ESSENTIAL INTRAPARTUM AND NEWBORN CARE (EINC)
→ Provide warmth
What is essential newborn care protocol?
→ is a series of time bound, chronologically -
ordered, standard procedures that a baby
receives at birth.
→ it is simple, to the point, use if primly, globally
accepted evidenced base protocol to essential
newborn care focusing on the first week of life
and do able even by a single help worker caring
for both mother and newborn
→ the protocol is organized by time so, evidence
base intervention that as closely continuous
update policies and guidelines and it must be in
accordance to recommended international
standards proven effective and applicable to the
country.
→ efforts will be exerted to generate information to
guide the planning and implementation of
newborn care programs and activities
→ research findings will be use to interventions and
approaches most responsive to affective growth
groups.
ESSENTIAL NEWBORN CARE
• December 7, 2009
→ DOH launched UNANG YAKAP campaign
→ Aim:
o Decrease infant mortality rate
by at least half
how is the newborn care protocol organized?
→ so, it organize by time bound. With cross
references to sections of WHO, PCPNC or world
health organization pregnancy child birth
postpartum and newborn care manual in 2006
with algorithms that represents clinical
pathways
→ so, the document is organized by time. It walks
a health worker through process of preparing
the delivery area, standard precaution through
essential newborn care practices in beginning at
the time of perineal bulging until 1 week of life
4 TIME – BOUND PROCEDURES
1. Immediate drying
• Objective:
→ Stimulate breathing
Annotated by: A. Balloran
• so the time within the first 30 seconds
• intervention: dry and provide warmth
• action: use a clean dry cloth thoroughly dry, dry
the baby while wiping the face, eyes, head, front
and back of the trunk, arms and legs and do a
quick check of newborns breathing while drying
and remove the wet cloth
• stimulates the newborn to breath normally and
minimize heat loss
• he/she should be dried while positioning on the
mothers abdomen
• a baby can die or damage quickly if breathing
does not start soon after birth
• after 30 secs of drying, newborn is breathing or
crying
2. Early uninterrupted skin-to-skin contact
• Objective:
→ Promotes warmth, bonding, prevent
infection (by colonization of maternal
normal flora) and hypoglycemia
• action: avoid any manipulation such as routine
suctioning
• 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
• a baby’s skin temp. falls within secs of being
born. If the temp. continue to fall the baby will
become ill or hypothermic and may die
• this is why a baby must be dry immediately after
birth and delivered unto his mother’s abdomen
covered with a one towel or piece of cloth over
his back
• it also explains why the mother and baby should
be covered with a warm and dry cover if the room
temperature is lower than 25 degree Celsius
• the skin to skin contact not only helps the baby
regulates the temperature but it also improves
bonding protects the baby from infection by
exposing him/her to good bacteria on the mother
and increases the baby blood sugar
• after the cord has been cut position the baby
between mothers breast to ensure that the
 ESSENTIAL INTRAPARTUM AND NEWBORN CARE (EINC)
baby’s temperature is keep to a correct level as
long as the skin contact continues
• the first skin to skin contact should last
uninterrupted for at least 1 hour after birth or
until after the first breast feed
• skin to skin contact can restart anytime if the
baby and mother have to be parted for any
treatment or care procedure
• skin to skin contact effect on immuno protection
• colonization with maternal skin flora and
stimulation of the mucosa associated with
lymphoid tissue system and the ingestion of
colostomy (unang gatas nang nanay)
3. Delayed cord clamping
• Objective:
→ To reduce anemia, intraventricular
hemorrhages (IVH), and transfusion in
preterm
• the time bound is 1 to 3 minutes
• intervention: delayed or non-immediate cord
clamping
• action: 1. remove the first set of gloves
immediately prior to cord clamping. clamp and
cut the cord after the cold pulsation has stop.
• initial cord care put ties tightly around the cord
at 2 cmand 5 cm from the newborns abdomen
• Cut between ties with sterile instrument.
• observe oozing blood
• do not apply any substance to the stamp, do not
bind or bandage the stamp, leave the stamp
uncover
• properly tied clamp of the umbilical cord it
reduces the risk of anemia in both term and pre
term babies, less intraventricular hemorrhage
and no significant impact on incident of post
partum hemorrhage
4. Breastfeeding within the 1st hour of life
• Objective:
→ To facilitate initiation of early
breastfeeding through sustained contact
• Time bound: Within 90 minutes of age
• intervention: provide breast feeding support for
initiation of breastfeeding
• action: leave the baby on the mothers chest in
the skin to skin contact
Annotated by: A. Balloran
• observe the newborn, place identification tag
and bracelet and to maintain skin to skin contact
uninterrupted at least 90 minutes after birth and
after thorough breastfeed complete
• if the baby wants to breastfeed to his mother
there signs of mouth, tongue, licking or rooting
and as a nurse make verbal suggestion to the
mother to encourage his newborn towards the
breast
NON TIME – BOUND PROCEDURES
Done after the 1st full breastfeeding
• Immunization
• pwedeng hindi on the spot kaagad na gagawin
• Eye care (Crede’s prophylaxis)
• Vitamin k administration
• Weighing
• washing/bathing (postponed up to 6 hrs)
→ Hinders crawling reflex
• kahit madelay is okey na yon
NEW TRENDS
• Position: position of comfort*
• No NPO (nothing per orem)
→ Light meals are allowed
• No IV unless CS
• No Shaving
• No fundal push/pressure
• No routine episiotomy
• Companion of choice during labor
• Mobility during labor (within reason)
• Non-pharmacologic pain relief before offering
anesthesia
UNNECESSARY PROCEDURES
• Suctioning
• has no benefit
• if the amniotic fluid is clear and especially with
newborn who cry or breath immediately after
birth
• suctioning is indicated only if the nose, mouth is
block with secretion or other materials
• Separation for observation
• Administration of pre-lacteals
• the newborn may develop learned preferences
for the bottle and leading to a nipple confusion
and inefficient sucking can lead failure in
breastfeeding
 ESSENTIAL INTRAPARTUM AND NEWBORN CARE (EINC)
• fasifier likewise contributes to nipple confusion
• this determines the chance of unsuccessful or
successful breastfeeding by contributing to a
viscous cycle of four attachment, sore nipple, and
lactational insufficiency
• Water formula
• Foot printing
• has been proven to be inadequate technique for
a newborn identification purposes
• better identification technique such as DNA,
Geno typing and human leucocyte antigen test
can serve more this purpose accdg to American
academy of pediatrics
• Application of substances to the cord
• they do not apply such betadine, alcohol
• cleaning with alcohol and bandages delay
healing of the stamp
• the ff. procedure were observe to have been
routinely given in hospitals but in fact are not
recommended for all neonates
6. Arrange materials/supplies in linear sequence
(gloves, dry linen, bonnet, oxytocin injection,
plastic clamp, instrument clamp, scissors, 2
kidney basins, eye ointment, stethoscope,
vitamin K, Hepatitis B and BCG vaccine, and
cotton balls)
7. Clean the perineum with antiseptic solution.
8. Wash hands and put on 2 pairs of sterile gloves
aseptically (if same worker handles perineum
and cord)
AT THE TIME OF DELIVERY
9. Encourage woman to push as desired.
10. Drape the clean, dry linen over the mother’s
abdomen or arms in preparation for drying the
baby.
11. Apply perineal support and control delivery of
the head.
12. Call out time of birth and gender of the baby.
Inform the outcome to the mother.

EINC PROCEDURE
PRIOR TO WOMAN’S TRANSFER TO DELIVERY
ROOM
• Ensure that the mother is in her POSITION OF
CHOICE
• place the mother in a comfortable position
• ASK the mother if she wishes to eat/drink or void
• Communicate with the mother. Inform her the FIRST 30 SECONDS – AFTER DELIVERY
progress of labor, give reassurance and 13. Thoroughly dry the baby for at least 30 seconds,
encouragement starting from the face and head, going down to
• Active stage of labor: starts at 5cm cervical the trunk and extremities while performing a
dilation quick check for breathing.
WOMAN ALREADY IN THE DR – PREPARING
FOR DELIVERY
1. Check the temperature in the Delivery Room
area. It should be 25-28 degrees Celsius.
2. Ask the woman if she is comfortable in semi-
upright position.
3. Ensure the woman’s privacy
4. Remove all jewelries, wash hands.
5. Prepare a clear, clean newborn resuscitation
area. Check if equipment is clean, functional, and
within easy reach.

Annotated by: A. Balloran

 ESSENTIAL INTRAPARTUM AND NEWBORN CARE (EINC)
1-3 MINUTES – AFTER DELIVERY
14. Remove wet cloth
15. Place baby in skin-to-skin contact on the
mother’s abdomen or chest.
16. Cover baby with a dry cloth and baby’s head with
a bonnet.
• Temperature check
→ Room: 25-28
degree Celsius
→ Baby: 36.5 – 37.5
degree Celsius
17. Use wet cloth to wipe the soiled gloves, then
dispose wet cloth properly.
18. Remove first set of gloves and decontaminate
them properly (0.5% chlorine solution for at least
10 minutes).
19. Palpate umbilical cord to check for pulsations.
After pulsations stopped, clamp the cord using
plastic clamp or cord tie 2cm from the base.
20. Place the instrument clamp 5 cm from the base
and then clamp.
21. Cut near plastic clamp (not midway).
22. Perform the remaining steps of AMTSL (Wait for
strong uterine contraction then apply controlled
cord traction and counter traction on the uterus
(Brandt-Andrews Maneuver and Crede’s
Maneuver), continue until placenta was
delivered. Massage the uterus until it is firm.
→ AMTSL – Active management of third
stage of labor such as administration of
uterotonic drug which preferably
oxytocin or immediate after the birth of
the baby
→ Brandt – Andrews Maneuver – tracking
the cords slowly, widing it around the
clamp and exert up down, downward,
Annotated by: A. Balloran
sideward pressure and yung isang
kamay sa fundus ni mommy.
→ credes maneuver – paglalagay or
pagtitiin sa hypogastric area
23. Inspect the lower vagina and perineum for
laceration.
HOW TO EFFECITVELY DELIVER A BABY
• Delivery of placenta
→ active management of 3rd stage has been
shown to reduce total blood loss
o Brandt – Andrews Maneuver:
abdominal hand secures the
uterine fundus to prevent
uterine inversion while the
other exerts sustained
downward traction on umbilical
cord
o Crede maneuver – cord is fixed
with lower hand while the
uterine fundus is secured and
sustained upward traction is
applied using abdominal hand
Brandt – Andrews Maneuver
24. Examine the placenta for completeness and
abnormalities. (Schultz or Duncan Presentation)
→ shiny Schultz – clean
→ dirty Duncan - dirty
25. Clean the mother.
before and after
26. Check baby’s color and breathing. Check if
mother is comfortable and uterus is contracted.
 ESSENTIAL INTRAPARTUM AND NEWBORN CARE (EINC)
27. Dispose the placenta in a leak-proof container or
plastic bag.
28. Decontaminate (0.5% chlorine solution)
instruments before cleaning and decontaminate
second pair of gloves before disposal.
29. Advise mother to maintain skin-to-skin contact.
Baby should be prone on mother’s chest in
between the breasts with head turned to one
side.
15 – 90 MINUTES – AFTER DELIVERY
30. Advise mother to observe for feeding cues.
Support mother and instruct her on positioning
and attachment.
31. After a complete breastfeeding, administer eye
ointment, thorough physical exam, and then do
injection of vitamin K, Hepatitis B and BCG
vaccine injections.
32. Advise optional/delayed bathing of baby.
33. Complete all records.
Administration of Crede’s Prophylaxis
1. Verify the type of prophylaxis to be used.
(ERYTHROMYCIN EYE OINTMENT)
2. Do hand washing.
3. Gather supplies (check for expiration date).
4. Ensure that the medication is clearly labeled.
5. Place the infant in supine position.
6. With one hand, open eyelids
7. Apply ointment from inner to outer canthus.
8. Make sure that the tip of the ointment tube
will not touch the eyelids of the infant.
9. Avoid the infant’s hands to get contact with his
eyes.
10. hand washing.
11. Document the procedure
TIME: FROM 90 MIN – 6 HRS
INTERVENTION: Give vitamin K prophylaxis, Hepatitis B
and BCG vaccination at birth
Administration of Vitamin K
1. Do hand washing.
2. Prepare the needed materials.
Get vitamin k (Phytomenadione) cotton balls,
kidney basin, syringe, medicine tray
10 milligram per 1 ml
Annotated by: A. Balloran
3. Get vitamin k
(Aquamephyton/Phytomenadione)
4. Check the expiration date and if it is clearly
labeled.
5. Tap liquid in top chamber of the ampule into
the bottom part.
6. Wipe the neck of the ampule with cotton ball.
7. Snap top off away from your body.
8. Using a tuberculin syringe, withdraw medication
by inverting the ampule or by holding it and
insert the needle then pull the plunger.
9. Remove the syringe from the ampule and
remove bubbles from the syringe.
10. Check the dosage of the medication in the
syringe.
11. Place the infant in a supine position.
12. Locate for vastus lateralis.
13. Clean the injection site using cotton ball with
alcohol. Do it in a circular motion, from inner to
outer.
14. Hold the thigh of the infant firmly.
15. Inject the needle in a 90-degree angle then
aspirate.
16. If no blood, introduce the medication slowly.
17. Remove the needle and apply pressure on site.
18. Discard the syringe after use.
19. Wash hands.
20. Document the procedure done.
HEPATITIS B VACCINE
• All newborns born in a hospital or a birthing
center received a first vaccination against
hepatitis B within 90 minutes to 6 hours
(1mg IM)
• Infants whose mothers are positive for HBSaG
also received Hep B immune Globulin
BCG VACCINE
• Bacillus Calmette Guerin (BCG) for tuberculosis
0.5ml to be given ID