As discussed by Ma’am Aurisita Maganis Delos Reyes, MAN, RN.
Essential Intrapartal and Newborn Care (EINC)
EINC determines the appropriate and inappropriate interventions based on the stage of labor. This is based on the R.A. 7600 Rooming-In and Breastfeeding Act and E.O. 51 (Milk Code of the Philippines)
Immediate Essential Care of the Newborn (Unang Yakap)
- Immediate and Thorough Drying (first 30 seconds): rubbing of the newborn for 30 seconds or until the newborn responds by crying. This stimulates lung expansion. Assess breathing and suction if necessary (not routinely). Suction the mouth before the nose for 5 to 10 seconds. After, position the newborn prone on top of the mother.
- One of the reasons to utilize rigorous force in rubbing the baby is the promote oxygenation. One of the disorders of the newborn is asphyxia neonatorum, where the newborn fails to breathe within 60 seconds. This is also part of why properly-timed cord clamping (step 3) is done.
- Suctioning is not done to prevent vagal stimulation (leading to bradycardia) and hypoxia. It is only indicated if an obstruction (e.g. secretions, meconium) within the airway and mouth. While the newborn breathes through the nose, the newborn may perform reflex breathing, which is a deep breath through the mouth, preventing aspiration.
- Lung Expansion creates increased pressure in the left side of the heart, causing the closure of the foramen ovale and ductus arteriosus fetal structures.
- The baby, when placed prone on the mother, can display the crawling reflex. This is a sign of readiness for the newborn to breastfeed.
- Early Skin-to-skin Contact (within 1 minute): place a bonnet on the baby’s head. The initial bath is done 6 to 8 hours after birth (also known as the second period of reactivity). Benefits for early skin-to-skin contact is for heat transfer (prevent hypothermia), transfer of normal skin flora (Staphylococcus aureus), and bonding.
- A lack of skin-to-skin contact is connected to SIDS. This is connected to the lack of the newborn’s ability to lift their head.
- The child’s vernix caseosa is ideally maintained, as it serves as an insulator and has a bacteriostatic effect. Alkaline soap is not used for bathing, but rather a non-alkaline bathing solution to avoid removing skin flora and promote the development of the newborn’s immune system.
- Properly-Timed Cord Clamping
- Non-separation of Newborn from Mother for Early Breastfeeding
Practice Questions
Q: What is the most rapid period of growth? Slowest? A: Newborn, School-age
Q: No question, just know that R.A. 7600 and E.O. 51 are often in the NLE.
Q: How long does the ductus arteriosus take to close after birth? A: 24 hours.
Q: What is the desired temperature of the newborn? A: 36.5°C to 37.5°C
Q: What is the normal flora of the skin? A: Staphylococcus aureus
Q: What is the normal flora of the birth canal? What does it produce and what function does it serve? A: Doderline bacillus; it produces lactic acid, maintaining the acidic environment of the birth canal and prevents infection.
Q: How long does it take for vernix caseosa to be shed from a newborn’s skin? A: ~24 hours.
Q: What are the two functions of the vernix caseoa? A: Thermoregulation and a bacteriostatic effect.
Q: Why is a bonnet important for a newborn? A: The head introduces a large amount of heat loss for a newborn, especially with a large head-to-body proportion.