EINC

For Safe & Quality Care of Birthing Mothers & Their

NewbornsDean Ma. Imelda Ocampo-Javier

College of Nursing, UPHSD Las PinasVP 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.


• Announcement of major new commitments for women’s and children’s health.

• Goals 4 and 5 relate to the reduction of child mortality by two-thirds and improvement of maternal health.


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.


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.


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.


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.


Under Five Year Old Deaths, 2008


• 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.


“Only if measures are instituted to reduce newborn mortality more rapidly can we hope to achieve

MDG 4 by 2015.”



Maternal Mortality Rate

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.


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)


DOH Policies

C. Adopting New Policies and Protocol on Essential Newborn Care (A.O. No. 2009-0025)

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


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)


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 Evidence Base for EINC Practices


A. Essential Intrapartum Care

1. Unnecessary Interventions:• Enema• Shaving• Restricted Intake• Intravenous Infusion• Fundal Pressure• Early Amniotomy and Oxytocin Augmentation


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



2. Recommended Practices:

• Skin to Skin Contact (SSC)Effects on BreastfeedingEffects on the Infant’s Cardiorespiratory StabilityEffect on Infant’s Body Temperature and CryingEffect on Blood Sugar LevelsEffect on Immunoprotection



• Properly Timed Cord ClampingEffects on Full-term InfantsEffects on Preterm Infants

• Initiation of Breastfeeding


Thank You!

EINC

Documents

Transcript of EINC