Midwife Licensure Exam Independent Delivery & Emergency Obstetric Care — Essential Intrapartum & Newborn Care (EINC / "Unang Yakap")Concept Map

Concept

Intrapartum Maternal Care

Sub Concepts

• Companion of choice for continuous support
• Freedom of movement and position changes
• Oral fluids and light food in labor
• Non-pharmacologic pain relief
• Partograph monitoring
• Restricted routine interventions
• AMTSL (Active Management Third Stage Labor)

Relationship To Central

First half of EINC protocol—creates safe labor environment and prevents complications

Concept

The Warm Chain

Sub Concepts

• Warm delivery room (25-28°C)
• Immediate thorough drying
• Removal of wet cloth
• Skin-to-skin contact
• Bonnet on baby's head
• Delayed first bath (6-24 hours)
• Warm hands and surfaces

Relationship To Central

Critical parallel principle preventing hypothermia—major cause of newborn death

Concept

Four Time-Bound Core Steps (First 90 Minutes)

Sub Concepts

• Step 1: Immediate and Thorough Drying (0-30 seconds)
• Step 2: Early Skin-to-Skin Contact (after drying)
• Step 3: Properly-Timed Cord Clamping (1-3 minutes)
• Step 4: Non-Separation for Early Breastfeeding (within 1 hour)

Relationship To Central

Sequential actions that form the heart of EINC—each step timed and dependent on previous

Concept

Step 1 — Immediate Drying (0-30 seconds)

Sub Concepts

• Place newborn prone on mother's abdomen
• Dry thoroughly: head, back, trunk, arms, legs
• Remove wet cloth immediately
• Do NOT wipe off vernix (protective coating)
• Quick breathing assessment while drying
• Provides tactile stimulation to trigger respiration

Relationship To Central

First action after birth; provides stimulation AND prevents hypothermia

Concept

Step 2 — Early Skin-to-Skin Contact

Sub Concepts

• Place baby prone on mother's bare chest/abdomen
• Cover both mother and baby with dry cloth
• Put bonnet on baby's head
• Maintain continuous uninterrupted contact
• Stabilizes heart rate, blood sugar, breathing
• Mother's body acts as thermal regulator
• Colonizes baby with mother's protective flora

Relationship To Central

Keeps baby warm, stabilizes vitals, establishes protective flora colonization

Concept

Step 3 — Properly-Timed Cord Clamping (1-3 minutes)

Sub Concepts

• Wait until pulsations STOP (typically 1-3 minutes)
• Clamp at 2 cm from base of cord
• Second clamp at 5 cm from base
• Cut between clamps with sterile blade/scissors
• Dry cord care—nothing applied to stump
• No alcohol, antiseptics, or dressings
• Do NOT milk or strip cord as substitute

Relationship To Central

Allows placental transfusion; boosts newborn's iron stores and blood volume

Concept

Step 4 — Non-Separation & Early Breastfeeding

Sub Concepts

• Keep baby in continuous skin-to-skin contact
• Do NOT separate for routine care initially
• Observe feeding cues: drooling, rooting, mouthing
• Support first breastfeed within first hour
• Colostrum provides antibodies and immune protection
• Defer weighing, vitamin K, eye care, bath, exams until after first feed
• Breast crawl and self-attachment during skin-to-skin

Relationship To Central

First feed within first hour gives colostrum; establishes bonding and feeding success

Concept

Newborn Care After First Breastfeed

Sub Concepts

• Vitamin K 1 mg IM (0.5 mg for LBW/preterm)
• Eye prophylaxis: erythromycin or tetracycline ointment
• Immunizations: BCG and Hepatitis B birth dose
• Newborn examination and anthropometrics
• Vitamin A supplementation
• Newborn screening per program
• First bath delayed 6-24 hours

Relationship To Central

Procedures performed once bonding and first feed established

Concept

Eliminated Unnecessary Procedures

Sub Concepts

• Routine suctioning of mouth and nose
• Early (immediate) cord clamping
• Immediate bathing and vernix removal
• Mother-baby separation for routine care
• Routine aggressive stimulation (slapping, hanging upside down)
• Applying substances to cord stump
• Routine footprinting that interrupts skin-to-skin
• Routine gastric suction/aspiration in well baby

Relationship To Central

Practices EINC removed because they are useless or harmful to normal newborns

Concept

Newborn Danger Signs—Detect & Refer

Sub Concepts

• Not breathing, gasping, or abnormal breathing (too fast/slow)
• Severe chest in-drawing or grunting
• Convulsions or seizures
• Floppiness, lethargy, or no movement
• Temperature instability (cold or hot to touch)
• Poor feeding or inability to feed
• Severe jaundice (yellow palms and soles)
• Bleeding from umbilical cord stump

Relationship To Central

Midwife identifies these signs and recognizes need for immediate BEmONC referral

Concept

DOH Institutional Framework

Sub Concepts

• DOH Administrative Order No. 2009-0025
• Institutionalization of Essential Newborn Care
• Integration with Unang Yakap program
• Implementation in RHU, BHS, lying-in clinics
• BEmONC compliance for referral-capable facilities
• MNCHN (Maternal and Newborn Child Health and Nutrition) program alignment

Relationship To Central

Legal and policy basis for EINC implementation in Philippine health system

Concept

Midwife's Preparatory & Clinical Role

Sub Concepts

• Prepare warm, draft-free environment (25-28°C)
• Have two clean dry cloths ready before birth
• Practice hand hygiene and asepsis
• Time each step precisely against clock
• Advocate for mother's companion, mobility, fluids, non-drug pain relief
• Recognize sick newborn and remove from sequence
• Teach family about skin-to-skin and feeding cues
• Document observations and newborn condition

Relationship To Central

Specific actions and responsibilities midwife performs to deliver EINC safely

To

Four Time-Bound Core Steps

From

EINC Protocol

Strength

strong

Relationship

The core steps are the heart of EINC; each step must occur in sequence within first 90 minutes

To

The Warm Chain

From

Four Time-Bound Core Steps

Strength

strong

Relationship

All core steps work together to maintain body temperature; warm chain is the linking principle throughout

To

The Warm Chain

From

Step 1 Immediate Drying

Strength

strong

Relationship

Drying prevents heat loss through evaporation and provides tactile stimulation to start breathing

To

The Warm Chain

From

Step 2 Skin-to-Skin Contact

Strength

strong

Relationship

Mother's body acts as primary heat source; maintains temperature throughout bonding period

To

Newborn Health Outcomes

From

Step 3 Cord Clamping at 1-3 minutes

Strength

strong

Relationship

Delayed clamping provides iron-rich placental transfusion; reduces anemia and iron-deficiency anemia in infancy

To

Colostrum & Immune Protection

From

Step 4 Non-Separation & Early Breastfeeding

Strength

strong

Relationship

First feed within first hour delivers colostrum—the baby's first vaccine with antibodies and immune factors

To

Prevention of Infection

From

Early Breastfeeding

Strength

strong

Relationship

Colostrum and continued breastfeeding protect newborn from sepsis and gastrointestinal infections

To

BEmONC Referral

From

Newborn Danger Signs

Strength

strong

Relationship

Midwife detects signs and immediately refers to Emergency Obstetric and Newborn Care facility; does not attempt management

To

EINC Core Principles

From

Eliminated Procedures

Strength

strong

Relationship

Removed procedures (routine suctioning, early cord clamping, immediate bath) are replaced by evidence-based EINC steps

To

AMTSL & Postpartum Prevention

From

Intrapartum Maternal Care

Strength

strong

Relationship

Oxytocin, controlled cord traction, and uterine massage in third stage prevent postpartum hemorrhage

To

Labor Progress & Intervention Reduction

From

Companion of Choice

Strength

moderate

Relationship

Continuous support from chosen companion shortens labor duration and reduces need for pharmacologic interventions

To

Normal Labor Progression

From

Freedom of Movement

Strength

moderate

Relationship

Upright positions and mobility enhance uterine contractions and fetal descent; reduce pain perception

To

Early Problem Detection

From

Partograph Monitoring

Strength

strong

Relationship

Continuous partograph use identifies prolonged labor or arrest without need for repeated vaginal exams

To

Warm Chain Success

From

Warm Delivery Room

Strength

strong

Relationship

Room temperature 25-28°C with no drafts is the foundation; prevents heat loss from first moment of birth

To

Newborn Thermoregulation & Infection

From

Vernix Protection

Strength

moderate

Relationship

Do NOT wipe off vernix; it protects temperature regulation and acts as natural skin barrier

To

The Warm Chain

From

Bonnet on Baby's Head

Strength

strong

Relationship

Head is large surface area for heat loss; bonnet prevents radiant and evaporative heat loss

To

The Warm Chain

From

Delayed First Bath

Strength

strong

Relationship

Delaying bath 6-24 hours preserves vernix, maintains warmth, and protects natural skin flora

To

Prevention of Hemorrhagic Disease

From

Vitamin K 1 mg IM

Strength

strong

Relationship

Given after first feed to prevent Vitamin K Deficiency Bleeding (VKDB) in newborn

To

Prevention of Ophthalmia Neonatorum

From

Eye Prophylaxis

Strength

strong

Relationship

Erythromycin or tetracycline ointment prevents gonococcal and chlamydial conjunctivitis

To

Newborn Protection Program

From

BCG & Hepatitis B Immunization

Strength

strong

Relationship

Birth-dose immunizations provide early protection against TB and hepatitis B infection

To

EINC Implementation

From

DOH Administrative Order 2009-0025

Strength

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Relationship

Legal mandate for Essential Newborn Care implementation across Philippine health system; frames EINC as standard of care

To

EINC Delivery

From

Midwife's Role

Strength

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Relationship

Midwife is the independent primary provider for normal births; responsible for all EINC steps and recognizing complications

To

Infection Prevention

From

Hand Hygiene & Asepsis

Strength

strong

Relationship

Clean hands and sterile technique at every step prevent cord infection, eye infection, and systemic sepsis

To

EINC Success

From

Precise Timing

Strength

strong

Relationship

Time-bound steps (drying 30 sec, cord clamp 1-3 min, first feed within 1 hour) are critical to protocol effectiveness

To

Prompt Referral & Prevention of Death

From

Recognition of Sick Newborn

Strength

strong

Relationship

Early detection of danger signs triggers immediate removal from EINC sequence and referral to BEmONC; prevents poor outcomes