EINC (Essential Intrapartum Newborn Care)

Part 1
THINGS TO REMEMBER
 Before a birth, the delivery area should be the range temperature
o 25 – 28 C
 The cord should be clamped when the pulsations stopped by 1-3 mins after
delivery of baby.
 Allowing a mother to have her companion of choice during labor to shorten the
length of labor and support.
 The mothers progress of labor in EINC is monitored using a Partograph.
 Not recommended practices during labor
o Routine perineal shaving on admission for labor and delivery
 Perineal shaving did not protect against maternal fever, perineal
wound infection, and perineal wound dehiscence.
 No neonatal infection was observed
o Routine enema during the first stage of labor
 Less fecal soiling during delivery by 64% is the clear benefit
 Enemas do not protect against maternal puerperal infection,
episiotomy dehiscence, neonatal infection, and neonatal pneumonia.
o Routine NPO
 No evidence of improved outcomes for mother nor newborn if on NPO
 Very small probable risk of maternal aspiration mortality 7/10 M births
 For normal, low risk birth, no need for NPO except when intervention
is anticipated.
o Routine IVF
 Advantage:
  Ready access for emergency medicine.
 Disadvantage:
 Interferences with the natural birthing process.
 Restricts woman’s freedom to move.
 Not as effective as food and fluids in labor to treat/prevent
dehydration, ketosis or electrolyte imbalance.
o Routine vaginal douching
o Routine amniotomy to shorten spontaneous labor
 Risk of dysfunctional labor by 25%
 No difference in duration of 1st & 2nd stage of labor, CS rate, cord
prolapse, maternal infection, and Apgar score <7 at 5 mins among
women with or without amniotomy.
o Routine oxytocin augmentation
 Should be used by doctors only when indicated and in facilities where
there is immediate access to CS
 Never use IM oxytocin before birth of the infant because its dosage
cannot be adapted to the level of uterine activity.
 Recommended practices during labor
o Admission to labor when in active phase.
o Companion of choice to provide continuous maternal support
o Mobility and upright position
o Allow food and drink
o Use of WHO partograph to monitor progress of Labor
o Limit IE to 5 or less.
 Recommended practices during delivery
o Upright position during delivery
 Anterior – posterior and transverse diameters of pelvic outlet

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  Enhances fetal movement through the maternal pelvis in descent for
birth
 Efficiency of uterine contractions
 Improved fetal alignment
 Duration of 2nd stage of labor
 Episiotomies
 Abnormal FHR patterns
 No difference in upright or recumbent delivery position in birth
injuries, admission to NICU, 3rd and 4th degree lacerations
o Encourage to push only when there is urge to push


o Selective episiotomy (non-routine)
 Posterior perineal trauma by 12%
 2nd – 4th degree tears by 33%
 Need for suturing by 29%
 Anterior perineal trauma by 84%
 No difference in infection rate with or without episiotomy

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 o Perineal support and controlled delivery of the head
 During delivery of the head, encourage woman to stop pushing and
breath rapidly with mouth open.
 Keep one hand on the head as it advances during contractions while
the other hand supports the perineum.
o Active management of the third stage of labor
 Administration of uterotonic oxytocin within one min of delivery of the
baby
 Controlled cord traction with counter traction on the uterus
 Uterine massage
o Delayed cord clamping
o Controlled cord traction with countertraction to deliver the placenta
o Uterine massage
 Practices not recommended during delivery
o Perineal massage in the 2nd stage of labor
o Fundal pressure during the 2nd stage of labor

Postpartum care
 Recommended
o Routine inspection of birth canal for lacerations
o Inspection of placenta & membranes for completeness
o Early resumption of feeding
o Uterine massage every 15 to 30 mins
o Prophylactic antibiotics for 3rd/ 4th degree tears
o Early postpartum discharge

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Part 2
THINGS TO REMEMBER:
 After the baby is born the first action performed is to dry the baby.
 During drying and stimulation of the baby, your quick check shows that the baby is
crying the next action is to do the skin to skin contact.
 The newborn should be bath after at least 6 hours.
 Not recommended cord care
o Milk the cord towards the baby.
o Use a binder or “bigkis”
o Apply alcohol onto the cord
 EINC recommended practice for newborn care
o Immediate and thorough drying
o Properly timed cord clamping
o Early skin-to-skin contact
 The second stage of Labor is marked principally by delivery of the baby.
 To determine the frequency of the contraction, a nurse in the labor room
observers and time the contraction from the start of one contraction to the
beginning of the next contraction.
 In assessing the status of labor of a primigravida just brought to the delivery room,
it is important to assess the Fetal heart rate.
 To know that the baby is about to be born if there is an expulsion of mucus plug
from the uterus and appearance if bloody show.

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Recommended Newborn Practices
 Antenatal Steroids
o Dexamethasone
 6mg IM q 12 hrs x 4 doses
o Betamethasone
 12mg IM q 24hrs x 2 doses
 Thermoregulation (room temp at 25-28 C)
o Check temperature of the DR
o Check for air drafts
o Turn fans and air conditioners off before the delivery
o Non- mercury thermometer
 Immediate and thorough drying
o Immediate drying
 Stimulated breathing
 Prevents hypothermia
o Hypothermia can lead to
 Infection
 Coagulation defects
 Acidosis
 Delayed fetal to newborn circulatory adjustment
 Hyaline membrane disease
 Brain hemorrhage
o Dry the newborn thoroughly for at least 30 seconds
o Follow an organized sequence
o Wipe gently, do not wipe off the vernix
o Remove the wet cloth, replace with a dry one
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 o Drying should be the first action (full 30 seconds)
 Unless the infant is both floppy/limp and apneic
 Skin-to-skin contact
 Properly-timed cord clamping
 Non-separation of mother and baby
 Dry cord care
 Early breastfeeding