4 Core Steps of Einc

4 CORE STEPS OF EINC
3 COMPONENTS OF AMTSL
Maria Dalisay C.Caponpon,RN,RM,MAN

Member,APSOM Training Group
• Available delivery
equipment (bed semi-
upright), supplies, NB
resuscitation equipment
Place of delivery is clean

and warm (25-28ºC) , no
draft D10, L3
Assist the mother in an upright position
Check Room Temperature : 25-28 oC
Linear arrangement of Instruments
Arrange instruments in a linear fashion, according
to the order that they are going to be used:
2 pairs of gloves, 2 sets of clean towel, bonnet,

syringe with 10 u oxytocin, plastic cord clamp,
forceps, scissors, 1 placental basin, 1 basin with
0.5% decontaminating solution, eye ointment,
Vaccines - Vitamin K, Hepatitis B and BCG.
Proper Hand Washing
Wear Double Gloves
Upon delivery, call out the time of birth
and sex of the baby
Place the baby on a waiting towel atop the
mothers abdomen
Dry the baby immediately and
thoroughly for 30 sec. while checking
breathing and color
Remove the wet cloth
Place the baby skin to skin with the
mother and put a dry cloth over the
baby’s back
Place a Bonnet on the baby’ head
Palpate mother’s abdomen
or
do IE to check for another baby
and confirm only 1.

Giving of Oxytocin
Prepare the site for

Oxytocin injection : - 1st
- Site : thigh or
deltoid
-Purpose : prevent
bleeding
-Dose : 10 IU IM
-Given: 1st min after
birth of the
Newborn
Remove the 1st
pair of gloves
and place it on
decontaminating
solution.
Palpate Umbilical
Cord until
pulsation stop
or
Prepare to clamp by
1-3 min after
birth.
Clamping of Umbilical Cord
 Using the sterile plastic
cord clamp,
 Clamp at 2 cm. from the
umbilical base.
 Another clamp,
instrument clamp, at
5 cm. from umbilical
base.
 Cut close to the plastic
clamp.
 Place the instrument
clamp with cut end of
umbilicus atop the
inguinal area.
 Place the scissors in
decontaminating
solution – 1st basin
 Reposition baby skin to
skin with mother.
Delivery of the Placenta
 Palpate for the uterus,
feel for a strong
contraction, see to it that
there is no active
bleeding.
 Place one hand above
symphysis pubis while
keeping slight tension on
the cord with the other
hand and awaits uterine
contraction.
 Apply steady controlled
cord traction along axis
of vagina during
contraction while
applying counter traction
abdominally – 2nd
 Deliver the placenta with

both hands , move it
upward to deliver the
membranes completely.
 Place placenta in 2nd

basin.
Perform Uterine Massage
Management of 3rd Stage of Labor
Management of Postpartum Hemorrhage
Laceration and Repair
 Check for laceration
- Perineum
- Vagina
- Vulva
Repair of Laceration :
- interlocking suture
- continues suture
- interrupted suture
- inverted T suture
Check, Estimate, Clean and Wash
 Check for completeness
of Placenta and its
Membrane
 Estimate degree of blood

loss.
 Clean the mother and put
sanitary pad.
Decontaminate all
instruments used.
 Wash gloves then remove

 Wash hands
FETO-MATERNAL MONITORING
 Check on :
 Mothers vital sign
 Baby’s breathing and
warmth.
Monitor:
 1st hour : every 15 min.
 2nd hour: every 30
 Then for 1st 6 hrs.: q hr.
Keep the mother and baby

together
( skin to skin )
Skin-To-Skin Contact and Breastfeeding
Signs of Readiness to Breastfeed: Feeding Cues
Feeding Cues
 Observe Feeding Cues:
 This is expected by
20-60 min after birth.
Licking Mouthing
Eyes Moving About Crying Baby becomes

more active
Feeding Cues
BREASTFEEDING
 Encourage and
Support breastfeeding
 Record event in chart

CARE OF THE NEWBORN
ROUTINE NEWBORN CARE
AFTER THE FIRST BREASTFEED
 Check and Prepare
medications needed for
POST-NATAL CARE.
 Eye antiseptic
 Stethoscope
 Vitamin k, I mg. and
syringe
 Hepatitis B, 0.5 ml. vaccine
and syringe
 BCG, 0.1 ml. vaccine and
syringe
 Cotton Balls & sterile water
 Perform Hand
Washing
 Position the Baby on

the mother’s chest or
at her side.
 Inform the mother

what is being done.
Eye Ointment Application
 Apply eye ointment:
 Given : within the 1st
60 min of age
 Purpose: prevent
infection, baby being
exposed to germs from
passing through the
birth canal
 Application : from
inner to outer direction
Thorough Examination of the baby
 Assess the Breathing
-listen for grunting
-count breaths/min ( 30-60 )
-look for chest-in-drawing
 Listen for the Heart Beat
(100-160 / min )
 Assess the baby’s warmth
-Use axillary thermometer
(36.5 – 37.5 C)
-Feel for the sole of the foot
 Look at baby’s movement
-symmetrical or not
 Look for bruises, swelling
usually at presenting part
 Look for pallor,
note the abdomen
 Look for malformations
 Assess tone
 Weigh and Measure the baby
 Inform & Reassure the mother
of the findings
 Handwashing
Giving of Vitamin K
 Purpose : prevent
bleeding in baby
 Site : lateral part of left
thigh ( outer middle third
site of the vastus lateralis )
 Direction : prepare site of
injection, use sterile
water / alcohol for asepsis
 Dose : aspirate 1 mg vit K
into syringe and inject IM
at baby’s left thigh
Giving of Hepatitis B Vaccine
 Purpose : prevents liver
infection which may later
cause cirrhosis or cancer
 Site : lateral part of the
right thigh ( outer middle
third site of vastus
lateralis )
 Direction: prepare site of
injection, use sterile water
for asepsis
 Dose : aspirate 0.5 ml hep
vaccine into syringe and
inject IM at baby’ right
thigh
Giving of BCG Vaccine
 Purpose : prevents
complication of TB –
like meningitis and TB
of bone
 Site : right deltoid
 Direction: prepare the
site of injection, use
sterile water for asepsis
 Dose: aspirate 0.1 ml
BCG vaccine into
syringe and inject
intradermally.
 Replace baby to prone
position
 Skin to skin with

mother
 Mother should be
inform that Bathing is
delayed until at least 6
hours of age
 Hand washing
 Record in chart.
4 CORE STEPS OF EINC
*Carry out Eye Care
and
Immunization
procedures
*Rooming In
*Exclusive Breast
Feeding for 6
3 Components of AMTSL
1. Oxytocin administration
10 IU IM
2. Cord traction and

Counter traction
3. Uterine massage
THANK YOU

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4 CORE STEPS OF EINC

Maria Dalisay C.Caponpon,RN,RM,MAN

Place of delivery is clean

2 pairs of gloves, 2 sets of clean towel, bonnet,

do IE to check for another baby

and confirm only 1.

Prepare the site for

 Deliver the placenta with

 Place placenta in 2nd

 Estimate degree of blood

 Wash gloves then remove

Keep the mother and baby

Eyes Moving About Crying Baby becomes

 Record event in chart

 Position the Baby on

 Inform the mother

 Skin to skin with

2. Cord traction and

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