Essential Intrapartum & Newborn Care (EINC / "Unang Yakap") - Concept Map
EINC: Evidence-Based Safe Birth Protocol for Normal Deliveries
Related concepts
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
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
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
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
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
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
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
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
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
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
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
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
Concept connections
- EINC ProtocolFour Time-Bound Core StepsThe core steps are the heart of EINC; each step must occur in sequence within first 90 minutes
- Four Time-Bound Core StepsThe Warm ChainAll core steps work together to maintain body temperature; warm chain is the linking principle throughout
- Step 1 Immediate DryingThe Warm ChainDrying prevents heat loss through evaporation and provides tactile stimulation to start breathing
- Step 2 Skin-to-Skin ContactThe Warm ChainMother's body acts as primary heat source; maintains temperature throughout bonding period
- Step 3 Cord Clamping at 1-3 minutesNewborn Health OutcomesDelayed clamping provides iron-rich placental transfusion; reduces anemia and iron-deficiency anemia in infancy
- Step 4 Non-Separation & Early BreastfeedingColostrum & Immune ProtectionFirst feed within first hour delivers colostrum—the baby's first vaccine with antibodies and immune factors
- Early BreastfeedingPrevention of InfectionColostrum and continued breastfeeding protect newborn from sepsis and gastrointestinal infections
- Newborn Danger SignsBEmONC ReferralMidwife detects signs and immediately refers to Emergency Obstetric and Newborn Care facility; does not attempt management
- Eliminated ProceduresEINC Core PrinciplesRemoved procedures (routine suctioning, early cord clamping, immediate bath) are replaced by evidence-based EINC steps
- Intrapartum Maternal CareAMTSL & Postpartum PreventionOxytocin, controlled cord traction, and uterine massage in third stage prevent postpartum hemorrhage
- Companion of ChoiceLabor Progress & Intervention ReductionContinuous support from chosen companion shortens labor duration and reduces need for pharmacologic interventions
- Freedom of MovementNormal Labor ProgressionUpright positions and mobility enhance uterine contractions and fetal descent; reduce pain perception
- Partograph MonitoringEarly Problem DetectionContinuous partograph use identifies prolonged labor or arrest without need for repeated vaginal exams
- Warm Delivery RoomWarm Chain SuccessRoom temperature 25-28°C with no drafts is the foundation; prevents heat loss from first moment of birth
- Vernix ProtectionNewborn Thermoregulation & InfectionDo NOT wipe off vernix; it protects temperature regulation and acts as natural skin barrier
- Bonnet on Baby's HeadThe Warm ChainHead is large surface area for heat loss; bonnet prevents radiant and evaporative heat loss
- Delayed First BathThe Warm ChainDelaying bath 6-24 hours preserves vernix, maintains warmth, and protects natural skin flora
- Vitamin K 1 mg IMPrevention of Hemorrhagic DiseaseGiven after first feed to prevent Vitamin K Deficiency Bleeding (VKDB) in newborn
- Eye ProphylaxisPrevention of Ophthalmia NeonatorumErythromycin or tetracycline ointment prevents gonococcal and chlamydial conjunctivitis
- BCG & Hepatitis B ImmunizationNewborn Protection ProgramBirth-dose immunizations provide early protection against TB and hepatitis B infection
- DOH Administrative Order 2009-0025EINC ImplementationLegal mandate for Essential Newborn Care implementation across Philippine health system; frames EINC as standard of care
- Midwife's RoleEINC DeliveryMidwife is the independent primary provider for normal births; responsible for all EINC steps and recognizing complications
- Hand Hygiene & AsepsisInfection PreventionClean hands and sterile technique at every step prevent cord infection, eye infection, and systemic sepsis
- Precise TimingEINC SuccessTime-bound steps (drying 30 sec, cord clamp 1-3 min, first feed within 1 hour) are critical to protocol effectiveness
- Recognition of Sick NewbornPrompt Referral & Prevention of DeathEarly detection of danger signs triggers immediate removal from EINC sequence and referral to BEmONC; prevents poor outcomes
Diagrams
EINC / Unang Yakap: Complete Concept Hierarchy
Master concept hierarchy showing all major domains of EINC: intrapartum maternal care, the warm chain principle, the four time-bound core steps, post-feed newborn care, eliminated procedures, danger signs requiring referral, and the midwife's role. This is the visual overview of the entire chapter.
The Four Time-Bound Core Steps: Sequential Process (First 90 Minutes)
Step-by-step flowchart showing the exact sequence and timing of the four core EINC steps in the first 90 minutes, with decision points for identifying a baby that needs resuscitation/referral. Critical for understanding the time-dependent nature of EINC.
The Warm Chain: Preventing Hypothermia in Newborns
Visual representation of how the warm chain prevents hypothermia at every stage—from room preparation through delivery, immediate drying, skin-to-skin contact, delayed bathing, and even during transport if referral is needed. Shows the continuous nature of temperature protection.
Newborn Danger Signs: Detect & Refer Protocol
Systematic detection flowchart for newborn danger signs organized by body system (respiratory, neurological, thermoregulation, feeding, jaundice, cord/bleeding). Shows the midwife's detect-and-refer pathway at each point, emphasizing that complications are identified and referred to BEmONC—not managed by the midwife.
Newborn States During EINC Protocol
State diagram showing the progression of a normal newborn through EINC from birth through discharge, with decision points where danger signs may trigger deviation to resuscitation or BEmONC referral. Shows both the normal pathway and the abnormal/referral pathways.
Intrapartum Maternal Care (EINC Maternal Half)
The maternal (intrapartum) half of EINC showing continuous support, freedom of movement and choice, non-routine interventions, and AMTSL to prevent postpartum hemorrhage. This precedes and sets the stage for the newborn-focused core steps.