Essential Intrapartum

and Newborn Care,

Breast Feeding
&KMC
PGI ALANES & PGI GICARO
ty and morbid
INTRODUCTION

are directly
1. Every year approximately 40,000 Filipino neonates die, mostly from
preventable causes.

2. The majority die within the first week.

3. The high mortality and morbidity rates in newborns are directly related to

opriatehospital
inappropriate hospital and community practices employed throughout the
Philippines.
01
EINC
UNANG YAKAP
A campaign that seeks to engage national and local
sectors, public and private health sectors, individuals and
organizations, mothers, fathers and families, to embrace
the Essential Newborn Care Protocol to ensure a bright
and healthy future for our newborns
UNANG YAKAP
a simple, cost-effective newborn care intervention that can improve neonatal as
well as maternal care.
an evidence-based intervention that :
 
• emphasizes a core sequence of actions, performed methodically (step-by-step)
• is organized so that essential time bound interventions are not interrupted
• fills a gap for a package of bundled interventions in a guideline format

a series of time bound, chronologically-ordered, standard procedures that a baby

receives at birth
EVERY NEWBORN HAS NEEDS
● To breathe normally
● To be warm
● To be protected
● To be fed

Providing Warmth: Check the environment

Check for air drafts
Turn off AC before delivery to prevent hypothermia
Hypothermia can lead to complications of
○ Acidosis
○ Bradycardia
○ Pulmonary Hemorrhage
EINC STEPS
1 2
IMMEDIATE AND EARLY SKIN-SKIN
THOROUGH CONTACT
DRYING

3 4
NON-SEPARATION OF
PROPERLY TIMED NEWBORN AND
CORD-CUTTING MOTHER FOR EARLY
INITIATION OF BREAST
FEEDING
Immediate and
thorough drying
IMMEDIATE AND THOROUGH DRYING
Immediate drying:
 Stimulates Breathing
 Prevents Hypothermia

Should be the first action Immediately done for a full 30 seconds

• Do a quick check of breathing while drying ( tachypnea, retractions, grunting)
• >95% of newborns breathe normally after birth and only <5% would need
resuscitation
• If infant is still both floppy and limp / apneic after a few seconds of thorough
drying  Call for help and do additional resuscitative measures
Hypothermia

 Infection
 Coagulation defects
 Acidosis
 Delayed Fetal to Newborn Circulatory adjustment
 Hyaline membrane disease
 Brain Hemorrhage
IMMEDIATE AND THOROUGH DRYING
Follow an organized sequence
○ Start with mouth and nose, eyes and face;
next the head; the trunk and the arms and
then legs.

● Wipe gently, don’t wipe off vernix.

○ Vernix Caseosa - cheesy like substance
which gives the baby Warmth

● Use 2 sets of linen

Remove the wet cloth, replace with dry one
○ Wet cloths induce cold stress/heat loss
resulting in pallor and apnea
IMMEDIATE AND THOROUGH DRYING

● If not breathing, stimulate it to cry by drying (rubbing the back

and streaking soles of the feet)
○ Don’t SLAP, SHAKE or RUB the baby (traditional way; not
recommended anymore)
● Don’t ventilate unless baby is floppy/limp and not breathing
● Don’t suction unless mouth/nose are blocked by secretions
EARLY SKIN-TO-
SKIN CONTACT
Skin-to-skin contact

BENEFITS OF SKIN TO SKIN CONTACT

“BLEST”

B – Breastfeeding success
L – Lymphoid tissue system stimulation
E – Exposure to maternal skin flora
S – Sugar (protection from hypoglycemia)
T - Thermoregulation
 Skin-to-skin contact

BREASTFEEDING SUCCESS
 Reduces crying, improves mother-baby interaction, keeps
the baby warmer, & helps women breastfeed successfully.
 Positively associated with breastfeeding status at 1 & 4 mos
of age; longer duration of breastfeeding
 Improves maternal affectionate & attachment behaviors
 shorter crying time
Skin-to-skin contact

THERMOREGULATION
 If breathing or crying:
Position prone on the mother’s abdomen or chest
 Cover the newborn
o Dry linen for back
o Bonnet for head
 Temperature Check
■ Room : 25-28 °C
■ Baby : 36.5 – 37.5 °C
PROPERLY TIMED
CORD CLAMPING
PROPERLY TIMED CORD CLAMPING

When preparing for delivery, don 2 pairs of gloves after

thorough handwashing
● Remove the first set of gloves
● Palpate umbilical cord
● Wait 1-3 mins. or until cord pulsations stopped.
 PROPERLY TIMED CORD CLAMPING
DELAY 3-5 MINS AFTER BIRTH OR
UNTIL PULSATIONS STOP
WHICHEVER COMES FIRST
1. Clamp cord with sterile plastic
clamp or tie: 2 cm from the
umbilical base
2. Clamp again: 5 cm from the base
(3 cm from plastic clamp)
3. Cut the cord close to the plastic
clamp
CORD CARE
• Do not milk the cord...
 Towards baby -increase in hematocrit level
 Towards placenta - baby will become anemic
• Observe for the oozing of blood. If blood oozes,
place a
• second tie between the skin and the clamp
• DRY cord care is recommended
 Do not apply any substance onto the cord
• Don’t use a binder or “bigkis”
CORD CARE
● Harm of Early Bathing
○ Removes vernix
➔ Vernix is a protective barrier to E.coli and Group B Strep
○ Hinders crawling reflex
○ Can lead to hypothermia and its complications
PROPERLY TIMED CORD CLAMPING

BENEFITS OF PROPERLY TIMED CORD

CLAMPING

1. Prevents anemia in both term and preterm infants

2. Decreases the need for transfusion in preterms
3. Prevents bleeding in the brain in premature babies
NONSEPARATION
OF NEWBORN
AND MOTHER
Non-separation of infant and mother
1. Non-separation for 90 mins after birth or after a full breast feed
2. Leave the newborn between the mother’s breast in continous skin-to-
skin contact
 Never leave the mother and baby unattended
 Monitor mother and baby q15 minutes in the first 1-2 hrs . Assess
breathing and warmth of the baby.
 Breathing assess: grunting, chest-indrawings or rapid breathing
 Warmth: Check if feet are cold to touch (if no thermometer)
 The baby may rest for 20-30 mins up to 120 min before showing signs
of readiness to feed
OTHER EINC RECOMMENDATIONS
Recommended obstetric practices
● Antenatal steroids for preterm abor
● Providing mothers with birth plan
● Allowing a companion of choice during labor
● Allowing mother to assume position of choice
and mobility during labor
● Use of partograph
● Upright positing during delivery
● Active management during the 3rd stage of
labor
OTHER EINC RECOMMENDATIONS
Recommends against these traditional
newborn care practices
● Foot printing
● Use of bigkis or binder
● Early bathing and removal of vernix
● Artificial milk substitutes

Recommends against routine practice

● Perineal shaving
● Enema
● Npo
● Iv fluid administration
● Episiotomy
Breastfeeding
Breastfeeding
“Breast is best” – ideal nutrition from birth to 6 months is
exclusive breastfeeding
6 months and beyond = BM is not enough, start
complementary feeding
Composition
Per 100ml of BM Effect In formula?

Maternal sIgA 50-100 Protection against specific pathogens found in the Absent
mg mother and child’s environment.
• Endogenous production of sIgA many weeks after
birth
Maternal white cells Probable protection against infection, and persist Absent
in the offspring for many years
Lysozyme 5-25 mg Lysis of susceptible bacteria Absent

Milk lipids Can inhibit binding of pathogens to host cells, and Less effective in
cause lysis of enveloped pathogens formula
Oligosaccharides 100- Inhibit pathogenic binding Absent
150 mg
Lactoferrin 500-600 Wide range of synergistic protective properties Some have
mg bovine lactofferin
 Composition
Per 100ml Effect Formula

Growth factors: Promotes maturation of gut, increasing capacity for Absent

epidermal growth digestion, absorption, reduces permeability
factor
Cytokines Promote development of immune system Absent

BSSL (bile salt- Highly efficient fat digesting enzyme augments and Absent
stimulated lipase) compensates for low levels of endogenous lipase
Amylase Possibly augments infants low level of endogenous Absent
production for <2 years, functional role unclear
Hormone prolactin May condition maturation of the infant while endocrine Absent
system is not yet developed
Other Benefits of breastmilk
 Growth promotion of crypt cells in the infant's gut or other cells in the
body
 Aids in digestion
 Protects preterms from sepsis and necrotizing enterocolitis
 Contains DHA that enhances intelligence and brain development
 Sterile, Safe
 Prevents Obesity
 Promotes early return to pre-pregnancy weight
 Protects the mother’s health against diseases, obesity and
postpartum hemorrhage
 Promotes emotional bonding between the baby and mother
 Economic benefits for the family: FREE
Contraindications
 Galactosemia
 Septicemia
 Active TB
 Breast Cancer
 Malaria
 Substance Abuse
 Severe neurosis or Psychosis
 HIV
Breastfeeding
cues
1. Eye movement under closed lids
2. Increased alertness, movements
of arms and legs
3. Tossing, turning or wiggling
4. Mouthing, licking, tonguing
movements
5. Rooting
6. Changes in facial expression
7. Squeaking noises or light
fussing
8. * CRYING IS A LATE SIGN OF
HUNGER
9. It take 20-60 min. after a newborn
is ready to feed
Breastfeeding Initiation
1. Correct positioning of the Baby
2. ○ Baby’s body needs to be:
3. ■ In line with ear, shoulder and hip in a
straight line
4. ■ Close to mother’s body
5. ■ Supported at the head, shoulders,the
whole body
6. ■ Facing the breast
Proper Latching
Proper latching
• Mouth wide open
• Lower lip turned outwards
• Baby’s chin touching (or nearly
touching) the breast
• Areola more visible above
• Suckling is slow with pauses
 Kangaroo
Mother Care
(KMC)
Kangaroo Mother
Care (KMC)

Kangaroo Mother Care is an affordable alternative technology that addresses the

needs of low-birth weight infants. The kangaroo Mother Care position where in
the baby is held against the mother’s chest on skin-to-skin contact provides all
the basic requirements for newborn survival. The method has been proven by
research to improve neonatal mortality rates and is one of the key components
of the DOH administrative order on essential newborn care.           
Target populations
 Low-birth infants
 Preterms
When to start KMC
1. For Low-birthweight neonates, KMC can be started as early as EINC as long
as conditions are stable
2. For those with complications, KMC will have to be delayed until the
medical conditions improve. In low birthweight neonates weighing

• If >/= 1800g – If without any serious prematurity-related complications, KMC can be

started soon after birth

• If between 1200g – 1799g : prematurity-related problems are frequent and require

special treatment initially, early neonatal mortality rates are high. May take a week
or more before KMC can be initiated

• <1200g and AOG <30wks incur frequent and severe problems due to preterm birth:
mortality is very high and only a small proportion survive prematurity-related
problems..
Benefits of Kangaroo Mother
Care
• Better weight gain
• Decreased risk of infection
• improved maternal, family and infant
bonding
• Increased breastfeeding rates
• Maternal and family empowerment
• Decreased cost of care
THANK YOU