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

Marks

1

Topic

EINC Overview

Difficulty

easy

Template Id

T1

Examiner Tip

The word 'Intrapartum' is the one most often misspelled or replaced incorrectly. Write it out carefully and completely.

Model Answer

EINC stands for Essential Intrapartum and Newborn Care.

Question Type

very_short_answer

Answer Structure

• Line 1: State the complete expanded form — 'Essential Intrapartum and Newborn Care' [1 mark]

Scoring Breakdown

Common Mark Deductions

• Writing 'Essential Infant and Newborn Care' — 'Intrapartum' is the correct second word
• Omitting any one word of the acronym
• Writing only the abbreviation without expanding it

Key Phrases To Include

• Essential
• Intrapartum
• Newborn Care

Marks

1

Topic

EINC Policy Basis

Difficulty

easy

Template Id

T2

Examiner Tip

Memorize '2009-0025' as a pair — the year 2009 and the number 0025. Examiners specifically look for the AO number, not just a general DOH reference.

Model Answer

EINC is institutionalized by DOH Administrative Order No. 2009-0025, titled 'Adopting Policies and Guidelines on Essential Newborn Care.'

Question Type

very_short_answer

Answer Structure

• Line 1: State the exact AO number and year — 'DOH AO No. 2009-0025' [1 mark]

Scoring Breakdown

Common Mark Deductions

• Stating only 'DOH guidelines' without the specific AO number
• Giving the wrong year or wrong AO number
• Confusing this AO with the Rooming-In and Breastfeeding Act (RA 7600)

Key Phrases To Include

• DOH Administrative Order
• 2009-0025
• Unang Yakap

Marks

2

Topic

EINC Overview

Difficulty

easy

Template Id

T3

Examiner Tip

Always connect the Filipino name to its clinical meaning — examiners reward students who show they understand the concept behind the name, not just its translation.

Model Answer

The popular name of EINC is 'Unang Yakap,' which is Filipino for 'First Embrace.' The name reflects the skin-to-skin contact between mother and newborn immediately after birth, which is at the heart of the EINC protocol.

Question Type

very_short_answer

Answer Structure

• Line 1: State the popular name — 'Unang Yakap' [1 mark]
• Line 2: Provide the English translation and its significance — 'First Embrace,' referring to skin-to-skin contact [1 mark]

Scoring Breakdown

Common Mark Deductions

• Translating as 'First Hug' — 'First Embrace' is the accepted term
• Stating the name without explaining its meaning or connection to EINC
• Misspelling 'Unang Yakap'

Key Phrases To Include

• Unang Yakap
• First Embrace
• skin-to-skin contact
• bonding

Marks

2

Topic

Cord Clamping — EINC Step 3

Difficulty

medium

Template Id

T4

Examiner Tip

The two conditions — time (1–3 min) AND cessation of pulsations — are both part of the correct answer. Give both to be safe.

Model Answer

According to EINC, the umbilical cord should be clamped AFTER the cord pulsations have stopped, which is typically between 1 and 3 minutes after birth. This is called properly-timed (or delayed) cord clamping. It allows the placental transfusion to continue, giving the newborn additional blood volume and iron stores that help prevent neonatal anemia.

Question Type

short_answer

Answer Structure

• Line 1: State the correct timing — '1 to 3 minutes after birth' or 'after pulsations stop' [1 mark]
• Line 2: State the rationale — placental transfusion / prevents neonatal anemia / increases iron stores [1 mark]

Scoring Breakdown

Common Mark Deductions

• Stating only '3 minutes' without mentioning pulsations as the guide
• Omitting the rationale entirely
• Confusing delayed clamping with milking/stripping the cord (EINC does NOT recommend routine milking)

Key Phrases To Include

• 1 to 3 minutes
• after pulsations stop
• placental transfusion
• iron stores
• neonatal anemia

Marks

2

Topic

Cord Clamping Technique — EINC Step 3

Difficulty

medium

Template Id

T5

Examiner Tip

Remember '2 and 5' for cord clamping, and 'dry cord care = nothing applied' for stump management. These specific numbers almost always appear in licensure exams.

Model Answer

After cord pulsations have stopped (1–3 minutes after birth), place the FIRST clamp approximately 2 cm from the base of the cord (from the newborn's abdomen) and the SECOND clamp approximately 5 cm from the base. Cut the cord between the two clamps using a sterile blade or sterile scissors. The stump is then managed with dry cord care — no substances (no alcohol, no antiseptic, no dressings) are applied.

Question Type

short_answer

Answer Structure

• Line 1: Position of first clamp — 2 cm from the base [0.5 mark]
• Line 2: Position of second clamp — 5 cm from the base [0.5 mark]
• Line 3: Instrument used — sterile blade or sterile scissors, cut between the clamps [0.5 mark]
• Line 4: Post-cut care — dry cord care, nothing applied to the stump [0.5 mark]

Scoring Breakdown

Common Mark Deductions

• Reversing the measurements (5 cm first, 2 cm second)
• Stating that alcohol or antiseptic is applied to the stump — this contradicts EINC dry cord care
• Not specifying 'sterile' instrument

Key Phrases To Include

• 2 cm from the base
• 5 cm from the base
• sterile blade
• sterile scissors
• dry cord care
• nothing applied

Marks

3

Topic

Four Core Steps of EINC

Difficulty

medium

Template Id

T6

Examiner Tip

Write the steps as a numbered list with a one-line explanation for each. Examiners award marks per step, so even partial credit is available if you get 3 out of 4 steps correctly.

Model Answer

The four time-bound core steps of EINC (Unang Yakap) performed in the first 90 minutes of life are: 1. Immediate and thorough drying — performed within the first 30 seconds of birth to stimulate breathing and prevent hypothermia. 2. Early skin-to-skin contact — newborn placed prone on the mother's bare chest/abdomen immediately after drying, covered with a warm dry cloth and bonnet. 3. Properly-timed cord clamping — cord is clamped only after pulsations stop, typically 1–3 minutes after birth, to allow placental transfusion. 4. Non-separation of newborn from mother for early breastfeeding — baby stays skin-to-skin and is supported to breastfeed within the first hour of life, with all other procedures (weighing, vitamin K, eye care, bath) deferred until after the first feed.

Question Type

short_answer

Answer Structure

• Intro: 'The four time-bound core steps of EINC are:' [sets up the answer clearly]
• Step 1: Immediate and thorough drying — 30 seconds — stimulates breathing and prevents hypothermia [1 mark]
• Step 2: Early skin-to-skin contact — prone on mother's bare chest, covered with dry cloth and bonnet [0.5 mark]
• Step 3: Properly-timed cord clamping — after pulsations stop, 1–3 minutes [0.5 mark]
• Step 4: Non-separation for early breastfeeding — within the first hour, all other care deferred [1 mark]

Scoring Breakdown

Common Mark Deductions

• Listing steps out of order — EINC is a time-bound sequence; order matters
• Missing the timing for each step (e.g., just writing 'drying' without '30 seconds')
• Writing 'immediate cord clamping' — this is the OLD practice EINC replaced
• Stating that routine suctioning is one of the steps — it is NOT

Key Phrases To Include

• immediate and thorough drying
• 30 seconds
• skin-to-skin contact
• properly-timed cord clamping
• 1–3 minutes
• after pulsations stop
• non-separation
• early breastfeeding
• within the first hour
• first 90 minutes

Marks

2

Topic

EINC Step 1 — Drying

Difficulty

easy

Template Id

T7

Examiner Tip

Examiners want the mechanism, not just the outcome. Say 'evaporative heat loss' not just 'to keep warm'; say 'tactile stimulation' not just 'to make the baby breathe.'

Model Answer

Immediate and thorough drying of the newborn within the first 30 seconds of birth is important for two reasons: 1. Prevention of hypothermia — A wet newborn loses heat rapidly through evaporation. Drying removes the moisture and helps maintain the baby's body temperature. 2. Stimulation of breathing — The tactile stimulation provided by vigorous drying encourages the newborn to initiate and sustain respirations.

Question Type

short_answer

Answer Structure

• Intro: 'Immediate drying is important because...' [frames the answer]
• Reason 1: Prevents hypothermia — wet = rapid evaporative heat loss [1 mark]
• Reason 2: Stimulates breathing — tactile stimulation initiates respirations [1 mark]

Scoring Breakdown

Common Mark Deductions

• Stating 'to clean the baby' — this is not the EINC rationale
• Mentioning only one reason when two are asked for
• Not mentioning the mechanism (evaporation for hypothermia; tactile stimulation for breathing)

Key Phrases To Include

• hypothermia
• evaporative heat loss
• tactile stimulation
• breathing
• 30 seconds

Marks

3

Topic

EINC Step 1 — Drying; Vernix Care

Difficulty

medium

Template Id

T8

Examiner Tip

Case-based 'Is this correct?' questions need a definitive YES or NO in the first line, followed by the reason. Never leave the examiner guessing your position.

Model Answer

No. Wiping off the vernix caseosa is NOT consistent with EINC guidelines. EINC specifies that the vernix caseosa (the white, waxy coating on the newborn's skin) should NOT be removed. The rationale is: 1. Thermoregulation — Vernix acts as a natural insulating layer, helping the newborn maintain body temperature and supporting the warm chain. 2. Infection protection — Vernix contains antimicrobial proteins that form a natural barrier against bacterial colonization, protecting the newborn's skin. The correct EINC action is to dry the baby thoroughly (removing moisture) while leaving the vernix intact. The first bath should be delayed for at least 6 hours (many protocols recommend up to 24 hours), allowing the vernix to provide continued protection.

Question Type

short_answer

Answer Structure

• Opening: Clear statement — 'No, this is NOT consistent with EINC' [sets up the answer, needed for marks]
• Body Point 1: Vernix should NOT be removed — rationale: thermoregulation [1 mark]
• Body Point 2: Vernix should NOT be removed — rationale: infection protection / antimicrobial barrier [1 mark]
• Closing: Correct action — dry the baby but leave vernix; bath deferred at least 6 hours [1 mark]

Scoring Breakdown

Common Mark Deductions

• Saying 'partly correct' or being ambiguous — a clear YES or NO is required
• Giving the rationale without stating whether the action is correct or incorrect
• Not mentioning the timing of the first bath

Key Phrases To Include

• NOT consistent with EINC
• vernix caseosa
• thermoregulation
• antimicrobial
• infection protection
• leave intact
• bath delayed
• at least 6 hours

Marks

5

Topic

EINC Eliminated Practices

Difficulty

hard

Template Id

T9

Examiner Tip

For 5-mark questions, the examiner allocates 1 mark per point. Write 5 CLEAR, SEPARATE points. A numbered list with a brief explanation per point is the most mark-efficient format.

Model Answer

EINC (Unang Yakap), institutionalized by DOH AO No. 2009-0025, identified the following unnecessary and harmful routine practices that should be eliminated for normal newborns: 1. Routine suctioning of the mouth and nose This should NOT be done for a normal newborn with clear amniotic fluid who is already breathing or crying. Routine suctioning can cause bradycardia, apnea, and injury to the delicate mucosa of the airway. 2. Immediate (early) cord clamping Clamping the cord within seconds of birth cuts off the placental transfusion, depriving the baby of iron-rich blood. EINC requires waiting until pulsations stop (1–3 minutes) to allow this natural blood transfer. 3. Immediate bathing of the newborn Bathing immediately after birth removes the vernix caseosa (which provides thermal insulation and antimicrobial protection) and causes rapid heat loss, predisposing the newborn to hypothermia. The first bath should be deferred for at least 6 hours. 4. Separation of mother and newborn for routine procedures Separating the baby from the mother for weighing, footprinting, or injections during the first hour disrupts skin-to-skin contact, bonding, and the first breastfeed. All non-urgent procedures must be deferred until after the first feed. 5. Application of substances to the cord stump Applying alcohol, antiseptics, or dressings to the umbilical stump is unnecessary and can cause irritation or infection. EINC promotes dry cord care — the stump should be kept clean and dry with nothing applied. Bonus/alternative: Aggressive stimulation (e.g., slapping, holding upside down) is harmful; drying is the appropriate form of stimulation.

Question Type

long_answer

Answer Structure

• Intro: Brief statement referencing EINC/DOH AO 2009-0025 [sets context, 0.5 mark]
• Practice 1: Routine suctioning + rationale (bradycardia, apnea, mucosal injury) [1 mark]
• Practice 2: Early/immediate cord clamping + rationale (cuts off placental transfusion) [1 mark]
• Practice 3: Immediate bathing + rationale (hypothermia, removes vernix) [1 mark]
• Practice 4: Mother-baby separation + rationale (disrupts bonding and first feed) [1 mark]
• Practice 5: Applying substances to cord stump + rationale (dry cord care is correct) [0.5 mark for practice + 0.5 for reason]

Scoring Breakdown

Common Mark Deductions

• Listing the practices without explaining WHY each is harmful — the rationale is worth marks
• Listing fewer than 5 practices
• Confusing eliminated practices with recommended EINC steps (e.g., writing 'drying' as a harmful practice)
• Not linking early cord clamping to the loss of placental transfusion

Key Phrases To Include

• routine suctioning
• bradycardia
• apnea
• early cord clamping
• placental transfusion
• immediate bathing
• hypothermia
• vernix
• separation
• first breastfeed
• dry cord care
• nothing applied

Marks

3

Topic

Warm Chain

Difficulty

medium

Template Id

T10

Examiner Tip

The word 'unbroken' or 'continuous' is key in defining warm chain — it means every single step is connected, and any break in the chain allows the baby to become cold.

Model Answer

The warm chain refers to an unbroken series of steps taken from the moment of birth to keep the newborn warm, since newborns cannot effectively regulate their own body temperature and cool rapidly after delivery. Four measures that maintain the warm chain are: 1. Warm, draft-free delivery room — room temperature maintained at 25–28°C, with windows and doors closed and fans directed away from the baby. 2. Immediate drying and removal of the wet cloth — removes evaporative heat loss within the first 30 seconds. 3. Skin-to-skin contact with the mother — the mother's body acts as a natural warmer; both are covered with a dry blanket. 4. Placing a bonnet on the newborn's head — the head is a large surface area for heat loss and must be covered.

Question Type

short_answer

Answer Structure

• Intro: Define 'warm chain' — unbroken steps to prevent heat loss; newborns cannot self-regulate [1 mark]
• Measure 1: Warm room (25–28°C) [0.5 mark]
• Measure 2: Immediate drying + removing wet cloth [0.5 mark]
• Measure 3: Skin-to-skin contact with mother [0.5 mark]
• Measure 4: Bonnet on head [0.5 mark]

Scoring Breakdown

Common Mark Deductions

• Defining 'warm chain' as just 'keeping the baby warm' without mentioning it is an unbroken sequence
• Listing fewer than four measures
• Writing 'warm incubator' as a measure — warm chain is about low-tech, bedside prevention

Key Phrases To Include

• warm chain
• unbroken series
• thermoregulation
• 25–28°C
• immediate drying
• wet cloth removed
• skin-to-skin
• bonnet

Marks

2

Topic

Early Breastfeeding — EINC Step 4

Difficulty

easy

Template Id

T11

Examiner Tip

The phrase 'first vaccine' is a high-yield answer phrase. If you use it and explain it (passive immunity from antibodies), you almost always earn the mark.

Model Answer

Colostrum is the first milk produced by the mother in the early days after birth. It is thick, yellowish, and rich in maternal antibodies (immunoglobulins), protein, and nutrients. In EINC, early breastfeeding within the first hour ensures the newborn receives colostrum, which is often called the 'baby's first vaccine' because its antibodies provide passive immunity and protect the newborn from infections. Colostrum also promotes gut development and helps prevent neonatal hypoglycemia.

Question Type

short_answer

Answer Structure

• Line 1: Define colostrum — first milk, thick/yellowish, rich in antibodies and protein [1 mark]
• Line 2: State its importance — passive immunity ('first vaccine'), infection protection, gut development, prevents hypoglycemia [1 mark]

Scoring Breakdown

Common Mark Deductions

• Describing colostrum as 'dirty milk' or 'unsuitable for the baby' — this is a cultural misconception EINC counters
• Not connecting colostrum to the EINC step of early breastfeeding within the first hour
• Omitting the immune protection function

Key Phrases To Include

• colostrum
• first milk
• antibodies
• immunoglobulins
• first vaccine
• passive immunity
• within the first hour

Marks

3

Topic

Post-Feed Newborn Care — Vitamin K, Eye Prophylaxis, Immunizations

Difficulty

medium

Template Id

T12

Examiner Tip

The timing — 'AFTER the first breastfeed' — is just as important as the drugs themselves. State it explicitly in your answer to show you understand the EINC sequence.

Model Answer

After the first breastfeed is completed, the following medications are given to the newborn according to EINC: 1. Vitamin K (Phytomenadione) — 1 mg intramuscularly (IM) for normal birth-weight newborns; 0.5 mg IM for low-birth-weight or preterm infants. Purpose: Prevents hemorrhagic disease of the newborn (Vitamin K Deficiency Bleeding or VKDB), since newborns are born with very low Vitamin K stores and cannot yet produce it from gut flora. 2. Eye Prophylaxis (Erythromycin or Tetracycline eye ointment) — applied as a thin ribbon to the lower conjunctival sac of both eyes. Purpose: Prevents ophthalmia neonatorum (neonatal conjunctivitis), which can be caused by Neisseria gonorrhoeae or Chlamydia trachomatis acquired during passage through the birth canal. 3. Immunizations — Hepatitis B birth dose and BCG vaccine are given per the national immunization schedule.

Question Type

short_answer

Answer Structure

• Intro: 'After the first breastfeed, the following are given:' [frames the answer]
• Drug 1: Vitamin K — 1 mg IM (0.5 mg for LBW/preterm) — prevents hemorrhagic disease of the newborn [1 mark]
• Drug 2: Eye prophylaxis — erythromycin or tetracycline ointment — prevents ophthalmia neonatorum [1 mark]
• Drug 3: Immunizations — Hepatitis B + BCG [1 mark]

Scoring Breakdown

Common Mark Deductions

• Stating these are given immediately after birth — they are deferred until AFTER the first breastfeed
• Omitting the dose or route for Vitamin K
• Writing 'silver nitrate' for eye prophylaxis — the current Philippine standard is erythromycin or tetracycline

Key Phrases To Include

• Vitamin K
• phytomenadione
• 1 mg IM
• hemorrhagic disease of the newborn
• VKDB
• erythromycin
• eye prophylaxis
• ophthalmia neonatorum
• after the first breastfeed
• Hepatitis B
• BCG

Marks

5

Topic

EINC Intrapartum Maternal Care

Difficulty

hard

Template Id

T13

Examiner Tip

AMTSL almost always appears in 5-mark intrapartum questions and is worth more marks than other components. Make sure you describe all THREE elements: (1) oxytocin 10 IU IM within 1 minute, (2) controlled cord traction, and (3) uterine massage.

Model Answer

EINC (Unang Yakap) is not only about newborn care — its intrapartum component transforms how the midwife cares for the mother during labor and delivery. The key components of EINC intrapartum maternal care are: 1. Companion of choice — The mother has the right to have a partner, family member, or doula present with her continuously during labor and birth. Continuous support has been shown to shorten labor and reduce the need for interventions. 2. Freedom of movement and positioning — The mother is encouraged to walk and change positions during labor. She gives birth in the position she finds most comfortable, rather than being routinely confined to the lithotomy (flat on her back) position. 3. Oral fluids and light food in labor — The mother may drink fluids and eat light food during normal labor as tolerated. Routine 'nothing by mouth' (NPO) orders are not required for normal labor. 4. Non-pharmacologic pain relief and comfort measures — The midwife supports the mother using breathing techniques, back massage, warm compresses, and reassurance, reducing dependence on medications. 5. Restricted routine interventions — EINC eliminates routine procedures that have no proven benefit in normal labor, including routine enema, routine perineal shaving, routine episiotomy, routine IV lines, and routine oxytocin augmentation. 6. Monitoring with the partograph — Labor progress is monitored using the WHO partograph rather than repeated unnecessary vaginal examinations. 7. Active Management of the Third Stage of Labor (AMTSL) — Oxytocin 10 IU IM is given within one minute of birth, followed by controlled cord traction and uterine massage, to prevent postpartum hemorrhage (PPH).

Question Type

long_answer

Answer Structure

• Intro: 'EINC intrapartum care addresses the mother's experience during labor and delivery, including:' [frames the answer]
• Component 1: Companion of choice [0.5 mark]
• Component 2: Freedom of movement and position [0.5 mark]
• Component 3: Oral fluids and light food [0.5 mark]
• Component 4: Non-pharmacologic pain relief [0.5 mark]
• Component 5: Restricted routine interventions (no routine enema, shaving, episiotomy, IV) [1 mark]
• Component 6: Partograph monitoring [0.5 mark]
• Component 7: AMTSL — Oxytocin 10 IU IM within 1 minute [1 mark]
• Closing: Brief statement tying this to the goal of reducing maternal morbidity [0.5 mark]

Scoring Breakdown

Common Mark Deductions

• Discussing only newborn steps and ignoring the intrapartum maternal component — the question specifically asks about the mother
• Omitting AMTSL or giving the wrong dose/route/timing for oxytocin
• Writing 'oxytocin drip' instead of '10 IU IM' — AMTSL oxytocin is given IM, not IV drip in this context
• Not mentioning the partograph as the monitoring tool

Key Phrases To Include

• companion of choice
• freedom of movement
• position of choice
• oral fluids
• non-pharmacologic pain relief
• no routine episiotomy
• no routine enema
• partograph
• AMTSL
• oxytocin 10 IU IM
• within one minute
• postpartum hemorrhage

Marks

3

Topic

Newborn Danger Signs — Recognize and Refer

Difficulty

medium

Template Id

T14

Examiner Tip

In the PRC MLE context, danger signs questions always carry the implicit expectation that you know these require REFERRAL. Adding 'refer to a higher facility' after listing the signs demonstrates the midwife's professional role.

Model Answer

The following are newborn danger signs that the midwife must recognize and for which immediate action (including urgent referral to a higher level of care) is required: 1. Not breathing, gasping, or very fast/very slow breathing — suggests respiratory distress or birth asphyxia. 2. Severe chest in-drawing or audible grunting — signs of respiratory compromise. 3. Convulsions (seizures) — suggest hypoglycemia, birth asphyxia, meningitis, or other serious conditions. 4. Floppiness (hypotonia), lethargy, or absence of movement — indicate a severely ill newborn. 5. Very cold or very hot to touch (temperature instability) — hypothermia or fever, both dangerous in newborns. Other danger signs include: poor feeding or inability to feed, yellow palms and soles (severe jaundice), and a bleeding cord stump.

Question Type

short_answer

Answer Structure

• Intro: 'Newborn danger signs requiring immediate action include:' [sets up the list]
• Sign 1: Abnormal breathing — not breathing, gasping, too fast, or too slow [0.5 mark]
• Sign 2: Chest in-drawing or grunting [0.5 mark]
• Sign 3: Convulsions [0.5 mark]
• Sign 4: Floppiness/lethargy/no movement [0.5 mark]
• Sign 5: Temperature instability — very cold or very hot [0.5 mark]
• Optional: Poor feeding, severe jaundice, bleeding cord stump [0.5 mark for any one additional]

Scoring Breakdown

Common Mark Deductions

• Listing only general signs without being specific (e.g., 'baby is sick' is not a danger sign)
• Describing only the sign without any mention that these require urgent action or referral
• Listing fewer than five signs when five are asked for

Key Phrases To Include

• not breathing
• gasping
• chest in-drawing
• grunting
• convulsions
• floppiness
• lethargy
• temperature instability
• poor feeding
• refer

Marks

5

Topic

Midwife's Role in EINC — Environmental Preparation

Difficulty

hard

Template Id

T15

Examiner Tip

Case-based 5-mark questions reward students who connect each preparation item to its EINC rationale. Don't just list what to prepare — explain WHY in terms of the EINC sequence (warm chain, skin-to-skin, etc.).

Model Answer

In preparation for delivery at the lying-in clinic, the midwife must set up the environment to support the EINC protocol (Unang Yakap, DOH AO No. 2009-0025). The goal is to ensure the room is warm, clean, and ready for the four time-bound core steps. 1. Warm, draft-free delivery room The delivery room temperature must be maintained at 25–28°C. All windows and doors should be closed, and fans or air-conditioning units should be turned off or directed away from the delivery area. This supports the warm chain and prevents neonatal hypothermia from the moment of birth. 2. Prepare two clean, dry cloths Two dry, clean cloths must be ready before birth: the FIRST cloth is used for immediate drying of the newborn (and is then discarded/removed to prevent heat loss from a wet cloth), and the SECOND cloth is used to cover both the mother and newborn during skin-to-skin contact. 3. A bonnet for the newborn A small bonnet or cap must be available to cover the newborn's head immediately after drying, since the head is a large surface area for heat loss. 4. Clean hands and proper asepsis The midwife performs thorough handwashing and wears clean gloves. Sterile scissors or a sterile blade, two sterile cord clamps or ties, and other delivery supplies are prepared in advance. 5. Medicines and equipment for post-feed care Oxytocin 10 IU IM for AMTSL, Vitamin K 1 mg IM, erythromycin eye ointment, BCG and Hepatitis B vaccines, and the newborn screening kit are prepared but are NOT given until the appropriate time in the EINC sequence. 6. A clean, warm surface for the mother The delivery bed is prepared and clean linen is available. The room is ready for the mother to have a companion of choice and freedom of movement in labor. By preparing the environment this way, the midwife ensures that the four time-bound EINC steps — drying, skin-to-skin, cord clamping, and early breastfeeding — can be executed without interruption.

Question Type

case_study

Answer Structure

• Intro: Reference EINC / Unang Yakap as the guiding protocol [0.5 mark]
• Item 1: Warm, draft-free room — 25–28°C, close windows/doors, fans away [1 mark]
• Item 2: Two clean dry cloths — first for drying, second for cover during skin-to-skin [1 mark]
• Item 3: Bonnet ready for the newborn's head [0.5 mark]
• Item 4: Clean hands, asepsis, sterile instruments for cord clamping [1 mark]
• Item 5: Medicines prepared but timed correctly (oxytocin for AMTSL; Vitamin K, eye care, vaccines deferred until after first feed) [1 mark]
• Closing: Statement that preparation supports uninterrupted EINC sequence [0.5 mark if not already woven in]

Scoring Breakdown

Common Mark Deductions

• Describing general delivery room preparation without linking to EINC principles
• Forgetting to specify '25–28°C' for room temperature — a vague 'warm room' is not specific enough
• Not mentioning the purpose of each cloth (one for drying, one for covering)
• Saying medicines are given 'immediately after birth' — this contradicts the EINC sequence
• Missing the AMTSL preparation (oxytocin ready)

Key Phrases To Include

• 25–28°C
• draft-free
• two dry cloths
• warm chain
• bonnet
• sterile
• clean hands
• oxytocin 10 IU IM
• Vitamin K
• after the first breastfeed
• EINC sequence