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EINC = Essential Intrapartum and Newborn Care

4 core steps of EINC

I. Immediate and thorough drying

II. Early skin-to-skin contact
III. Properly timed cord clamping
IV. Non-separation of newborn from mother for early breastfeeding

Prior to patients transfer to the DR

Ensure that mother is on her position of choice when in labor

Ask mother if she wishes to eat or drink
Communicate with the mother inform her of the progress of labor,
give reassurance and encouragement

Patient already in the DR

1. Arrange things in a linear fashion: gloves, dry linen, bonnet, Oxytocin

injection plastic clamp, scissors, 2 kidney basins
2. Clean the perineum with antiseptic solution.
3. Wash hands.
4. Put on 2 pairs of sterile gloves aseptically. (If same worker handles
perineum and cord).

AT THE TIME DELIVERY

1. Encourage woman to push as desired

2. Apply perineal support and do controlled delivery of the head
3. Call out time of birth and sex of baby
4. Inform the mother of outcome

First 30 seconds

Place the baby on a clean, dry cloth/towel on the mothers abdomen

Thoroughly dry baby for at least 30 seconds starting from the face and
head, going down to the trunk and extremities.

1 3 minutes

Remove the wet cloth

Place baby on skin to skin contact on the mothers abdomen
Cover the baby with a clean, dry cloth/towel.
Cover the babys head with a bonnet.
Exclude a 2nd baby by palpating the abdomen. Use the wet cloth to
wipe the soiled gloves. Give IM Oxytocin within 1 minute of babys
birth. Dispose of the wet cloth properly.
Remove the first set of gloves
Decontaminate these properly (by soaking in 0.5% chlorine solution for
at least 10 minutes).
Palpate umbilical cord to check for pulsations.
After pulsations have stopped, clamp cord using the plastic cord clamp
at 2 cm from base.
Place the instrument clamp 5cm from the base.
 2

Cut near plastic clamp (midway).

Perform the remaining steps of the active management of the third
stage of labor.
wait for strong uterine contractions then apply controlled cord
traction and counter traction on the uterus, continuing until
placenta is delivered
massage the uterus until it is firm
Inspect the lower vagina and perineum for lacerations/tears and repair
lacerations/tears if necessary.
Examine the placenta for completeness and abnormalities.
Clean the mother: flush perineum and apply perineal pad/napkin/cloth.
Check babys color and breathing; check that mother is comfortable,
uterus is contracted.
Dispose the placenta in a leak-proof container or plastic bag.
Decontaminate (soaked in 0.5% chlorine solution) instruments before
cleaning; decontaminate 2nd pair of gloves before disposal.
Advise mother to maintain skin-to-skin contact. Baby should be prone
on mothers chest/in between the breasts with head turned to one side

15-90 minutes

Advise mother to observe for feeding cues

Support mother, instruct her on positioning and attachment
Wait for FULL BREASTFEED to be completed
After a complete breastfeed, administer eye ointment (FIRST), do
thorough physical examination, give Vit. K, hepatitis B and BCG
(simultaneously explain purpose of each intervention).
Advise OPTIONAL/DELAYED bathing of the baby (explain the rationale).
Advise breastfeeding per demand and about Danger Signs for early
referral
In the first hour:
- check babys breathing and color; and check mothers vital signs
and massage uterus every 15 minutes.
In the second hour: check mother-baby dyad every 30 minutes to 1
hour
Complete all records: admin. of eye ointment, Vit K, hepatitis B
and BCG

Intrapartum care - Unnecessary interventions:

1. Enema
2. Shaving
3. Restricted intake of food and fluids
4. Routine intravenous infusion
5. Fundal pressure
6. Early amniotomy and Oxytocin augmentation
7. Routine episiotomy

Newborn care Unnecessary interventions:

1. routine suctioning
2. foot printing
3. early bathing and washing
4. routine separation
5. giving glucose water or artificial milk substitutes