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For Safe & Quality Care of Birthing Mothers & Their Newborns

Dean Ma. Imelda Ocampo-Javier College of Nursing, UPHSD Las Pinas VP Finance, MCNAP

The MDG Challenge for Safe and Quality Care for Birthing Mothers & Newborns Millenium Development Goals 4 and 5

The Essential Intrapartum and Newborn Care (EINC) Protocol

UN Summit on MDG held on December 2000 in Geneva and attended by 189 Heads of States.

Adoption of a global action plan to achieve the eight anti-poverty goals by their 2015 target date.
The Essential Intrapartum and Newborn Care (EINC) Protocol

Announcement of major new commitments for womens and childrens health. Goals 4 and 5 relate to the reduction of child mortality by two-thirds and improvement of maternal health.

The Essential Intrapartum and Newborn Care (EINC) Protocol

Global Situation
Almost 11 million children under 5 years of age will die from causes that are largely preventable.

Among them are 4 million babies who will not survive the first month of life.
The Essential Intrapartum and Newborn Care (EINC) Protocol

Global Situation
More than half a million women will die during pregnancy and childbirth. The Philippines is one of the 42 nations that account for 90% of global under-five mortality.

The Essential Intrapartum and Newborn Care (EINC) Protocol

National Situation
An estimated 82,000 Filipino children die annually before even reaching their 5th birthday. Almost one-half (45 percent) of these children are newborns less than 28 days old.

The Essential Intrapartum and Newborn Care (EINC) Protocol

Under Five Year Old Deaths, 2008


From 1988, childhood death rates in the Philippines initially showed a substantial decline.

But the downward trend leveled off in the past 10 years because the neonatal mortality rate remained practically unchanged.
The Essential Intrapartum and Newborn Care (EINC) Protocol

Under Five Year Old Deaths, 2008

The Essential Intrapartum and Newborn Care (EINC) Protocol

At present, around 40, 000 newborns die in the country each year from complications of prematurity (41%), birth asphyxia (15%) or severe infection (16%).

Most of the deaths occur within the first two days of life, with conditions surrounding labor, delivery and the immediate postpartum period as contributory factors.
The Essential Intrapartum and Newborn Care (EINC) Protocol

Only if measures are instituted to reduce newborn mortality more rapidly can we hope to achieve MDG 4 by 2015.

The Essential Intrapartum and Newborn Care (EINC) Protocol

Maternal Mortality Rate

The Essential Intrapartum and Newborn Care (EINC) Protocol

The 4 core steps of ENC are:


1. Immediate and thorough drying of the newborn. 2. Early skin-to-skin contact between mother and newborn. 3. Properly-timed cord clamping and cutting. 4. Non-separation of newborn and mother for early breastfeeding.

The Essential Intrapartum and Newborn Care (EINC) Protocol

DOH Policies
A. Revitalization of the Mother-Baby Friendly Hospital Initiative in Health Facilities with Maternity and Newborn Care Services (A.O.
No. 2007-0026)

B. Implementing Health Reforms for the Rapid Reduction of Maternal and Neonatal Mortality (A.O. No. 2008-0029)
The Essential Intrapartum and Newborn Care (EINC) Protocol

DOH Policies
C. Adopting New Policies and Protocol on Essential Newborn Care (A.O. No. 20090025)

D. The Aquino Health Agenda: Achieving Universal Health Care for All Filipinos (A.O. No.
2010-0036)

The Essential Intrapartum and Newborn Care (EINC) Protocol

WHO Guidelines
A. Baby Friendly Hospital Initiative: Revised, Updated and Expanded for Integrated Care
(Section 4: Hospital Self-Appraisal and Monitoring, January 2006)

B. Pregnancy, Childbirth, Postpartum and Newborn Care (PCPNC): A guide for essential practice. (Integrated Management of
Pregnancy and Childbirth, 2006)
The Essential Intrapartum and Newborn Care (EINC) Protocol

WHO Guidelines
C. WHO Recommendations for the Prevention of Postpartum Hemorrhage, 2006 D. Newborn Care until the First Week of Life Clinical Practice Pocket Guide, 2009

The Essential Intrapartum and Newborn Care (EINC) Protocol

The Evidence Base for EINC Practices

The Essential Intrapartum and Newborn Care (EINC) Protocol

A. Essential Intrapartum Care


1. Unnecessary Interventions: Enema Shaving Restricted Intake Intravenous Infusion Fundal Pressure Early Amniotomy and Oxytocin Augmentation
The Essential Intrapartum and Newborn Care (EINC) Protocol

A. Essential Intrapartum Care


2. Recommended Practices: Maternal Position Pain Relief in Labor Antenatal Steroids Continuous Support During Childbirth Hand Hygiene Partograph Use Active Management of the Third Stage of Labor (AMTSL)
The Essential Intrapartum and Newborn Care (EINC) Protocol

B. Essential Newborn Care


1. Unnecessary Interventions: Routine suctioning Footprinting Early bathing and washing Routine Separation Caregivers Continue Artificial Feeding

The Essential Intrapartum and Newborn Care (EINC) Protocol

B. Essential Newborn Care


2. Recommended Practices: Skin to Skin Contact (SSC)
Effects on Breastfeeding Effects on the Infants Cardiorespiratory Stability Effect on Infants Body Temperature and Crying Effect on Blood Sugar Levels Effect on Immunoprotection
The Essential Intrapartum and Newborn Care (EINC) Protocol

B. Essential Newborn Care


Properly Timed Cord Clamping
Effects on Full-term Infants Effects on Preterm Infants

Initiation of Breastfeeding

The Essential Intrapartum and Newborn Care (EINC) Protocol

Thank You!