional Study Program)

Supervisor :
Bayu Irianti, SST, M.Keb

Arranged by :
Fadila Putri (NIM: P20624519009)
Auffaa Shaffarina (NIM: P20624519006)

MINISTRY OF HEALTH OF THE REPUBLIC OF INDONESIA

TASIKMALAYA HEALTH POLYTECHNIC
MIDWIFERY DEPARTMENT
TASIKMALAYA
2021
 FOREWORD

Praise be to Allah SWT, who has given His grace, knowledge, favors and
guidance, so that the author is able to complete this paper. Salawat and also His
greetings may always be bestowed on the Messenger of Allah SWT, Muhammad
SAW to his family, friends, and people who are always istiqomah in his path.

This paper is the author created in order to fulfill one of the requirements
for assessing the course assignments Maternity and BBL Midwifery Care. This
paper discusses "Evidence Based on Newborns and Journal Studies". Making this
paper using the literature study method, namely collecting and reviewing material
from references.

The author would like to thank all those who have helped the perfection of
this paper, especially the course supervisor who has provided enlightenment and
has guided the author in learning and discussion. The author hopes that this paper
is useful for the author and the readers themselves. The author realizes that this
paper is still far from perfect, so the author expects constructive criticism and
suggestions from readers so that this paper becomes better and perfect.

Tasikmalaya, February 14, 2021

Author

TABLE OF CONTENTS

FOREWORD..................................................................................................
TABLE OF CONTENTS...............................................................................
CHAPTER I INTRODUCTION
A. Background ..........................................................................................
B. Writing purpose....................................................................................
1. General purpose .............................................................................
2. Special purpose ..............................................................................
CHAPTER II DISCUSSION
A. Baby Friendly.......................................................................................
1. Definition of Baby Friendly............................................................
2. Baby Friendly Implementation.......................................................
3. How to Achieve the Baby Friendly Initiative Program..................
B. Early Initiation of Breastfeeding..........................................................
1. Definition of Early Initiation of Breastfeeding...............................
2. Procedures for Early Initiation of Breastfeeding............................
3. Benefits of Early Initiation of Breastfeeding..................................
4. Early Initiation Stages of Breastfeeding.........................................
C. Temperature Regulation of Newborns by Skin to Skin Contact..........
1. Thermoregulation...........................................................................
2. Hypothermia in Infants...................................................................
3. How to Maintain Baby's Temperature............................................
D. Cutting the Umbilical Cord..................................................................
E. Umbilical Cord Care.............................................................................
1. Definition of Umbilical Cord Care.................................................
2. How to Care for the Umbilical Cord..............................................
3. Principles of Umbilical Cord Care.................................................
CHAPTER III CLOSING
A. Conclusion ...........................................................................................
B. Suggestion ............................................................................................
BIBLIOGRAPHY
PIG
PRELIMINARY
A. Background
 In the past, health development was not as good as now, when the birth
was carried out by a traditional birth attendant, after the baby was born, early
initiation of breastfeeding was not immediately done. Instead, what is done is
that the baby is immediately cleaned or bathed in warm water after the
umbilical cord is cut. In the past, cutting the umbilical cord was done
immediately after birth using bamboo. Along with the times and technology,
the umbilical cord is cut with scissors immediately after birth. This care is still
happening today, but not as much as in the past, because midwives are
required to always update their knowledge. Until now, many new midwifery
care sciences, one example is cutting the umbilical cord is not done
immediately after birth.
Midwives are required to always update their knowledge, the
background of this is because the health status of a country is determined by
the ratio of the high and low rates of maternal mortality and perinatal
mortality rate. Based on the high rates of maternal and infant mortality, WHO
establishes one very important effort to achieve an increase in comprehensive
and quality midwifery services, namely the implementation of evidence-based
practice or care. Where the evidence-based practice has been scientifically
proven and can be used as the basis for new, safer and better quality practices
that are expected to control maternal mortality and infant mortality rates.
Therefore, we compiled a paper entitled Evidence Based on Newborns and
Journal Studies.

B. Writing purpose
1. General purpose
a. To fulfill course assignments Maternity and Newborn Midwifery Care
2. Special purpose
 a. To find out what Evidence Based Newborns are
b. To find out what is meant by Baby Friendly based on Evidence Based
Newborns
c. To find out what is meant by Early Initiation of Breastfeeding based on
Evidence Based Newborns
d. To find out what is meant by Newborn Temperature Regulation based
on Evidence Based Newborns
e. To find out what is meant by cutting the umbilical cord based on
evidence based newborns
f. To find out what is meant by umbilical cord care based on evidence
based newborns

CHAPTER II
DISCUSSION
A. Baby Friendly
1. Definition of Baby Friendly
 The Baby Friendly Hospital Initiative (BFHI), also known as the
Baby Friendly Initiative, is an international initiative established by WHO
and UNICEF to promote, protect and support the initiation and
continuation of breastfeeding. More than 152 countries around the world
are implementing initiatives that have a measurable and proven impact,
increasing the likelihood of babies being exclusively breastfed during the
first six months.
2. Baby Friendly Implementation
Baby Friendly implementation can be done as follows:
a. Starting breastfeeding early and exclusively
That is, breastfeeding starts immediately after the baby is born,
a maximum of the first half hour after delivery. BFHI was updated in
2018 and includes Ten Steps to Successful Breastfeeding (Ten Steps
2018) and the International Code of Marketing of Breastmilk
Substitutes (WHO Code).
The aim of the 10 Steps, updated in 2018 is to ensure maternity
services provide quality care for infants and the essential support
needed to help mothers breastfeed, the 10 Steps 2018 is divided into
two parts: Critical management procedures and Clinical practice.

Ten Steps to Successful Breastfeeding updated in 2018.

Critical management
procedures
1a. Comply with relevant Codes and resolutions.
1b. Have a written infant feeding policy that is
routinely communicated to staff and parents.
1c. Establish a sustainable monitoring and data
management system.
2. Ensure that staff have sufficient knowledge,
competence and skills.
Main clinical practice
3. Discuss the importance and management of
breastfeeding with pregnant women and their
families.
4. Facilitates direct and uninterrupted skin-to-skin
contact and supports mothers to start breastfeeding
after birth.
5. Support mother to initiate and maintain
breastfeeding and deal with common difficulties.
6. Do not give a breastfed newborn baby any food or
liquid other than breast milk, unless there is
medical indication.
7. Allows mother and baby to stay together and
practice joint care 24 hours a day.
8. Encourage mothers to recognize and respond to
their baby's cues to suckle.
9. Advise mothers about the use and risks of feeding
bottles and teats.
10. Coordinate discharge so that parents and their
babies have timely access to ongoing support and
care.

b. Cut the umbilical cord

Cutting the umbilical cord is carried out with a delay of 3 minutes.
c. Perform umbilical cord care
Umbilical cord care is done by:
1) Let the umbilical cord dry on its own
2) Dry gauze method
3) 70% alcohol gauze method
4) Antiseptic method and dry gauze
d. Bounding attachments
It is a bond that occurs between parents and newborns which
includes the giving of affection, outpouring of mutual attention. The
success in the bonding relationship between a baby and its mother can
affect the relationship over time by providing a sensual response
between mother and baby at initial birth contact, namely by:
1) Touch
2) Eye contact
 3) Body odor
4) Sound
5) The rhythm of life
e. Keep the baby warm
Ways to prevent heat loss in babies are:
1) Dry the baby's body thoroughly
2) Cover the baby with a clean, warm blanket or cloth
3) Cover or cover the baby's head
4) Do not cradle the baby naked
5) Do not bathe the baby before 6 hours postpartum
6) Instruct the mother to hug and breastfeed the baby
3. How to reach the Baby Friendly Initiative program
In order to achieve the Baby Friendly Initiative program, all
hospital providers and maternity facilities will:
a. Have a written policy on regular breastfeeding that is communicated to
all health care staff.
b. Train all health staff staff in the skills necessary to implement this
policy.
c. Inform all pregnant women about the benefits and management of
breastfeeding.
d. Help the mother to start breastfeeding within half an hour of birth.
e. Show mothers how to breastfeed and how to maintain breastfeeding if
they need to be separated from their baby.
f. Give breast milk to newborns, unless there is medical indication.
g. Practice rooming-in to allow mother and baby to stay together.
h. Encourage breastfeeding on demand.
i. Not giving a pacifier to a nursing baby.
j. Encourage the formation of breastfeeding support groups and
encourage mothers to contact them after discharge from the hospital or
clinic.
B. Early Initiation of Breastfeeding
1. Definition of Early Initiation of Breastfeeding
 Early initiation of breastfeeding is the activity of finding the
mother's nipple, which is the process by which a baby begins to self-feed
immediately after birth, usually within the first hour after birth. The way
babies initiate early breastfeeding is called The Breast Crawl or crawling
to find the breast.
The first half hour after delivery, immediately position the baby to
suck the mother's nipple properly. This baby suction will stimulate the
pituitary to release the hormone oxytocin, which works to stimulate
smooth muscle to squeeze out milk in the alveoli, lobes, and ducts that
contain milk that is released through the nipples, this situation will force
the hormone prolactin to continue to produce breast milk.
2. Procedures for Early Initiation of Breastfeeding
a. Once born, the baby is placed on the mother's stomach which has been
covered with a dry cloth.
b. Dry the baby's entire body including the head as soon as possible.
c. The umbilical cord is cut and then tied.
d. The varnish (white fatty substance) that sticks to the baby's body
should not be cleaned because this substance makes the baby's skin
comfortable.
e. Without being swaddled, the baby is directly lying on his chest or
stomach with the baby's skin and the mother's skin. Mother and baby
are enveloped together. If necessary, the baby is given a hat to reduce
heat loss from his head. Often we worry that the baby is cold.
According to research, if the baby is cold, the mother's skin
temperature will automatically increase by two degrees to cool the
baby. The mother's skin is a thermoregulator or thermal synchrony for
the baby's body.
f. The baby is left to find the mother's nipple independently. At that time,
the mother can stimulate the baby with a gentle touch. Usually, babies
are ready to drink breast milk in 30-40 minutes after birth.
g. Unlike babies born in normal conditions, they can breastfeed their
mothers without assistance. Babies born by caesarean section are only
 about 50% likely to succeed in Early Initiation of Breastfeeding,
including the birth of babies using chemical drugs or medicated labor.
h. In the process of Early Initiation of Breastfeeding, the mother's mental
readiness is needed. The mother should not feel uncomfortable when
the baby is placed on top of her. At this time, support from families,
especially husbands, is urgently needed by mothers who will carry out
Early Initiation of Breastfeeding after giving birth.
3. Benefits of Early Initiation of Breastfeeding
a. Prevents hypothermia because the mother's chest warms the baby
properly as the baby crawls to find the breast.
b. Babies and mothers become calmer, less stressed, breathing and heart
rate more stable, due to the contact between the skin of the mother and
baby.
c. Early Immunization. Sapping and licking the surface of the mother's
skin before starting to suck on the nipple is the baby's natural way of
accumulating the good bacteria that he needs to build his immune
system.
d. Strengthen the relationship between mother and child (Bonding
Atthacment) because the first 1-2 hours, the baby is on alert. After that,
babies usually sleep for a long time.
e. Babies who are given the opportunity to breastfeed early are more
successful at exclusive breastfeeding and will be breastfed for longer.
f. The touch of the baby's hand in the nipple and its surroundings,
emutants and licks of the baby on the mother's nipple stimulates the
release of the hormone oxytocin.
g. Babies who are given the opportunity to initiate early breastfeeding
receive colostrum earlier than those not given the opportunity.
Colostrum is special breast milk that is rich in endurance, important for
resistance to infection, important for intestinal growth, and even the
survival of the baby.
h. Mother and father will be very happy to meet their baby for the first
time in this condition. In fact, the father had the opportunity to make
 his son on his mother's chest. An inner experience for the three which
is very beautiful.
i. Psychomotor development is faster.
j. Supports cognitive development
k. Prevent bleeding in mothers, because early initiation of breastfeeding
produces the hormone oxytocin
l. Reducing the risk of developing breast and ovarian cancer.
4. Early Initiation Stages of Breastfeeding
a. The first stage is called a quite alert stage. Within 30 minutes, usually
the baby is silent. But do not consider the early breastfeeding process a
failure if after 30 minutes the baby remains silent. Do not take the
baby, at least 1 hour attached.
b. The second stage, the baby begins to make a tasting sound and a
sucking motion in its mouth. In 30 to 40 minutes, the baby puts his
hand in his mouth.
c. The third stage, the baby salivates. But the saliva that dripped from the
baby's mouth should not be cleaned. This smell the baby smells. The
baby also smells the amniotic fluid on his hands which smells the same
as the smell of his mother's nipples. So baby looks for the smell.
d. The fourth stage, the baby has started moving his legs. Her tiny feet
stomped to help her body maneuver to find the nipple. Especially for
the fourth stage, mothers also feel the benefits. The pounding of the
baby in the uterus helps the labor to finish, it helps the mother remove
the placenta.
e. In the fifth stage, the baby will lick the mother's skin. Bacteria that
enter through the mouth will become good bacteria in the baby's
digestion. So let the baby do the activity.
f. The last stage is when the baby finds the mother's nipple. The baby is
about to feed for the first time. The process for breastfeeding varies.
Some are up to 1 hour.
C. Temperature Regulation of Newborns by Skin to Skin Contact
1. Thermoregulation
 When in the mother's womb, the fetus does not need to regulate
body temperature, this is because the temperature in the uterus fluctuates
slightly. The fetal temperature is usually 0.6 ° C higher than the mother's
temperature. The ability of newborns is unstable in controlling temperature
adequately because the temperature regulation in newborns is still not
good for a while, namely because the baby's hypothalamus is still
immature, and is still susceptible to hypothermia, At birth, in general it
will lose body heat, This is caused by several factors including: Having a
body surface area that is relatively larger than its mass, having thin skin
and permeable to heat, having less subcutaneous fat for insulation (to
heat), having a limited capacity to generate heat, its ability to produce heat
and a particularly poor sympathetic response.
2. Hypothermia in Infants
a. Causes of Hypothermia in Infants
The mechanism of hypothermia is due to a decrease in body
temperature that occurs through:
1) Radiation: the baby's body heat radiates to the environment around
the baby which is colder, for example: the baby is placed in a cold
place
2) Evaporation: evaporation of amniotic fluid or water that wets the
baby's skin, for example: the baby is not drained directly from the
amniotic fluid
3) Conduction: the transfer of the baby's body heat because the baby's
skin is in direct contact with a cooler surface, for example: a wet
diaper is not changed immediately
4) Convection: loss of body heat due to the flow of air around the
baby, for example: the baby is placed near an open door or window
b. Symptoms of Hypothermia
1) Babies become less active, lethargic, hypotonic, unable to suck
breast milk, moaning
2) Gasping, slow breathing, decreased heart rate
 3) Sclerema develops: hard, reddish skin, especially on the back, legs
and arms
4) The face of the baby is bright red
5) Hypothermia causes changes in body metabolism that result in
heart failure, bleeding in the lungs, jaundice and death
3. How to Maintain Baby's Temperature
Every baby born has an immature temperature control system.
When born, the baby is in a lower temperature than in the womb and is
wet.
Ways to prevent heat loss in babies are:
a. Set up a warm delivery room and baby room (minimum temperature
25 ° C)
b. Dry immediately and replace the wet cloth with a warm dry cloth
c. Skin-to-Skin Contact
The World Health Organization's Baby Friendly Initiative
(BFI) has identified skin-to-skin contact as a major factor in the
creation of the breastfeeding process.
The warmth of the mother's body ensures that the baby does
not have to waste his precious energy to maintain body temperature.
Recent data show that there appears to be some kind of "temperature
synchronization" between mother and baby when skin-to-skin contact
is taking place.
After the umbilical cord is cut, place the baby on his stomach
on the mother's chest or stomach. Straighten and try to get the baby's
shoulders against the mother's chest or stomach. Try to keep the baby's
head between the mother's breast with a position slightly lower than
the mother's nipple. Then cover the body of the mother and baby with
the same warm cloth and put a hat on the baby's head. The baby's head
has a relatively large surface area and the baby will quickly lose heat if
it is not covered. In order to keep baby warm, mother and baby's body
must be in one garment (a new appropriate technology) known as the
Kangaroo Method. Mother should wear loose front buttoned clothes.
d. Allowing the baby to find its mother's nipple as an attempt to
breastfeed as soon as possible
e. Do not weigh or bathe the baby immediately
f. Wear adequate clothing and blankets (during early initiation,
breastfeeding covers the baby and mother in 1 blanket and puts a hat
on the baby)
g. Performed admission within the first 24 hours
h. Kangaroo Mother Care (KMC) or Attached Baby Care
KMC is skin contact between mother and baby early,
continuously and combined with breastfeeding. The goal is to keep the
baby warm. KMC can be done in the hospital or at home after going
home.
1) Benefits of KMC
a) The emotional bond between mother and baby.
b) Maintain the baby's body temperature.
c) An upright baby position will help the baby breathe regularly.
d) Prepare the mother to care for the baby at home.
e) Train mothers how to breastfeed properly and correctly.
f) Train babies to suck and swallow regularly and in a
coordinated manner.
2) The right KMC way
a) Place the naked baby except for the diaper, hat, and socks
against the mother's chest between the two breasts with an
upright position directly against the mother's skin and facing
the mother.
b) The position of the baby in the "frog position" is flexion at the
elbows and stalks, the head and chest of the baby are located on
the mother's chest with the head slightly extended.
c) Cover the baby with mother's clothes or a sling plus a warm
blanket.
d) Make sure the mother and baby are comfortable, if anyone can
use special clothes.
 e) If not, the mother can wear clothes that are larger than the
mother's body, and the mother can wear a scarf wrapped
around the mother's stomach so that the baby does not fall.
f) Mother can carry out daily activities while holding her baby.
g) Breastfeed every baby wants.
3) Advantages of KMC
a) Cheap, safe and easy to implement.
b) Maintain the baby's body temperature (skin to skin contact)
c) Process of training and support for mothers and families.
d) Shorten hospital treatment (can go home early).
e) Mothers can remain free to move for daily activities.
f) Can monitor the baby's condition at any time.
D. Cutting the Umbilical Cord
Based on evidence based, cutting the umbilical cord should be
postponed because it is very unfavorable for the baby and for the mother.
Given the phenomena that occur in Indonesia, among others, the high rate of
morbidity or mortality in infants, one of which is caused by asphyxia,
jaundice. It turns out that one of the temporary assumptions in the case of the
phenomenon above is due to the presence of ICC (Imediettly Cord Clamping)
in the Normal Delivery Care step, namely cutting the umbilical cord
immediately after the baby is born.
Based on research with delays in cutting the cord can:
1. Increased level of hematocrit in the blood
2. Increased level of hemoglobin in the blood
3. Decreased rate of anemia in infants
4. Reduced risk of jaudice / jaundice
By delaying cutting the umbilical cord in babies born prematurely or at
low birth weight and if previously there was fetal distress can prevent low Hb
levels in the early neonatal period. Reduced blood flow results in lower levels
of hematocrit and haemoglbin in newborns and can lead to iron anemia in the
baby's growth.
 There are so many unfavorable effects on cutting the umbilical cord
immediately after the baby is born and in this study it is said that the risk of
brain injury, cerebral palsy, asphyxia, autism, the incidence of jaundice and
even anemia in infants is very much.
Therefore, delaying the cutting of the umbilical cord is a very
important action, because it takes time to change the oxygen circulation from
the placenta to the pulmonary circulation. Because in this transitional period it
is very important to postpone cutting the umbilical cord because it will benefit
the baby and reduce the risk of trauma.
Looking at the results of the above studies, it can be concluded that cutting the
umbilical cord immediately after the baby is born is very unfavorable for both
the baby and the mother.
E. Umbilical Cord Care
1. Definition
Umbilical cord care is an effort to prevent umbilical cord infection
which is actually a simple action, the most important thing is that the
umbilical cord and the area around the umbilical cord is always clean and
dry, and always wash your hands with clean water and use soap before
treating the umbilical cord.
2. How to Care for the Umbilical Cord
Early recognition and treatment of umbilical cord infections is very
important to prevent sipsis, therefore there are several ways regarding
umbilical cord care, namely:
a. Let the umbilical cord dry on its own
Allowing the umbilical cord to dry on its own and just cleaning
it every day does not cause infection, the important thing is not to put
anything around the umbilical cord area as it can lead to infection
b. Dry gauze method
One of the recommendations by WHO in caring for the
umbilical cord is to use clean gauze pads that are changed frequently
c. 70% alcohol gauze method
 The umbilical cord is cared for and kept clean using 70%
alcohol, at least twice a day every four hours and more often if it looks
wet or sticky
d. Antiseptic method and dry gauze
The umbilical cord wound is cleaned and treated with 70%
alcohol or 10% povidone iodine and wrapped in sterile gauze, the
dressing is changed every day and every time the rope is wet or dirty
3. Principles of Umbilical Cord Care
a. Do not wrap or apply any ingredients or ingredients to the cord stump.
b. Rubbing alcohol or betadin is still permitted as long as it does not
cause the umbilical cord to become wet or damp.
 CHAPTER III
CLOSING
A. Conclusion
The Baby Friendly Hospital Initiative (BFHI), also known as the Baby
Friendly Initiative, is an international initiative established by WHO and
UNICEF to promote, protect and support the initiation and continuation of
breastfeeding. Early initiation is the initiation of breastfeeding within the first
hour after the baby is born. The way babies initiate early breastfeeding is
called The Breast Crawl or crawling to find the breast. Newborns are not able
to regulate their body temperature so they are easily stressed by environmental
changes. When a new baby is born and enters room temperature, the baby's
body cools quickly when the amniotic fluid evaporates from the body. Based
on evidence based, cutting the umbilical cord should be postponed because it
is very unfavorable for the baby and for the mother. Umbilical cord care is an
effort to prevent umbilical cord infection which is actually a simple action, the
most important thing is that the umbilical cord and the area around the
umbilical cord is always clean and dry, and always wash your hands with
clean water and use soap before treating the umbilical cord.
B. Suggestion

Readers are expected to be able to know and understand evidence

based BBL, so that we can understand and in particular we can apply it in
everyday life after we become a midwife so that the quality of midwifery
 services provided is better so that we can control the maternal and child
mortality rates.

BIBLIOGRAPHY

Eka, H. 2020. Evidence Based in Neonate Care. Midwife Information. Accessed

February 15, 2021. https://www.informasibidan.com/2020/03/evidence-
based-dalam-asuhan-neonatus.html?m=1
Esbati, A. Taylor, J. Dkk. 2020. 'Perspectives about the baby friendly hospital /
health initiative in Australia: an online survey'. International
Breastfeeding Journal. Vol 1. Hm 2. Accessed February 15, 2021.
https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.
1186/s13006-020-00266-z
Jayanti, I. 2019. Evidence Based in Midwifery Practice. Deepublish: Yogyakarta
Mawaddah, S. 2018. 'Relationship between Early Breastfeeding and Giving
Exclusive Breastfeeding to Babies'. Journal of Health Information. Vol
16 (2). Hm 214-224. Accessed February 15, 2021.
https://jurnal.poltekeskupang.ac.id/index.php/infokes/article/download/
185/178
Nuryanti, N. Neni, M. Sulistyaningsih 3. 2018. 'Proper care of midwives and
nurses reduces the risk of hypothermia in newborns'. Aisyiyah's Journal
of Nursing and Midwifery. Vol 14 (1). Hm 52. Accessed February 15,
2021.
https://ejournal.unisayogya.ac.id/ejournal/index.php/jkk/article/downloa
d/549/232
Taren, D & Lutte, C. 2017. 'The Role of Breastfeeding Protection, Promotion and
Support in a Developing World'. Researchgate. Vol 1. Hm 361-374.
Accessed February 15, 2021.
https://www.researchgate.net/publication/313743299_The_Role_of_Br
eastfeeding_Protection_Promotion_and_Support_in_a_Developing_Wo
rld