Essential Newborn Care. What is it really?

Keep the baby with the mama!

Keep the baby WITH THE MAMA!

Keep the baby WARM!
(if you are in a warm climate, then there’s not a lot to do in this area)

Make sure the baby is breathing!

I’ve been enjoying my research on this topic today. The term “Essential Newborn Care” just sounds so, well, BIG. And, indeed, it *is* big! … But I find it quite humorous that we can’t just use words like

“Keep the baby with the mommy.”

I do have some comments on and appreciation for this directive from the WHO Philippines office…

Essential Newborn Care (ENC) 

The ENC Protocol is a step-by-step guide for health workers and medical practitioners issued by the Department of Health for implementation under Administrative Order 2009-0025.

What are these step-by-step interventions?

Immediate drying

Using a clean, dry cloth, thoroughly dry the baby, wiping the face, eyes, head, front and back, arms and legs.

[COMMENT:  If baby is vigorous, drying and rubbing off all the vernix really isn't such a great idea (see the instructions later in the directive regarding bathing the baby). OTOH, if everyone is taught to dry the baby, then you don't have to worry about differentiating between a vigorous and nonvigorous baby ... because you'll just be stimulating all of them!]

Uninterrupted skin-to-skin contact

Aside from the warmth and immediate bonding between mother and child, it has been found that early skin-to-skin contact contributes to a host of medical benefits such as the overall success of breastfeeding/colostrum feeding, stimulation of the mucosa—associated lymphoid tissue system, and colonization with maternal skin flora that can protect the newborn from sepsis and other infectious disease and hypoglycemia.

[COMMENT: LOVE THIS "Intervention"]

Proper cord clamping and cutting

Waiting for up three minutes or until the pulsations stop is found to reduce to chances of anemia in full term and pre-term babies. Evidence also shows that delaying cord clamping has no significant impact on the mother.

[COMMENT: YES!!! While not my idea of delayed cord clamping, THREE MINUTES is a LIFETIME in the medical world!  It's interesting that three minutes is the time called out here, seeing as the research supports a 4 minute cord infusion ... but, 3 minutes is definitely better than immediate!]

Non-separation of the newborn from the mother for early breastfeeding initiation and rooming-in

The earlier the baby breastfeeds, the lesser the risk of death. Keeping the baby latched on to the mother will not only benefit the baby (see skin-to-skin contact) but will also prevent doing unnecessary procedures like putting the newborn on a cold surface for examination (thereby exposing the baby to hypothermia), administering glucose water or formula and foot printing (which increases risk of contamination from ink pads) and washing (the WHO standard is to delay washing up to 6 hours; the vernix protects the newborn from infection). 

[COMMENT:  Non-separating of the newborn from the mother is an intervention?  I do love this recommendation overall, though.]

——————————————————

Now … the harder part is to figure out just how do you get the basics of essential newborn care ingrained into the heart and hands of everyone who is at a birth?  I think the reality is that for births that take place out of the hospital / birth center, then the chances that these basics are happening are greater.  I am hoping to take a look at this with one of the groups of TBAs … much my hunch is that the report will be that they are indeed practicing these “interventions.”

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