ESSENTIAL INTRAPARTUM AND NEWBORN CARE (EINC)

Series of time bound chronologically ordered, standard procedures that a baby receives
from birth.

Purpose:
• To reduce child mortality

Planning:
Equipment (Arranged in linear sequence)
• 2 pair sterile gloves
• Dry linen
• Bonnet
• Oxytocin injection
• Plastic clamp
• Instrument clamp
• Scissors
• 2 kidney basins
• Eye ointment (Erythromycin)
• Stethoscope
• Vitamin K
• Hepatitis B
• BCG vaccine
• Cotton balls

Implementation:
Prior to woman’s transfer to DR
• Ensure that mother is in her position of choice
• Ask the mother if she wishes to eat/drink or void
• Communicate with the mother. Inform her progress of labor, give reassurance and
encouragement.

Woman already in the DR – Preparing for delivery

1. Check the temperature in the DR area. It should be 25-28 degree Celsius
2. Ask woman if she is comfortable in semi-upright position
3. Ensure the woman’s privacy
4. Remove all jewelry, wash hands (observing the WHO 1-2-3-4-5 procedure). RATIONALE:
Jewelry can harbor microorganisms.
5. Prepare a clear, clean newborn resuscitation area. Check if equipment is clean, functional, and
within easy reach.
6. Arrange materials/supplies in linear sequence. RATIONALE: Promotes efficiency and avoids
confusion
7. Clean the perineum with antiseptic solution
8. Wash hands and put on 2 pairs of sterile gloves aseptically (if the 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 the time of birth and gender of the baby. RATIONALE: for proper documentation
Inform the outcome to the mother.

First 30 seconds – After delivery

13. Thoroughly dry the 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. RATIONALE:
Stimulates breathing and provides warmth

1-3 minutes- After delivery

14. Remove wet cloth
15. Place the baby in skin-to-skin contact on the mother’s abdomen or chest. RATIONALE:
Promotes warmth, bonding, prevent infection (by colonization of maternal normal flora) and
hypoglycemia.
16. Cover the baby with a dry cloth and the baby’s head with a bonnet. RATIONALE: Provides
warmth and prevents hypothermia
17. Use wet cloth to wipe the soiled gloves, then dispose wet cloth properly
18. Remove the first set of gloves and decontaminate them properly (0.5 % chlorine solution for
at least 10 minutes). RATIONALE: To maintain sterility when handling umbilical cord
19. Palpate umbilical cord to check for pulsations. After pulsations stopped, clamp the cord using
plastic clamp or cord tie 2cm from the base. RATIONALE: To reduce anemia, intraventricular
hemorrhages (IVH), and transfusion in preterm
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 the AMTSL (Wait for strong uterine contraction then apply
controlled cord traction and counter traction on the uterus, continue until placenta was delivered.
Massage the uterus until it is formed). NOTE: DO NOT PULL the placenta as it can pull the uterus
along with it.
23. Inspect the lower vagina and perineum for laceration
24. Examine the placenta for completeness and abnormalities. RATIONALE: Some genetic
abnormalities can be attributed to the deviations of placenta or umbilical cord
25. Clean the mother.
26. Check baby’s color and breathing. Check if mother is comfortable and uterus is contracted.
27. Dispose the placenta in a leak proof container/ plastic bag.
28. Decontaminate (0.5% chlorine solution) instruments before cleaning and decontaminate a
second pair of gloves before disposal.
29. Advice mother to maintain skin to skin contact. Baby should be prone on the mother's chest
or in between the breasts with the head turned to one side. RATIONALE: For easier facilitation
of initiation of breastfeeding.

15-90 minutes
30. Advise mother to observe for feeding cues (opening of mouth, tonguing, licking, rooting)
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 injections.
32. Advise optional /delayed bathing of baby. RATIONALE: Washing exposes to hypothermia,
removes the vernix, a protective barrier to bacteria such as E. coli and Group B Strep, Washing
removes the crawling reflex.
33. Complete all records.

A Must Know:
4 time-bound procedures
1. Immediate drying
2. Early uninterrupted skin-to-skin contact
3. Delayed cord clamping
4. Breastfeeding for the 1st hour of life

Non time-bound procedure:

• Immunization
• Eye care (Crede’s prophylaxis)
• Vitamin k administration
• Weighing
• Washing/bathing (postponed up to 6 hrs)

New Trends:
• Position: position of comfort
• No NPO; 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)
• Nonpharmacologic pain relief before offering anesthesia

Unnecessary procedures:
• Suctioning
• Separation for observation
• Administration of pre-lacteals
• Water formula
• Foot printing
• Application of substances to the cord

Active Labor starts at 5cm, 2nd stage of labor At perineal bulging, with presenting part visible
APGAR SCORING
A scoring system that provides a numeric indicator of the baby’s physiologic capacities to
adapt to extrauterine life.

Purpose:
• To assess infant’s physiologic capacities after birth

Assessment:
APGAR rates heart rate, Respiratory efforts, Muscle tone, Reflex irritability and Color of
the newborn. Each of five signs is assigned a maximum score of 2, so the maximum score
achievable is 10. Apgar scoring is usually carried out 60 seconds after birth and is repeated in 5
minutes. A score under 7 suggests that the infant is having difficulty and a score under 4 indicates
that the baby's condition is critical. There is a high correlation between low 5 minute Apgar scores
and neurologic illness. Infants with very low scores require special resuscitative measures and
care.

Planning:
Implementation:

Heart rate:
Auscultating a newborn heart with a stethoscope is the best way to determine heart rate; however,
heart rate also may be obtained by observing and counting the pulsations of the umbilical cord at
the abdomen if the cord is still uncut
• Heart rate is more than 100 beats per minute = 2 points
• Heart rate is present, but less than 100 beats per minute = 1 point
• No heart rate = 0

Respiratory effort:
Respirations are counted by observing chest movements. A mature newborn usually cries and
aerates the lungs spontaneously at about 30 seconds after birth. By 1 minute the infant is
maintaining regular, although rapid, respirations. Difficulty with breathing might be anticipated in
a newborn whose mother received large amounts of analgesia or general anesthesia during labor
or birth
• Strong, vigorous cry = 2 points
• Weak cry, slow or difficult respirations = 1 point
• No respiratory effort = 0

Muscle tone:
Term newborns hold their extremities tightly flexed, simulating their intrauterine position. Muscle
tone is tested by observing their resistance to any effort to extend their extremities.
• Maintains a position of flexion with brisk movements = 2 points
• Minimal flexion of extremities = 1 point
• Limp and flaccid = 0

Reflex irritability (Grimace response):

Response to a suction catheter in the nostril or response to having the soles of the feet slapped.
A baby whose mother was heavily sedated for birth will probably demonstrate a low score in this
category
• Cries and sneezes when stimulated = 2 points
• Grimaces when stimulated = 1 point
• No response to stimulation = 0

Color:
All infants appear cyanotic at the moment of birth. They grow pink with or shortly after first breath,
which makes the color of newborns correspond to how well they are breathing. Acyanosis
(cyanosis of the hand and feet) is so common in newborns that a s core of 1 in this category can
be thought of as a normal
• Body and extremities pink = 2 points
• Body pink, extremities blue - = 1 point
• Body and extremities are blue (cyanotic) or completely pale (pallor) = 0
Record your findings/scores

Evaluation:
• Compare current assessment to previous assessments after 5 mins interval
• Conduct appropriate follow ups
• Report any deviation from normal to primary care provider