ESSENTIAL INTRAPARTUM AND NEWBORN CARE

Definition - Essential Intrapartum and Newborn care (EINC) is a package of evidence-based

practices recommended by the Department of Health (DOH), Philippine Health Insurance
Corporation (PhilHealth), and the World Health Organization (WHO) as the standard of care in
all births by skilled attendants in all government and private settings.
Purpose/s:
 Essential newborn care to minimize the risk of illness and maximize their growth and
development.
 This compasses interventions such as ensuring warmth, breastfeeding, love and safety
and infection control
Principles:
 Giving appropriate and immediate support on the health and nutrition of a newborn is
significant, in avoiding newborn complications that may result to death. ...
 Unang Yakap campaign or EINC protocol should be followed in order to ensure the
health of both the mother and the baby
 Care of newborns includes:
o Immediate and thorough drying,
o skin to skin contact of the newborn with the mother,
o cord clamping and cutting after the first minutes after birth,
o early initiation of breastfeeding, and exclusive breastfeeding.
o Newborns who do not start breathing on their own by one minute after birth
should receive positive pressure ventilation with room air by a self-inflating bag
and mask.
 Put 2 pairs of sterile gloves aseptically
 Ensure patient’s privacy
 Encourage breastfeeding

Equipment/ Materials:
 2 pairs of gloves
 2 dry linen
 bonnet,
 oxytocin ampule with 3cc syringe with needle,
 plastic clamp,
 instrument clamp,
 2 scissors,
 2 kidney basins.
In a separate sequence for after the 1st breastfeed:
  eye ointment, (stethoscope for PE),
 vit. K,
 hepatitis B and BCG vaccines (plus cotton balls and 3 tuberculin syringes with needles)

Steps and Rationale

STEPS RATIONALE
PREPARATION:
Prepare decontamination solution by mixing 1 This is done for decontamination for the
part of 5% chlorine each to 9 parts water to articles/equipment’s used in removing any
make 0.5% chorine solution. Change chlorine bacteria or microorganism present.
solution at the beginning of each day or
whenever solution is very contaminated or
cloudy
PRIOR TO PATIENT’S TRANSFER TO
THE DR
1. Ensure that mother is on her position
This helps to allow the mother to achieve her
of choice while in labor greatest comfort during labor
Proper position: Lithotomy, alternative is
Fowlers, side lying, squatting.
2. Ask mother if she wishes to eat/drink  It is not advisable for a mother in
or void. labor to eat or drink prior to the
delivery because she will just
eliminate those during the delivery.
 Voiding is okay as it helps the mother
achieve comfort prior to delivery
 This also prevent the obstructing of
the vagina that slow the birthing
process with full bladder.
3. Communicate with the mother-inform This helps the mother to be informed of her
her of progress of labor, give status, and make her relax. Thus, ensuring
reassurance and encouragement safe parturition (the act of child-birth)
PATIENT ALREADY IN THE DR
PREPARING FOR DELIVERY
1. Check temperature in DR area to be The air conditioner is turned off at the time of
25-28 C, check for draft delivery.
-To check for air draft, hold a piece of tissue
up and observe its movement. If it falls
straight to the ground, then there is no air
draft. But, if the tissues ways upon falling to
the ground, then there is an air draft.
Immediately check and close the windows or
door.
-Eliminating air draft is important as it
prevents the newborn to lose heat by
 convection when air currents carry heat away
from the baby’s body surface.
2. Ask patient if she is comfortable in the This helps to allow the mother to achieve her
semi-upright position which is the greatest comfort during delivery
default position
3. Ensure the patient’s privacy Close the door or curtains to provide privacy
4. Remove all jewelry and give it to the This is done to prevent disruption upon the
watcher delivery, and jewelry harbors microorganisms
5. Wash hands thoroughly observing the To reduce the transmission of microorganism
proper procedure (WHO 1-2-3-4-5)
6. Prepared clear, clean newborn This is done to place the set of equipment
resuscitation area. Check the needed for the delivery, in case of any
equipment if clean, functional and complications will occur, as well as to reduce
within easy reach the transmission of microorganism
7. Arrange materials/supplies in a linear This is done to easily identify and use the
fashion/sequence: 2 pairs of gloves, 2 instruments and supplies upon the delivery
dry linen, bonnet, oxytocin ampule
with 3cc syringe with needle, plastic
clamp, instrument clamp, 2 scissors, 2
kidney basins. In a separate sequence
for after the 1st breastfeed: Eye
ointment, (stethoscope for PE), vit. K,
hepatitis B and BCG vaccines (plus
cotton balls and 3 tuberculin syringes
with needles)
8. Clean the perineum with antiseptic This is done to reduce microorganisms
solution
9. Wash hands thoroughly observing the To reduce & prevent the transmission of
proper procedure. (WHO 1-2-3-4-5) microorganism
10. Put on 2 pairs of sterile gloves This is done in maintain sterility. Double
aseptically. (if same worker handles gloving is done if you’re going to handle both
perineum and cord care) perineum and cord
AT THE TIME OF DELIVERY
11. Encourage patient to push as desired This helps the mother to push down the best
she can
12. Drape the clean, dry linen over the This serves as the area for the newborn to be
mother’s abdomen or arms in placed, and prepare for the drying of the
preparation for drying the baby newborn
13. Apply perineal support and do This is done to safely handle the newborn
controlled delivery of the head once it comes out of the birth canal and
perineum
14. Call out time of birth and sex of baby This is done to inform the health care
provider who is assigned to document the
findings such as time of birth & the sex of the
baby.
15. Inform the mother of outcome This is done for the mother to be informed

FIRST 30 SECONDS
16. Place the baby on a clean, dry/towel
on the mother’s abdomen
17. Thoroughly dry baby for at least 30
seconds, starting from the face and
head, going down to the trunk and
extremities while performing a quick
check for breathing
about the sex and status of her baby
This is for the drying of the baby.
This is done to stimulate the baby to breathe
and prevent hypothermia.
Do not wipe off the vernix caseosa as it
continues to provide a natural protective
cover for the baby, against infection, as well
as it helps to insulate the baby, and thus
preventing hypothermia

Do not wash the baby within the first 6 hours

because washing can lead to hypothermia and
infection

To identify the baby’s appearance, pulse,

1-3 MINUTES
18. Remove the wet cloth
19. Place baby on skin-to-skin contact on This helps to achieve success in
the mother’s abdomen or chest
grimace, activity, and respiration whether if
extra medical care or emergency care is
needed
As it is already wet and dirtied, and to prevent
the baby from getting cold
breastfeeding, lymphoid tissue system
stimulation, exposure to maternal skin flora,
protection from hypoglycemia,
thermoregulation, and last but not the least,
promotion of the mother-child bonding.

The mother’s abdomen is warm & has the

same temperature as the incubator.
20. Cover the baby with a clean, dry To provide warmth and comfort
cloth/towel
21. Cover baby’s head with bonnet To provide warmth and comfort
22. Exclude a 2nd baby by palpating the This is done to determine if there is a second
abdomen or perform internal
baby. If there is one, do not give the oxytocin
examination in preparation for giving
now, and reassess for the delivery of the
oxytocin second baby
23. Administer oxytocin 10IU IM at 1 Oxytocin is given IM or IV to prevent uterine
minute after delivery of the baby atony, a condition in which the uterus fails to
contract after the delivery of the baby and it
can lead to a potentially life-threatening
condition known as postpartum hemorrhage
24. Inform the mother that an injection To informed & as part of consent of the
 will be given at her deltoid/thigh area mother before giving the injection.
25. Explain to the mother that this is to This is to informed & ensure that the mother
prevent bleeding is fully aware and also cooperates
26. Discard the sharps properly To prevent any accidental cuttings &
infections
CLAMPS AND CUTS THE UMBILICAL
CORD
27. Position the baby for clamping and Prone position This would provide a good
cutting of the cord so that the skin-t- position for clamping and cutting of the cord
skin contact with the mother is & maintain skin to skin contact.
maintained
28. Remove the first pair of gloves worn This is done to disinfect the used gloves as a
and place this in the decontaminating 0.5% chlorine solution is an antiseptic one,
solution thus removing bacteria and other
microorganism and preventing infection
29. Palpate the umbilical cord until This is done to check for cord pulsations
pulsations stops or prepare to clamp
by 1-3 minutes after birth
30. Clamp using the sterile plastic cord Not cutting the cord immediately gives
clamp at 2 cm from the base of the benefits, such as it helps to prevent anemia
umbilicus near the baby’s abdomen and protects preterm(s) from intraventricular
hemorrhage
31. Clamp the cord with instrument at 5 To prevent anemia and protects preterm(s)
cm from the umbilical base from intraventricular hemorrhage
32. Cut the cord close to the plastic clamp The best time to cut the cord is when the
pulsation already stops.
33. Place the instrument clamp with cut This is to make sure that after the placenta is
end of the umbilicus top of the out it should be easy to get.
inguinal area of the mother This would prevent compressing of the
umbilical cord.
34. Reposition the baby for skin-to-skin This is to provide comfort for the baby for the
contact with the mother skin-to-skin contact with the mother
35. Perform the remaining steps of the To assess the mother in delivering the
active management of the third stage placenta next such as not waiting for signs of
of labor (AMTSL) placental separation.
36. Palpate for the mother’s uterus and This is done check for contractions & to
feel for strong contraction deliver the placenta
37. Place one hand above the symphysis This is to put gently pressure on
pubis to await contractions while hypogastrium & feel the contractions
keeping slight tension on the cord with
other hand
38. Apply steady, controlled cord traction Avoid forceful pulling. Do not release support
along the axis of the vagina during a on the uterus until the placenta is visible at the
contraction while applying counter vulva
traction abdominally
Do not pull out because the placenta cord

39. Deliver the placenta
40. Catch the placenta with both hands,
then gently move it upward to deliver
the membranes completely
41. Perform uterine massage until it is
firm
42. Check mother’s perineum, vagina,
vulva for tears, lacerations
43. Check for completeness of the
placenta
44. Estimate degree of blood loss
45. Clean the mother up, flush perineum
and apply perineal pad/napkin
46. Dispose the placenta in a leak-proof
container of plastic bag
47. Put all used instruments in This is done to disinfect the used gloves as a
decontaminating solution before 0.5% chlorine solution is an antiseptic one,
cleaning
48. Rinse gloved hands in a basin of
decontamination solution to remove
blood
49. Grasp one glove near the cuff and pull
off the glove partway
50. With the first glove still over the
fingers, grasp the second glove near
the cuff
51. Pull off the first glove, being careful
to touch only inside surface of the
glove
52. Dispose of the gloves in the infectious
“yellow” trash bag
53. Perform hand washing
54. Monitor the condition of the mother This to make sure that the mother’s condition/
might be broken which is a great risk in
uterine inversion/infection.
This is to prevent bleeding & possible
infection.
To prevent the placenta from falling because
it’s spongy, squishy sack (soft & moist).
To expel the membranes out
To promote uterine contractions, comfort
thus, reducing PPH
This is done to determine if repairs are
needed, and thus preventing PPH
To determine that no part of the placenta have
been retained as this may result in PPH
To know how much blood was loss & be alert
of possible post-partum hemorrhage
The average amount blood loss after the birth
of a single baby in vaginal delivery is about
500 ml (or about a half of a quart) . While, the
average amount of blood loss for a cesarean
birth is approximately 1,000 ml (or one
quart). Most postpartum hemorrhage occurs
right after delivery, but it can occur later as
well.
To remove debris, such as blood, waste, or
secretions
To prevent infection
thus removing bacteria and other
microorganism and preventing infection
To remove blood from the gloves and
decontaminate as well.
This is a sterile technique in removing the
gloves
This is still applying sterile technique in
removing gloves
This is to maintain sterility
To properly dispose the correct trash bag &
prevent possible infections
To prevent cross contamination
 and the baby’s vital signs every 15 status is stable.
minutes. In the first hour every 30
minutes. In the second hour and
hourly for the first 6 hours
55. Keep the mother and baby together, To promote maternal-child dyad (bonding)
skin-to-skin contact and observe for
feeding cues expected by 20-60
minutes after birth like tonguing,
mouthing, licking, rooting, more
active, eyes moving about, crawling,
kicking
56. Encourage breastfeeding Because breastfeeding allows the baby to be
satisfied with his hunger and get enough milk
for nutrition and immunity. It also benefits the
development of emotional and cognitive
aspects
Breast feeding helps your baby healthy.
Encourage to breast feed baby within six
months
57. Complete all records For baseline data and future references

Name:
Sex:
Birth weight
Birthday :
Immunization:
Mothers name:
Father’s name:
Head & chest circumferences: