Midwife Licensure Exam Independent Delivery & Emergency Obstetric Care — Essential Intrapartum & Newborn Care (EINC / "Unang Yakap")Cheat Sheet
Essential Intrapartum & Newborn Care (EINC / "Unang Yakap") cheat sheet for Midwife Licensure Exam aspirants. If you could only take one sheet of paper into your review session, this is what it would look like. Professional Regulation Commission (PRC) — Board of Midwifery's most-tested concepts, all in one place.
Exam context
For the Midwife Licensure Examination, Professional Regulation Commission (PRC) — Board of Midwifery tests Independent Delivery & Emergency Obstetric Care under a "Core" label, with Essential Intrapartum & Newborn Care (EINC / "Unang Yakap") in the 2nd slot across 4 chapters. Midwife Licensure Exam candidates must clear the 75% weighted average cut on the 2026 paper, which draws about a meaningful share of Independent Delivery & Emergency Obstetric Care questions. Date to watch: April and November 2026 (expected).
Essential Intrapartum & Newborn Care (EINC / "Unang Yakap") - Cheat Sheet
Your last-minute revision companion for EINC/Unang Yakap — the DOH standard for safe, evidence-based birth care. This sheet covers the four time-bound core steps, the warm chain, intrapartum principles, and the critical procedures to DO and NOT to do. Master this, master a huge chunk of the MLE newborn care section.
Sections
Common Values
Value
25–28°C
Symbol
T
Quantity
Delivery room temperature for EINC
Value
~30 seconds
Symbol
t₁
Quantity
Duration of drying (stimulation) at delivery
Value
1–3 minutes
Symbol
t₂
Quantity
Time to clamp cord after birth pulsations stop
Value
Within first hour (ideally within first 30–60 min)
Symbol
t₃
Quantity
Window for first breastfeed
Value
2 cm from abdomen
Symbol
d₁
Quantity
First clamp distance from umbilical stump
Value
5 cm from abdomen
Symbol
d₂
Quantity
Second clamp distance from umbilical stump
Section Title
EINC Foundation & Legal Basis
Important Facts
- EINC addresses three of the biggest killers of newborns: hypothermia, infection (sepsis), and failure to breathe/feed.
- The protocol is deliverable by a midwife anywhere — a health station, lying-in clinic, or home birth — with minimal equipment (warm cloths, clean hands, sterile instruments).
- EINC is NOT optional best practice; it is the standard of care expected of every midwife in the Philippines.
- The entire sequence is timed: drying (~30 seconds), cord clamping (1–3 minutes after birth), first feed (within the first hour).
Key Definitions
Term
EINC (Essential Intrapartum & Newborn Care)
Example
A midwife at a RHU delivers a term baby: immediate drying, skin-to-skin contact, delayed cord clamping (1–3 min), and early breastfeeding within the first hour — that is EINC.
Definition
DOH-standardized protocol for safe, evidence-based care of mother and newborn at birth, eliminating harmful routine procedures and emphasizing normal physiologic birth.
Term
Unang Yakap (First Embrace)
Example
Mothers in the community know it as 'Unang Yakap' — the baby stays with the mother skin-to-skin right after birth.
Definition
Philippine common name for EINC, emphasizing the first hold and bonding between mother and newborn as the core of the protocol.
Term
DOH Administrative Order 2009-0025
Example
This AO is cited in facility protocols nationwide and is a frequent MLE reference.
Definition
The official DOH regulation institutionalizing EINC policies and guidelines for newborn care in all Philippine health facilities.
Term
Warm Chain
Example
Warm room → immediate drying → removal of wet cloth → skin-to-skin contact → bonnet → delayed bath — break any link and the baby cools.
Definition
An unbroken series of steps preventing heat loss in the newborn from delivery through the first hours of life.
Diagrams To Know
- The warm chain sequence (room temperature → drying → contact → covering → bonnet → delayed bath)
- The four core steps timeline (0–30 sec, 1–3 min, 0–60 min sequence)
Common Values
Value
40–100 mL (or up to 40 mL/kg of infant body weight)
Symbol
V_transfusion
Quantity
Placental transfusion volume from delayed cord clamping
Value
Approx. 25–40 mg iron (equivalent to weeks of iron supplementation)
Symbol
Fe_gain
Quantity
Iron supplementation equivalent from one delayed cord clamping
Section Title
The Four Core Steps of EINC (Time-Bound Sequence)
Important Facts
- DRYING is the stimulation that triggers breathing — NOT slapping, squeezing, or hanging upside down.
- Drying PREVENTS HYPOTHERMIA (evaporative heat loss) — the warm chain's first critical link.
- Do NOT wipe off the vernix caseosa; it is protective for thermoregulation and infection prevention.
- Skin-to-skin contact stabilizes the baby's heart rate, blood sugar, breathing, and colonizes the skin with mother's protective flora.
- Delayed cord clamping (1–3 min) gives the baby an extra 40–100 mL of blood rich in iron — reducing neonatal and childhood anemia.
- Early breastfeeding (within first hour) provides colostrum ('the baby's first vaccine') rich in antibodies and establishes bonding.
- Weighing, vitamin K, eye ointment, BCG, Hep B, and the bath are ALL DEFERRED until AFTER the first full breastfeed.
- Timing is CRITICAL: if you miss the first-hour window, the sequence is compromised.
Key Definitions
Term
Step 1: Immediate and Thorough Drying
Example
Baby born crying but wet; midwife dries head, back, trunk, arms, legs in about 30 seconds, removes the wet cloth, covers with a dry cloth while assessing breathing.
Definition
Within the first ~30 seconds of birth, dry the newborn completely on the mother's abdomen to prevent heat loss via evaporation and provide tactile stimulation for breathing; remove the wet cloth and cover with a dry one.
Term
Step 2: Early Skin-to-Skin Contact
Example
Baby is breathing and pink; placed skin-to-skin on mother's chest, covered with a dry blanket and bonnet; mother and baby stay together continuously.
Definition
Place a breathing, vigorous newborn prone, directly on the mother's bare chest/abdomen, both covered with a warm dry cloth and bonnet on baby; maintain uninterrupted contact.
Term
Step 3: Properly-Timed Cord Clamping
Example
Cord is still pulsing at 30 seconds; midwife waits 2 minutes, pulsations stop, then applies clamps at 2 cm and 5 cm from the umbilical base and cuts with sterile scissors between them.
Definition
Clamp and cut the cord ONLY after pulsations have ceased, typically 1–3 minutes after birth, to allow complete placental transfusion of blood and iron to the newborn.
Term
Step 4: Non-Separation for Early Breastfeeding
Example
Baby and mother remain skin-to-skin for 60+ minutes; baby shows feeding cues (rooting, crawling toward breast); first breastfeed occurs before weighing or injections.
Definition
Keep the newborn in continuous skin-to-skin contact with the mother, defer all routine procedures (weighing, vitamin K, eye care, bath), and support the first breastfeed within the first hour.
Diagrams To Know
- The four-step sequence with time windows (0–30 sec, continuous, 1–3 min, 0–60 min)
- The warm chain links (room → drying → contact → covering → bonnet → delayed bath)
- The cord clamping technique (2 cm clamp + 5 cm clamp + cut between)
Section Title
Cord Care & Cord Clamping Technique
Important Facts
- Apply the FIRST clamp 2 cm from the base of the cord (the baby's abdomen).
- Apply the SECOND clamp 5 cm from the base.
- CUT BETWEEN the two clamps with a sterile blade or scissors.
- Use ONLY sterile instruments for clamping and cutting.
- Do NOT apply any substance (alcohol, iodine, antiseptic, ointment, dressing) to the cord stump routinely — dry care is superior and reduces infection.
- If the cord is contaminated or showing signs of infection (foul smell, purulent discharge, red/warm skin around the base), refer for evaluation.
- The cord stump should be kept clean and dry; if soiled, gently wipe with a clean, dry cloth.
- Early cord clamping (before 1 minute) deprives the baby of the placental transfusion and increases neonatal anemia risk.
Key Definitions
Term
Dry Cord Care
Example
After clamping and cutting, the cord is left uncovered or covered with a clean, dry cloth; no alcohol swab, no betadine, no antibiotic ointment is applied routinely.
Definition
Keeping the umbilical cord stump clean and dry WITHOUT applying any substance (alcohol, antiseptics, dressings, or ointments); the gold standard for cord care.
Term
Delayed Cord Clamping
Example
At 30 seconds after birth, the cord is still pulsing; the midwife watches and waits; by 2 minutes, pulsations slow and stop; NOW the cord is clamped.
Definition
Deferring the clamping of the umbilical cord until pulsations have ceased, typically 1–3 minutes after birth, allowing the baby to receive blood from the placenta.
Term
Cord Stump (Umbilical Remnant)
Example
After clamping at 2 cm and cutting, the stump is about 2 cm long, attached to the umbilicus; it dries, darkens, and falls off around day 7–14.
Definition
The portion of the umbilical cord remaining attached to the baby's abdomen after clamping and cutting, which will dry and separate in 1–2 weeks.
Diagrams To Know
- The cord clamping and cutting technique (2 cm and 5 cm clamp positions, cut location)
Common Values
Value
Within 1 hour of birth (ideally 30–60 min)
Symbol
t_first_feed
Quantity
Window for first breastfeed
Value
At least 60 minutes (or longer)
Symbol
t_contact
Quantity
Duration of uninterrupted skin-to-skin contact minimum
Section Title
Early Breastfeeding & Non-Separation Principle
Important Facts
- The first breastfeed must occur WITHIN THE FIRST HOUR of life (ideally 30–60 minutes).
- Colostrum is the first vaccine — rich in IgA antibodies that protect against infection.
- Early, exclusive breastfeeding establishes milk supply, bonding, and feeding behavior.
- The baby's feeding cues (rooting, crawling, licking) indicate readiness; support self-attachment rather than forcing the baby to the breast.
- Non-separation means weighing, vitamin K, eye care, BCG, Hep B, and even the first bath are DEFERRED until AFTER the first feed.
- Continuous skin-to-skin contact is not a brief photo moment; it must be uninterrupted for at least the first hour.
- Separation for routine procedures interrupts bonding and increases the baby's stress (cortisol) and cold risk.
- The mother's body regulates the baby's temperature, heart rate, and blood sugar during skin-to-skin contact.
Key Definitions
Term
Colostrum
Example
Within the first hour, the baby breastfeeds and receives colostrum, which coats the newborn's mouth and gut, providing immune protection.
Definition
The first milk secreted by the mother's breast, rich in antibodies (IgA), proteins, and nutrients; the baby's first vaccine against infection.
Term
Feeding Cues
Example
During skin-to-skin, the baby licks the mother's skin, roots with its mouth, and crawls toward the breast — these are feeding cues; support the baby to self-attach.
Definition
Observable signs that a newborn is ready to feed: drooling, tonguing, licking, rooting, hand-to-mouth movement, 'breast crawl' movements, and mouthing.
Term
Breast Crawl (Self-Attachment)
Example
Baby placed on mother's chest at 10 minutes of life, moves toward breast, finds nipple, and self-attaches to feed by 20 minutes — the breast crawl.
Definition
The spontaneous movement of a newborn, when placed skin-to-skin on the mother's chest, to locate and latch onto the breast without external help.
Term
Non-Separation (Mother-Baby Dyad)
Example
Baby is NOT taken to be weighed, measured, or injected until at least 1 hour after delivery and after the first full breastfeed.
Definition
Keeping the mother and newborn together continuously in skin-to-skin contact, not separating for routine procedures until after the first breastfeed.
Diagrams To Know
- Feeding cues progression (drooling → rooting → crawling → latch)
- The breast crawl sequence (baby placed on chest → spontaneous movement → locates breast → self-attaches)
Common Values
Value
1 mg IM
Symbol
D_VitK_term
Quantity
Vitamin K dose for term newborn
Value
0.5 mg IM
Symbol
D_VitK_preterm
Quantity
Vitamin K dose for preterm/LBW newborn
Value
0.05 mL ID
Symbol
D_BCG
Quantity
BCG vaccine dose
Value
5–10 mcg IM
Symbol
D_HepB
Quantity
Hepatitis B vaccine dose (term newborn)
Value
6 hours (many protocols: 24 hours)
Symbol
t_bath_delay
Quantity
Minimum delay for first bath
Section Title
Newborn Care After First Feed: Vitamin K, Eye Care, Immunizations, Examination, Bath
Important Facts
- Vitamin K 1 mg IM is given AFTER the first breastfeed to prevent VKDB (hemorrhagic disease of the newborn).
- Dose is reduced to 0.5 mg IM for preterm or low-birth-weight newborns per protocol.
- Eye prophylaxis (erythromycin or tetracycline ointment) is applied to BOTH eyes using sterile technique; do not allow ointment in the eye to be wiped away.
- BCG is given intradermally (not IM or subcutaneously) on the upper arm; a bleb (raised wheal) should form.
- Hepatitis B birth dose must be given within 24 hours; earlier is better if possible.
- All immunizations and injections are deferred until AFTER the first breastfeed (within the first 1–2 hours post-delivery).
- The first bath is delayed at least 6 hours; many facilities delay 24 hours to allow vernix to be absorbed and body temperature to stabilize.
- If bathing earlier than 6 hours is needed (e.g., soiled with meconium), ensure the water is warm, the bath is quick, and the baby is dried and redressed immediately.
Key Definitions
Term
Vitamin K (Phytomenadione) Prophylaxis
Example
After the first breastfeed, the midwife gives the baby 1 mg vitamin K IM to the anterolateral thigh to prevent bleeding complications.
Definition
Administration of 1 mg IM to the newborn (0.5 mg for preterm/low-birth-weight) to prevent Vitamin K Deficiency Bleeding (VKDB/hemorrhagic disease of the newborn).
Term
Eye Prophylaxis (Ophthalmia Neonatorum Prevention)
Example
Using a sterile applicator, apply a thin line of erythromycin 0.5% ointment along the lower conjunctiva of each eye after the first feed.
Definition
Application of erythromycin or tetracycline eye ointment to both eyes of the newborn to prevent gonococcal and chlamydial conjunctivitis.
Term
BCG Vaccination (Birth Dose)
Example
After vitamin K and eye care, the baby receives 0.05 mL of BCG vaccine intradermally on the upper arm.
Definition
Intradermal immunization at birth to prevent tuberculosis; given as soon as possible after birth, ideally after the first feed.
Term
Hepatitis B Birth Dose
Example
Baby receives 5 mcg (or 10 mcg per schedule) of Hepatitis B vaccine IM on the anterolateral thigh, either at birth or before discharge.
Definition
IM immunization given to all newborns within 24 hours of birth to prevent vertical transmission of hepatitis B virus.
Term
Delayed First Bath
Example
The baby is not bathed until at least 6–24 hours after birth, preserving the vernix and reducing hypothermia risk.
Definition
Deferring the newborn's first full immersion bath for at least 6 hours (many protocols recommend ~24 hours) to preserve warmth and the protective vernix.
Diagrams To Know
- Sequence of care after first feed (vitamin K → eye ointment → BCG → Hep B → examination → bath when appropriate)
Section Title
Procedures to ELIMINATE (What NOT to Do)
Important Facts
- Routine suctioning of a vigorous, breathing newborn with clear amniotic fluid is HARMFUL — it can cause bradycardia, apnea, laryngospasm, and mucosal bleeding.
- Suctioning is indicated ONLY if the airway is obstructed (e.g., thick meconium, blood, secretions) and the baby cannot breathe or cry effectively.
- Aggressive stimulation (slapping, squeezing, hanging upside down) is NOT needed — drying is sufficient stimulation.
- Early cord clamping was common practice but deprives the baby of 40–100 mL of blood and iron; it increases neonatal anemia and childhood iron-deficiency anemia.
- Immediate bathing causes hypothermia and removes the protective vernix caseosa; bathing should be delayed at least 6 hours.
- Separation for routine weighing, injections, and examination interrupts bonding, causes stress to the baby (increased cortisol), and breaks the warm chain.
- Applying alcohol, iodine, or other substances to the cord stump increases infection risk; dry cord care is the evidence-based standard.
- Routine gastric suction or aspiration in a well newborn is unnecessary and can cause aspiration risk.
- Routine foot-printing for identification should NOT interrupt skin-to-skin contact in the first hour; defer it until after the first feed.
Key Definitions
Term
Routine Suctioning (Non-Meconium Aspiration)
Example
Baby is born crying and breathing well; there is NO indication to suction. Suctioning can cause bradycardia, apnea, and mucosal injury.
Definition
The unnecessary practice of suctioning the mouth and nose of a vigorous, breathing newborn with clear amniotic fluid; EINC eliminates this.
Term
Early (Immediate) Cord Clamping
Example
Old practice: cord clamped at 15–30 seconds. EINC practice: cord clamped at 1–3 minutes after pulsations cease.
Definition
Clamping the umbilical cord within seconds of birth, before pulsations cease; eliminates the placental transfusion and increases anemia risk.
Term
Immediate Bathing
Example
Old practice: baby bathed within 1 hour of birth. EINC practice: first bath delayed at least 6–24 hours.
Definition
Washing the newborn within the first few hours of birth, removing the protective vernix and causing rapid heat loss.
Term
Mother-Baby Separation for Routine Care
Example
Old practice: baby taken to nursery for weighing and injections while mother recovers. EINC practice: all procedures deferred until after first breastfeed, done with mother present.
Definition
Taking the baby away from the mother for weighing, measuring, injections, or examination in the first 1–2 hours of life.
Term
Applying Substances to Cord Stump
Example
Old practice: daily alcohol swabs or triple dye on the stump. EINC practice: leave stump clean and dry; no routine applications.
Definition
Routine use of alcohol, iodine, antiseptics, or dressings on the umbilical cord stump; dry cord care is superior.
Diagrams To Know
- List of eliminated vs. retained procedures (side-by-side comparison)
Common Values
Value
10 IU IM
Symbol
D_Oxytocin_AMTSL
Quantity
Oxytocin dose for AMTSL
Value
Within 1 minute of birth
Symbol
t_Oxytocin
Quantity
Timing for oxytocin administration after birth
Value
Every 4 hours (or admission and discharge)
Symbol
f_partograph
Quantity
Frequency of partograph plotting in normal labor
Section Title
EINC Intrapartum Care of the Mother
Important Facts
- A companion of choice during labor significantly reduces labor duration, pain, and the need for interventions like epidural, oxytocin augmentation, and cesarean.
- Freedom to walk and change position in labor improves pelvic mechanics, reduces pain, and facilitates descent of the baby.
- Oral fluids and light food in labor are safe and appropriate for most mothers; routine 'nothing by mouth' is not evidence-based for normal labor.
- Non-pharmacologic pain relief (breathing, massage, warmth, position changes) is effective and carries no fetal risk.
- The partograph is the low-tech, gold-standard tool for monitoring normal labor; it reduces unnecessary vaginal exams and identifies problems early.
- AMTSL (oxytocin 10 IU IM within 1 minute of birth + controlled cord traction + uterine massage) reduces postpartum hemorrhage risk by ~60%.
- Routine episiotomy is HARMFUL; it increases pain, infection, and long-term complications (3rd/4th degree tears, dyspareunia). Episiotomy is used ONLY for specific indications (fetal distress, instrumental delivery).
- Routine IV lines and continuous electronic fetal monitoring are not indicated in low-risk, normal labor.
- The mother's emotional state, support, and sense of control significantly affect labor outcomes and postpartum recovery.
Key Definitions
Term
Companion of Choice
Example
The mother's husband, mother, or best friend stays with her throughout labor and is present at birth; continuous support shortens labor and reduces interventions.
Definition
A person (partner, relative, friend) chosen by the mother to remain with her continuously during labor and delivery for emotional, physical, and informational support.
Term
Freedom of Movement and Position
Example
The mother walks during labor, squats during contractions, and gives birth in a semi-recumbent or standing position — her choice, not imposed.
Definition
The mother's ability to walk, change position, and adopt the birth position of her choice during labor and delivery, not confined to lying flat on her back.
Term
Non-Pharmacologic Pain Relief
Example
The midwife uses breathing techniques, counterpressure on the back, and warm water (shower/bath) to help the mother manage labor pain.
Definition
Comfort measures and coping strategies that do NOT use medications: breathing techniques, back massage, warm compresses, position changes, reassurance, and continuous support.
Term
Partograph Monitoring
Example
The midwife plots cervical dilation on the partograph every 4 hours (or at admission and discharge), visualizing progress and identifying prolonged labor early.
Definition
A graphic record of labor progression (cervical dilation, descent, contractions) used to monitor normal labor and detect abnormalities; reduces unnecessary vaginal examinations.
Term
Active Management of Third Stage of Labor (AMTSL)
Example
Immediately after the baby is born and breathing, the midwife gives oxytocin 10 IU IM, waits for the cord to stop pulsing, applies controlled traction, and massages the uterus to expel the placenta quickly.
Definition
Immediate, planned interventions after birth of the baby to prevent postpartum hemorrhage: oxytocin 10 IU IM within 1 minute, controlled cord traction, and uterine massage.
Term
Restricted Routine Interventions
Example
A mother in normal labor is NOT given an automatic IV, enema, or episiotomy; these are used only if there is a specific clinical indication.
Definition
Elimination of unnecessary procedures in normal labor: no routine enema, perineal shaving, episiotomy, IV lines, or oxytocin augmentation unless indicated.
Diagrams To Know
- The partograph (cervical dilation curve, action line, alert line)
Common Values
Value
≥60 breaths/minute at rest
Symbol
RR_danger
Quantity
Fast breathing (tachypnea) in newborn
Value
Jaundiced palms, soles, and entire body in first 24–72 hours
Symbol
Bili_danger
Quantity
Severe jaundice (bilirubinemia requiring action)
Section Title
Recognizing & Referring Newborn Danger Signs
Important Facts
- A newborn who does NOT breathe or cry after drying/stimulation requires immediate resuscitation and referral (covered in the emergency chapter).
- Danger signs in the first 72 hours: not breathing/gasping, severe chest in-drawing, grunting, convulsions, lethargy/floppiness, no movement.
- Temperature instability (cold to touch/shivering or hot/flushed) suggests hypothermia, infection, or other illness — refer.
- Poor feeding or inability to breastfeed (weak suck, no interest) requires immediate assessment and referral.
- Jaundice with yellow palms and soles (severe jaundice) in the first 24–72 hours requires urgent evaluation and possible phototherapy/exchange transfusion — refer.
- Bleeding from the cord stump, mouth, or other sites suggests Vitamin K deficiency bleeding (VKDB) or other bleeding disorder — refer urgently.
- Abdominal distension, vomiting, or no bowel movement by 48 hours suggests obstruction or other surgical problem — refer.
- Pustules, rash, or signs of infection (foul-smelling discharge, red/warm umbilicus, fever) suggest neonatal sepsis — refer.
- A baby with a bulging fontanelle, high-pitched cry, or stiffness suggests meningitis or intracranial problem — refer urgently.
- The midwife stabilizes (warm, gentle handling, feed if possible) and refers ALL danger signs; early detection saves lives.
Key Definitions
Term
Newborn Danger Signs
Example
A baby with severe chest in-drawing, fast breathing (>60/min at rest), grunting, or poor feeding is NOT normal and requires immediate referral.
Definition
Clinical indicators that the newborn is NOT normal and requires immediate assessment, management, or referral to a higher-level facility (BEmONC/MNCHN).
Term
Detect & Refer Framework
Example
The midwife sees a baby with convulsions or jaundiced palms and soles; she stabilizes the baby, keeps the baby warm and with the mother, and arranges urgent referral — she does NOT attempt to manage these independently.
Definition
The midwife's scope: recognize danger signs early (detect) and arrange immediate referral; managing complications is NOT the midwife's independent role.
Diagrams To Know
- Newborn danger signs checklist (breathing, chest, activity, temperature, feeding, color, cord, infection signs)
- The 'detect & refer' decision tree (normal vs. danger sign → action)
Section Title
The Midwife's Practical Role in Delivering EINC
Important Facts
- PREPARATION is key: ensure the room is warm, equipment is at hand, and the midwife is calm and confident.
- The midwife must be able to perform the ENTIRE four-step sequence smoothly and on time — drying (~30 sec), skin-to-skin contact, cord clamping (1–3 min), early feeding (0–60 min).
- The midwife watches the clock: if any step is delayed or skipped, outcomes suffer.
- Clean hands, clean cloth, and clean scissors are the minimal safe requirements — EINC does NOT require high-tech equipment.
- The midwife must know normal labor and normal newborn signs; she must also recognize danger signs and know when to refer.
- Communication with the mother and her companion about EINC builds trust and support.
- EINC requires a shift in mindset: from 'managing' births to 'supporting' normal birth and 'recognizing & referring' complications.
- The midwife's presence, calm demeanor, and continuity of care are therapeutic in themselves.
Key Definitions
Term
Environment Preparation
Example
Before the mother arrives in labor, the midwife checks room temperature, closes the windows, turns off the fan, and lays out two clean towels and a bonnet.
Definition
Pre-delivery setup to ensure the warm chain is activated: room temperature 25–28°C, windows/doors closed (no drafts), fans/AC directed away, two clean dry cloths ready.
Term
Clean Technique & Hand Hygiene
Example
The midwife washes her hands with soap and clean water before delivery, dries the baby with a clean cloth, and uses sterile scissors to cut the cord.
Definition
Observing asepsis at every step of EINC: washing hands before and after contact, using sterile instruments for cord clamping/cutting, and maintaining a clean environment.
Term
Advocacy for the Mother
Example
The midwife encourages the mother's companion, supports her movement and position changes, and protects her from unnecessary interventions like routine episiotomy or IV lines.
Definition
The midwife's responsibility to support the mother's choices and needs during labor and delivery, ensuring she is treated with respect and receives intrapartum EINC care.
Diagrams To Know
- The midwife's pre-delivery checklist (environment, equipment, hand hygiene)
- The EINC delivery flow (admission → labor support → delivery → four steps → danger sign assessment)
Must Remember
- EINC is institutionalized by DOH AO 2009-0025; it is the STANDARD of care, not optional, and covers both intrapartum (mother) and newborn care.
- The FOUR TIME-BOUND CORE STEPS in strict sequence: (1) Immediate & thorough drying (~30 sec), (2) Early skin-to-skin contact, (3) Cord clamping 1–3 min after pulsations stop, (4) Non-separation for early breastfeeding within 1 hour.
- DRYING = stimulation to breathe + prevention of hypothermia; do NOT wipe off vernix, do NOT use aggressive slapping/hanging.
- DELAYED CORD CLAMPING (1–3 min) gives the baby 40–100 mL of placental blood and iron; clamp at 2 cm and 5 cm from umbilical base, cut between with sterile instrument.
- DRY CORD CARE: keep stump clean and dry; NO alcohol, iodine, ointment, or dressing routine; apply substance only if contaminated/infected.
- FIRST BREASTFEED within 1 hour: colostrum is the 'first vaccine' rich in antibodies; skin-to-skin contact stabilizes baby's heart rate, blood sugar, breathing, and enables feeding cues (rooting, crawling, latch).
- PROCEDURES DEFERRED until after first feed: weighing, vitamin K (1 mg IM), eye ointment (erythromycin/tetracycline), BCG (0.05 mL ID), Hep B (5–10 mcg IM), examination, first bath (≥6 hours delay, many ~24 hours).
- ELIMINATE these harmful practices: routine suctioning (vigor. baby), early cord clamping, immediate bathing (removes vernix, causes cold), mother-baby separation, applying substances to cord, aggressive stimulation.
- WARM CHAIN (25–28°C room → dry → skin-to-skin → bonnet → delayed bath) prevents hypothermia, the #1 killer of newborns.
- INTRAPARTUM CARE (mother): companion of choice, freedom of movement/position, oral fluids, non-pharmacologic pain relief, partograph monitoring, AMTSL (oxytocin 10 IU IM within 1 min + controlled cord traction + uterine massage), no routine episiotomy/IV/enema.
Last Minute Tips
- TIMING IS EVERYTHING: Memorize the four-step timeline (drying 30 sec, cord 1–3 min, first feed within 60 min). The MLE will test whether you know when each step happens, not just what it is.
- DISTINGUISH 'DETECT & REFER' from 'MANAGE': The midwife recognizes newborn danger signs (breathing problems, convulsions, poor feeding, jaundice, bleeding) and REFERS to BEmONC; she does NOT manage complications independently. This is the foundation of RA 7392 scope.
- PRACTICE THE CORD CLAMPING TECHNIQUE: Know exactly where to place the clamps (2 cm and 5 cm from the umbilical base) and how to cut. Exam questions often ask about specific distances and the reason for delayed clamping (placental transfusion).
- KNOW WHAT CHANGED WITH EINC: The exam loves testing which old practices are NOW ELIMINATED. Memorize: no routine suctioning (vigor. baby), no immediate bath, no immediate cord clamping, no mother-baby separation in first hour. Each has a reason; know it.
- COLOSTRUM & EARLY FEEDING ARE LIFESAVING: The exam will test your understanding that exclusive breastfeeding within the first hour provides antibodies ('first vaccine'), establishes bonding, and supports newborn physiology. It is NOT optional; it is core EINC.
Comparison Tables
Rows
Values
- Immediate (within 15–30 seconds)
- Delayed (1–3 minutes after pulsations cease)
- Allows placental transfusion; baby receives 40–100 mL blood and iron; reduces anemia
Property
Cord Clamping Timing
Values
- Vigorous handling, slapping, hanging upside down
- Thorough, gentle drying on mother's abdomen (~30 sec); remove wet cloth
- Prevents hypothermia through drying; gentle stimulation triggers breathing without harm
Property
Drying & Stimulation
Values
- Immediate bath within 1 hour (washes off vernix)
- Delayed bath at least 6–24 hours (preserves vernix)
- Preserves warmth, protective skin barrier, and thermoregulation
Property
Newborn Bathing
Values
- Baby taken to nursery for weighing, exams, injections
- Baby stays with mother skin-to-skin; procedures deferred until after first feed
- Preserves bonding, stabilizes baby's physiology, enables early breastfeeding
Property
Mother-Baby Separation
Values
- All babies suctioned at birth
- Suctioning only if airway obstructed (thick secretions, blood, meconium)
- Avoids harm (bradycardia, apnea); vigorous baby does not need suctioning
Property
Routine Suctioning
Values
- Delayed until baby is 'cleaned up' and stabilized
- Within first 1 hour of life (ideally 30–60 min) during skin-to-skin
- Provides colostrum (first vaccine); establishes bonding and milk supply
Property
First Breastfeed
Values
- Routine alcohol swabs, iodine, or dressing applied
- Dry cord care; keep clean and dry; no routine substance
- Reduces infection risk; dry healing is faster and safer
Property
Cord Stump Care
Values
- Variable; not standardized
- 25–28°C warm, draft-free room maintained
- Prevents hypothermia; critical for survival in newborn
Property
Room Temperature
Values
- Given immediately at birth
- Given AFTER the first breastfeed (within 1–2 hours)
- Does not interrupt skin-to-skin and early feeding; prevents VKDB
Property
Vitamin K Timing
Values
- Given immediately at birth
- Given AFTER the first breastfeed (within first few hours)
- Does not interfere with early bonding and feeding
Property
Eye Prophylaxis Timing
Columns
- Aspect
- OLD Routine Practice
- EINC Standard Practice
- Why EINC is Better
Table Title
EINC Practice vs. Old Routine Practices
Rows
Values
- Not breathing, gasping, severe difficulty, >60 breaths/min at rest, grunting, severe chest in-drawing
- Assess airway, ensure baby is warm and dry, stabilize, refer urgently to BEmONC
- EMERGENT (within minutes)
Property
Breathing Problems
Values
- Limp/floppy, no movement, no response to stimulation, convulsions/seizures
- Keep baby warm with mother, assess for danger signs, refer urgently
- EMERGENT (within minutes)
Property
Activity & Muscle Tone
Values
- Cold to touch (hypothermia <36.5°C) or hot/flushed (fever >38°C)
- Warm the baby with mother (skin-to-skin), assess for infection signs, refer
- URGENT (within 1–2 hours)
Property
Temperature
Values
- Unable to feed, weak suck, no interest in breast, vomiting
- Assess for other signs of illness, support feeding, refer if poor feeding persists
- URGENT (same day)
Property
Feeding
Values
- Jaundiced palms and soles in first 24–72 hours (severe jaundice)
- Assess for other signs, ensure feeding, refer for serum bilirubin and possible phototherapy
- URGENT (within hours)
Property
Jaundice
Values
- Bleeding from cord stump, mouth, skin (bruising beyond normal), blood in stool/urine
- Apply gentle pressure if bleeding, keep warm with mother, refer urgently
- EMERGENT–URGENT (minutes to hours)
Property
Bleeding/Hemorrhage
Values
- Pustules, rash, foul-smelling discharge from cord, red/warm/swollen umbilicus, fever (>38°C), lethargy
- Isolate baby if possible, support care, keep warm, refer urgently for evaluation
- URGENT (within hours)
Property
Signs of Infection
Values
- Severe abdominal distension, vomiting (especially bilious), no stool by 48 hours, blood in stool
- Stop feeding if vomiting, keep warm, refer urgently to rule out obstruction or surgical problem
- EMERGENT–URGENT (hours)
Property
Abdominal/GI Problems
Columns
- Danger Sign Category
- Specific Signs to Watch
- Immediate Action by Midwife
- Urgency of Referral
Table Title
Newborn Danger Signs: Recognize & Refer
Rows
Values
- Support normal labor, monitor with partograph, deliver baby safely
- Manage eclampsia, severe hemorrhage, obstructed labor, sepsis, and other emergencies
- Hypertension >160/110, severe bleeding, convulsions, prolonged labor >12 hours, fever >38.5°C
Property
Maternal Complications
Values
- Vigorous drying, gentle stimulation; resuscitate with bag-mask if needed (see emergency chapter)
- Intubation, mechanical ventilation, oxygen therapy for respiratory distress syndrome (RDS), meconium aspiration
- No breathing after drying/stimulation, continued gasping, severe in-drawing, grunting >60 min
Property
Newborn Breathing
Values
- Activate warm chain; skin-to-skin contact stabilizes temperature in normal babies
- Manage severe hypothermia (<32°C), fever >38.5°C, and temperature instability despite warming
- Temperature <35.5°C that does not improve with skin-to-skin, or >38.5°C with other signs
Property
Newborn Temperature
Values
- Encourage early, frequent breastfeeding; monitor for danger signs
- Phototherapy, exchange transfusion for severe hyperbilirubinemia
- Jaundiced palms/soles in first 24–72 hours, suspected severe jaundice, or failed feeding
Property
Jaundice
Values
- Maintain clean technique, recognize danger signs, refer early
- IV antibiotics, cultures, sepsis workup, intensive monitoring
- Signs of infection (pustules, rash, fever, lethargy, poor feeding), foul cord smell, maternal fever/infection
Property
Infection/Sepsis
Values
- Recognize danger signs, keep baby warm, refer urgently
- Manage VKDB with IV vitamin K, coagulation studies, possible transfusion
- Bleeding from any site, bruising beyond normal, blood in stool/urine, or severe jaundice suggesting hemolysis
Property
Bleeding
Columns
- Aspect
- Midwife's Scope (EINC — Normal Care)
- BEmONC/MNCHN Facility (High-Risk/Complication Care)
- Trigger for Referral
Table Title
EINC vs. BEmONC Care: When to Refer
Previous chapter
Normal Spontaneous Delivery — Independent Conduct & Hands-On Technique
Next chapter
Partograph Use & Referral Decision-Making
Ready to practise for the Midwife Licensure Exam 2026?
Super Tutor's AI review plan adapts to your weak areas and builds a weekly practice schedule around your target Midwife Licensure Exam exam date.