10/10/2014
Essential lntrapartum and Newborn care (EINC) is the standard of care in all births by skilled attendants in all government/private settings.
The EINC practices for newborn care constitute a series of time- bound, chronologically-ordered, standard procedures that a baby receives at birth.
At the heart of the protocol are 4 time-bound interventions:
1) immediate drying;
2) skin-to-skin contact followed by clamping of the cord after 1-3 minutes;
3) non-separation of baby from mother
4) breastfeeding initiation
1. IMMEDIATE DYRING
• Using a clean, dry cloth, thoroughly dry the baby, wiping the face, eyes, head, front and back, arms & legs.
2. SKIN-TO-SKIN CONTACT
• If a baby is crying & breathing normally, avoid any manipulation, such as routine suctioning, that may cause trauma or introduce infection. Place the newborn prone on the mother’s abdomen or chest skin-to- skin.
• Cover newborn’s back with a blanket & head with a bonnet. Place identification band on ankle.
3. PROPER CORD CLAMPING & CUTTING
• Clamp & cut the cord after cord pulsations have stopped (typically at 1-3 mins).
• Put ties tightly around the cord at 2 cm & 5 cm from the newborn’s abdomen.
• Cut between ties with sterile instrument.
• Observe for oozing blood.
• Do not milk the cord towards the newborn.
• After cord clamping, ensure oxytocin 10 IU IM is given to the mother
4. Non-separation of baby from mother and breastfeeding initiation
• Observe the newborn. Only when the newborn shows feeding cues (e.g., opening of mouth, tonguing, licking, rooting), make verbal suggestions to the mother to encourage her newborn to move toward the breast (e.g., nudging).
• Counsel on positioning and attachment.
When the baby is ready, advise the mother to:
a. Make sure the newborn’s neck is neither flexed nor twisted.
b. Make sure the newborn is facing the breast, with the newborn’s nose opposite her ni**le and chin touching the breast.
c. Hold the newborn’s body close to her body.
d. Support the newborn’s whole body, not just the neck & shoulders.
e. Wait until her newborn’s mouth is opened wide.
f. Move her newborn onto her breast, aiming the infant’s lower lip well below the ni**le.
g. Look for signs of good attachment & suckling:
− Mouth wide open
− Lower lip turned outward
− Baby’s chin touching breast
− Suckling is slow, deep with some pauses
− If the attachment or suckling is not good, try again & reassess.
Notes
• Health workers should not touch the newborn unless there is a medical indication.
• Do not give sugar water, formula or other prelacteals.
• Do not give bottles or pacifiers.
• Do not throw away colostrum.