GROUP 3

According to the Department of Health (DOH), Essential Intrapartum and Newborn

Care (EINC) is a package of evidence-based practices that is recommended by the
DOH, PhilHealth and WHO.
The DOH and the WHO collaborated towards adopted systems to improve NB care
practices. Thus, for the reason that in 2008 a neonatal sepsis occurred in which an
urban hospital in the Philippines was found to be doing malpractices towards
intrapartum and newborn care.
Gaps were also noticed such as immediate cord clamping, early bathing and
delayed breastfeeding initiation.
The Department of Health has issued
directives to ensure the highest quality
of care for mothers and their
newborns. DOH policies describe
methods for providing standard
maternal and newborn care to the
general population and demand that
monitoring and evaluation systems be
put in place for these strategies.

Similarly, the Philippine Health

Insurance Corporation (Philhealth),
insists on the importance of safety and
quality care that is patient-centered in
its hospital accreditation process.
immediate and thorough drying
• immediate and thorough drying for 30 secs to one-minute arms the newborn and
stimulate breathing
• use a clean, dry cloth to thoroughly dry the baby by wiping the eyes, face, head, front
and back, arm and legs

early skin-to-skin contact

• place the newborn prone on the mother’s abdomen or chest skin-to-skin
• cover newborn’s back with a blanket and head with bonnet. Place identification.
• Prevents hypothermia, infection, and hypoglycemia

properly-time clamping and cutting off the cord after 1 to 3 minutes

• clam and cut the sort after cord pulsations have stopped
• put ties tightly around the cord at 2 cm using cord clamp and 5 cm from the
newborns abdomen
• cut between ties with sterile instrument
• prevents anemia, protects against brain hemorrhage and premature newborn.

non-separation of the newborn from the mother for early

breastfeeding initiation and rooming.
• Timebond; within 90 minutes of age
• Continuous non-separation for early breastfeeding which protects infants from
infection
immediate and thorough drying
• immediate and thorough drying for 30 secs to one-minute arms the newborn and
stimulate breathing
• use a clean, dry cloth to thoroughly dry the baby by wiping the eyes, face, head, front
and back, arm and legs

early skin-to-skin contact

• place the newborn prone on the mother’s abdomen or chest skin-to-skin
• cover newborn’s back with a blanket and head with bonnet. Place identification.
• Prevents hypothermia, infection, and hypoglycemia

properly-time clamping and cutting off the cord after 1 to 3 minutes

• clam and cut the sort after cord pulsations have stopped
• put ties tightly around the cord at 2 cm using cord clamp and 5 cm from the
newborns abdomen
• cut between ties with sterile instrument
• prevents anemia, protects against brain hemorrhage and premature newborn.

non-separation of the newborn from the mother for early

breastfeeding initiation and rooming.
• Timebond; within 90 minutes of age
• Continuous non-separation for early breastfeeding which protects infants from
infection
Fetal Heart Rate

Traditional
Fetal heart rate is being auscultated every 19
minutes during 2nd stage of labor.

FHR monitoring is an essential intrapartum

practice to detect signs of Hypoxemia and
Acidosis. Since frequent and intense uterine
contraction is common during the second
stage, it is recommended that FHR monitoring
be conducted every five minutes by
intermittent auscultation.

Modified
Newborn bathing

Traditional
Newborns should not be bathed until at least
6 hrs after birth

at least 24 h after birth to be consistent with

revised WHO recommendations in 2013

Modified
Excessive Use of Episiotomy

Traditional
Episiotomy was routinely provided to
primiparas

Contrary to the WHO recommendation which

states that an “acceptable” rate of
episiotomy is difficult to determine, and the
national policy of selective episiotomy which
is defined as no episiotomy unless it is
necessary for maternal or fetal reasons.

Modified
Fundal Pressure
Fundal pressure is strongly not
Traditional recommended in Philippines
national guidelines, since it does
not change desirable maternal
It was dominantly performed in primiparous outcomes such as duration of
women. Other associated factors were labor the 2nd stage, instrumental
augmentation by oxytocin and assisted delivery, or caesarean section,
vaginal birth. Providers reported that it has as well as neonatal outcomes
been shown that fundal pressure is effective such as low arterial cord pH and
to hasten the 2nd stage of labor. These Apgar scores.
qualitative findings explained our quantitative
findings; specifically, that providers applied Fundal pressure may also
fundal pressure to accelerate the delivery increase the occurrence of
and to avoid operative delivery. severe laceration and cervical
tears, and the possibility of
uterine rupture

Modified
Oxytocin During 2nd Stage of Labor

Traditional
Use of oxytocin prior to confirmation of delay
in labor may increase the risk of uterine
hyperstimulation, tachysystole, and fetal
heart rate alterations

This practice should be immediately

abandoned and strongly discouraged by the
national guidelines.

Modified
 Traditional and Modified Experience in
Quirino Memorial Medical Center (QMMC)

Traditional: Effective date: November 2008 –

February 2010

Modified: Effective Date: November 2008-

Present
Traditional and Modified Experience in Quirino
Memorial Medical Center (QMMC)

Traditional
Immediate Drying

Modified

Immediate and
Thorough drying
Traditional and Modified Experience in Quirino
Memorial Medical Center (QMMC)

Traditional
Appropriate Cord
Clamping

Modified

Properly-Timed Cord
Clamping
Traditional and Modified Experience in Quirino
Memorial Medical Center (QMMC)

Traditional
Skin-to-Skin Contact

Modified

Early skin-to-skin
Contact
Traditional and Modified Experience in Quirino
Memorial Medical Center (QMMC)

Traditional
Real Breastfeeding Initiation

Modified
Non-separation of Newborn
from Mother for Early
Breastfeeding
• Improvement in practices after
training of the hospital staff
• Patient and staff satisfaction
• Economic benefit
• Sepsis rates down to its lowest in
the last 10 years
• Antenatal steroids in Preterm Labor
• Improved hand-washing
• NO perineal shaving, routine
antibiotics & IVF
• 100% women off their backs
• Improvement in practices after • 90% episiotomy rates
training of the hospital staff • NICU admissions by1/3
• Patient and staff satisfaction • Non-separation & initiation of a full
• Economic benefit breastfeed
• Manipulation such as routine suctioning of
secretions if the baby is crying and breathing
normally.
• Putting the newborn on a cold or wet surface.
• Wiping or removal of vernix caseosa if present
• Foot printing
• Bathing earlier than 6 hours of life
• Unnecessary separation of the newborn primarily
for weighing, anthropometric measurements,
• intramuscular administration of vitamin K,
Hepatitis B vaccine and BCG vaccine
• Transferring of the newborn to the nursery or
neonatal intensive care unit without any
indication.
• Healthcare professionals
• obstetrician-gynecologists
• pediatricians/neonatologists
• nurses
• Midwives
• hospital administration officials
• Anesthesiologists
• hospital infection
• control officers
• hospital Phil Health/Quality officers
• clinical nutritionists
• clinical pharmacists
• nursing attendants
• health promotion and information
officers.
The wide variations in newborn care
practices in health facilities, both
government and private, and also the
proper sequence or order of newborn
care services need to be standardized
based on current evidences that show
reduction in neonatal mortality and
morbidity. This is to achieve the United
Nations Millennium Development Goal
4 of Reducing Under 5 Child Mortality
(through reduction of neonatal deaths).
The step-by-step interventions in EINC are:

(1) immediate and thorough drying of the

baby,
(2) early-skin-to-skin contact between the
mother and the newborn,
(3) properly-timed cord clamping, and
(4) non-separation of the mother and baby for
early breastfeeding initiation.
The United Nations Children's Fund (UNICEF), the World
Health Organization (WHO), the United Nations
Population Fund (UNFPA), and World Food Program
(WFP) today approached those engaged with the
reaction to the COVID-19 flare-up in the Philippines to
stress that the best method for saving infant lives is as
yet through the act of Essential Intrapartum and
Newborn Care (EINC, or "Unang Yakap") and the
advancement and assurance of breastfeeding while
stringently following precautionary measures for disease
anticipation and control
 Focus on breastfeeding

Working together for Unang

Yakap
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Essential intrapartum-newborn-care
https://www.slideshare.net/MukeshSah1/essential-intrapartumnewborncare-123487825