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Essential

Intrapartum and
Newborn Care:
A Step-by-Step
Guide

The QMMC Experience:


Nov 2008 to Present
Antenatal steroids in
Preterm Labor
Improved hand-washing
NO perineal shaving,
routine antibiotics & IVF

100% women off their


backs

90% episiotomy
rates

NICU admissions

Implementation of EINC at QMMC,


Nov 2008 to Feb 2010
Immediate Drying
Appropriate Cord Clamping
Unnecessary Suctioning
120%

Initial ENC work


of Dr. Vitangcol,
et al.

100%
80%

Skin-to-skin Contact
Real Breastfeeding Initiation

ENC
TRAINING

Weekly team
assess and
improve

60%
40%

20%

0%
39753.0

39995.0

40087.0

40210.0

Significant Results at
QMMC

Improvement in practices after


training of staff
Patient and staff satisfaction
Economic benefit

Computed Hospital Savings for 1


NSD
ITEMS

COST

BLADE

P3

NGT

P7

Cotton

P 2.50

Alcohol

P5

Betadine

P5

Distilled Water

P 11.50

IVF (1L)

P 52.50

IV Set

P 14.50

IV Catheter

P 11.50

Suture

P 97

Flet Enema

P 200

Blade for
Shaving

P5

Rubber Bulb

P 36

Lidocane

P 15

TOTAL

P 465.50

Using the NSD Census of


2009:

6,670 x P465.50 =

P 3,104,885/yr
or

P 258,740.72
per month

Significant Results at
QMMC

Improvement in practices after


training of staff
Patient and staff satisfaction
Economic benefit

Sepsis rates down to lowest in


last 10
years

ORs for Mortality,Sepsis &Severe


Disease
Risk of Harm
Protectio
Intervention
RR & CI
n

M: 0.25 (0.080.77)

Skin-to-Skin
Contact

S: 0.40 (0.20
0.79)
SD: 0.39 (0.24
0.64)

M: 0.00

Appropriate
Initiation
&Duration of
Breastfeeding
Unnecessary
Suctioning
0.10

1.0

S: 0.17 (0.04
0.74)
SD: 0.18 (0.08
0.46)
M: 8.75 (2.60
29.4)
S: 4.49 (2.268.89)
SD: 4.44 (2.72
7.25)

Achieving MDG 4 and 5


with EINC

Unang Yakap Training


Video

11

Antenatal

Upon
arrival at
Facility

During
Labor

Prior to
Delivery
Perineal
Bulging

At least 4 antenatal visits


Iron and folate supplementation
Tetanus Toxoid Vaccine
Prepare a BIRTH PLAN including UnangYakap
Identify mothers in PRETERM LABOR at point of entry
Administer 1st dose of Antenatal Steroid
History, Physical Exam and Vital Signs
Obtain Birth Plan, Determine Companion of choice
Allow Position of Choice

Use Partograph to monitor


labor

Allow mother to have oral


fluids and light snacks

IV fluid and NPO only when


indicated

Arrange all instruments in


a
linear fashion
Check resuscitation
Discuss care in the 1st hours
equipment
Perform Proper Handwashing and Put on 2 pairs of sterile
gloves
NO routine episotomy, fundal pressure
Check room temperature
and air drafts

Your 5 Moments of Hand


Hygiene
WHY? TO PROTECT THE PATIENT AGAINST GERMS CARRIED ON
YOUR HANDS
WHEN? Ex. Shake hands, clinical examination
WHY? TO PROTECT THE PATIENT AGAINST GERMS, INCLUDING
HIS/HER OWN, FROM ENTERING HIS BODY. WHEN? Ex. IV
insertion, internal exam, inserting a catheter , O.R.
WHY? TO PROTECT THE ENVIRONMENT AND YOURSELF FROM
THE PATIENTS GERMS.
WHEN? Ex. draining a catheter, internal exam, changing a soiled
diaper
WHY? TO PROTECT THE ENVIRONMENT AND YOURSELF FROM THE
PATIENTS GERMS.
WHEN? Ex. Shake hands, clinical examination
WHY? TO PROTECT THE ENVIRONMENT AND YOURSELF FROM THE
PATIENTS GERMS.
WHEN? Ex. Fixing the patients bed, regulating the IV fluid rate

our 5 Moments for Hand Hygie

1. Wet hands with warm running water, apply


soap and lather well.
2. Rub each area together counting
1-2-3-4-5

nse hands and dry thoroughly with a paper towel.

Time
Delivery

Mother
Support the perineum with
controlled delivery of the
head

First 30
secs

1 minute
to 3
minutes

Baby
Call out time of birth and
sex
Dry, check breathing
Put in skin-to-skin contact

Give Oxytocin IM
After excluding a 2nd baby

Feel for cord pulsation ,


Clamp, cut cord

Do controlled traction of
cord with counter-traction
Massage the uterus gently

Return baby to prone


position

Examine the placenta

15-90
minutes

> 6 hours

Support FIRST FULL BREASTFEED. Monitor as a DYAD q15


minutes
Continue uterine
Do PE, weigh, measure,
massage; Monitor every
eye care, inject Vit K, Hep
15 minutes
B, BCG
Transport to room TOGETHER
BREASTFEEDING SUPPORT

Optional: Bathing

Linear Arrangement of
Instruments

Immediate and
Thorough
Drying
Early Skin
to Skin

ContactProperly-timed
ClampingNon-

Separation
of Mother

EINC in Cesarean
Section

20

EINC in Meconiumstained
Vigorous Baby

Normal Delivery?

24

Websites
Download the
Essential Newborn Care (ENC)
Training Videos from:
www.doh.gov.ph
://www.wp://www.wpro.who.int/philippines/Pu
bDocs.htm
http://www.wpro.who.int/philippines/Pub
Docs.htm

EINC Implementation
1. Organize a multidisciplinary EINC
Working
Group
Clinical
staf
Physicians - OB, Pedia, Anesthesia, Infection
Control
Nurses, nursing assistants, midwives
Administrative staf
Medical Director
Finance/ Budget Officer
PhilHealth Officer
Medical Social Service
Engineering
CSR

EINC Implementation
2. Conduct a situational analysis of
your
facility
Time and motion studies of deliveries
and immediate newborn care practices
May be done periodically to determine
effectivity of program implementation
3. Conduct saturation training workshops
for all staf
involved
in maternal
and
newborn
care
DR/OR,
NICU, OB
and Pedia
Wards,
ER staff
services utility workers
Institutional/

EINC Implementation
4.

Revise hospital policies and procedures

Allow companion of choice


Remove footprinting
Revise Nursery admission/ discharge criteria preterms
Review newborn policies on diagnosis and
management
e.g. potential
sepsis,
vise hospital
forms
and hyperbilirubinemia
order sheets
Incorporate EINC in the newborn admission
forms,
modify newborn admitting orders,
checklist

EINC Implementation
6.

Realign hospital staf to do new tasks


Obstetrician to dry the baby
Pediatrician to clamp and cut the cord
Anesthesiologist to help in maintaining
skin-to-skin contact
DR/ NICU staff to monitor mother and
baby dyads
DR/ NICU nurse to weigh baby and to do
eye prophylaxis, IM injections
Utility worker to transfer mother-baby
dyad together

EINC Implementation
7.

Enable the environment for EINC


Provide ample space in the labor room
for companion, for mothers mobility
Provide back support for upright positioning
Include bonnet/extra linen in the OB pack
Designate an EINC Recovery Room or area

8. Disable the environment that


EINC
hinders
Remove the
transitional nursery provide
trolley
Close the Nursery!

Help us bring

to your community

III
Immediate
Newborn Care
(The First 90 minutes)
III
III
Care Prior
To Discharge
but after the first
90 minutes

V
V
Additional
Care

I
II
I
Essential
Newborn Care
From 90 min to 6
hours
IV
IV
Care after
Discharge

To 7 days

VI
VI
Enabling
The
Environment

VII
VII
Equipment
And Supplies
Maintenance
Checklist
32

III
Immediate
Newborn Care
(The First 90 minutes)

I
II
I
Essential
Newborn
From 90 min to 6
hours

33

III
III
Care Prior
To Discharge
but after the first
90 minutes

Breastfeeding
Warmth of the Baby
Hygiene
Sleeping
Danger Signs: serious illne
Signs of Jaundice and
Local Infection
Discharge Instructions

IV

IV
Care after
Discharge
To 7 days

Breastfeeding
Warmth of the Baby
Danger Signs
Very severe disease

V
V
Additional
Care

A. Newborn Resuscitation
B. Additional Care of a Small
Baby (or Twin):
Warmth, feeding support,
KMC, discharge planning
C. Dealing with Feeding
Problems:
Mother-infant separation,
manual expression of
breastmilk, cup feeding

VI
VI
Enabling
The
Environment

Preparing for the shifts workpla


After every delivery restock
Standard precautions general
standard precautions and cleanliness
Hand hygiene
Processing Instruments & Other Item
Step 1: Decontamination
Step 2: Cleaning
Step 3: High-Level Disinfection by
Boiling or Steaming
Sterilization by Steaming
(Autoclave)
Step 4: Store or Use

VII
VII
Equipment
And Supplies
Maintenance
Checklist

Warm and clean room


Handwashing
Waste
Sterilization
Supplies
Miscellaneous
For the Mother and Baby
equipment, delivery instrument
drugs, supplies, forms & record
plus for CEmONCs

Download the Pocket Guide


and Unang Yakap
flyer

www.wpro.who.int/philippines/Pub
Docs.htm

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