Essential Intrapartum & Newborn Care (EINC / "Unang Yakap") - Memory Anchors
Memorizing EINC protocols for the PRC Midwife Licensure Exam is not about cramming — it is about ANCHORING new information to something your brain already knows. Think of each anchor as a mental hook: the moment you see a question about EINC on the board exam, your hook pulls up the right answer automatically. The anchors in this set are built on four principles: (1) Make it EMOTIONAL — stories with feelings are remembered longer. (2) Make it RIDICULOUS — absurd images are harder to forget than plain facts. (3) Make it PERSONAL — Filipino cultural references make concepts feel familiar. (4) Make it SEQUENTIAL — chains link items so remembering one automatically brings the next. Work through all 18 anchors, practice the quick-recall chains, and play the revision game at the end. By the time you finish, the four EINC core steps, the eliminated practices, and the key time intervals will be hardwired in your memory — ready to surface the moment you sit down for the board exam.
Memory anchors
EINC institutionalized by DOH Administrative Order 2009-0025
Memory aid
Think: '2009 — Zero-Zero-25 — ZERO Harm to the Newborn.' The year 2009 was the year DOH decided ZERO harmful practices would be allowed. The code 0025 sounds like 'zero-zero, no suctioning' — the first big harmful practice eliminated. Every time you see AO 2009-0025, picture a big red ZERO stamped over a suction bulb.
Why it works
Linking an abstract AO number to a vivid image (zero over a suction bulb) creates a dual-coding memory trace — both verbal and visual — making it much harder to forget.
Example usage
Question: 'Which DOH Administrative Order institutionalized EINC?' → Recall the red ZERO image → Answer: DOH AO 2009-0025.
Recall trigger
Red ZERO over a suction bulb
The four time-bound core steps of EINC in correct order
Memory aid
Use the acronym D-S-C-B: 'Dry the baby, Skin-to-skin, Cord clamping, Breastfeed.' Pronounce it as 'DiSCo Baby' — imagine a disco ball lighting up a delivery room and a happy baby dancing under it. Each letter: D = Dry (immediately, ~30 sec), S = Skin-to-skin (right after drying), C = Cord clamping (1–3 min, after pulsations stop), B = Breastfeed (within the first hour). The DISCO is in ORDER — you cannot play the last song first.
Why it works
The word 'DiSCo' is familiar, fun, and Filipino students associate it with nightlife energy — high emotional charge = deeper memory encoding. The dance metaphor reinforces that the steps must be performed in sequence.
Example usage
Question: 'What is the correct sequence of the four EINC core steps?' → Think DISCO BABY → D-S-C-B → Dry, Skin-to-skin, Cord clamping, Breastfeed.
Recall trigger
Disco ball in the delivery room
Immediate drying must be done within the first 30 seconds
Memory aid
Think of a freshly cooked pandesal pulled from the oven. If you wrap it immediately in plastic while still steaming, it stays warm and soft. But if you leave it wet and uncovered, it gets cold and hard within 30 seconds. The newborn IS the pandesal — just born, wet, and losing heat every second. Your dry cloth is the warm wrapper. You have 30 seconds before heat loss begins to win. Act FAST, like a panadero grabbing the hot pan.
Why it works
Pandesal is a universally familiar Filipino object with strong sensory associations (warmth, comfort). The analogy maps perfectly: wet = cold = bad; dry wrap = warm = good. Emotional and sensory anchors make this unforgettable.
Example usage
Question: 'When should drying of the newborn begin after birth?' → Think pandesal from the oven → within the first 30 seconds, to prevent heat loss.
Recall trigger
Fresh pandesal wrapped immediately from the oven
Do NOT wipe off the vernix caseosa
Memory aid
Picture the vernix as a baby's natural 'Skin Armor' — like the thick white sunscreen surfers put on their noses before hitting the waves. It is the baby's OWN protection from the cold and from germs. Now imagine a midwife trying to wipe off a surfer's sunscreen RIGHT before he paddles into a big wave. That is WRONG and harmful. Vernix = keep it on. It is the baby's natural wetsuit and sunscreen combined.
Why it works
The surfer-sunscreen image is absurd enough to be memorable, and the emotional wrongness of removing protection creates a strong 'do NOT' memory trace — critical for exam questions that test what you should NOT do.
Example usage
Question: 'What should the midwife do about the vernix during EINC drying?' → Surfer analogy → Do NOT wipe off the vernix; it protects against cold and infection.
Recall trigger
Surfer's white nose sunscreen before a big wave
Skin-to-skin contact: mother's body regulates the baby's temperature
Memory aid
The mother's chest is a LIVING INCUBATOR — more accurate and more powerful than any machine. Think of it as a 'Bio-Thermostat.' When the baby is cold, the mother's chest automatically becomes WARMER. When the baby is too warm, the mother's chest cools slightly. A hospital incubator cannot do that — it is set to one fixed temperature. Skin-to-skin is the FREE, PORTABLE, SELF-ADJUSTING incubator every baby deserves. Tatay cannot provide it the same way — it must be the mother's bare chest.
Why it works
Comparing a free, natural process to an expensive hospital machine creates contrast — contrast is one of the strongest memory enhancers. Filipino students who have seen incubators in hospitals will immediately understand why skin-to-skin is special.
Example usage
Question: 'Why is skin-to-skin contact important after delivery?' → Living incubator → stabilizes temperature, heart rate, blood sugar, and breathing; colonizes baby with mother's protective flora.
Recall trigger
Bio-Thermostat / Living Incubator on Nanay's chest
Delayed cord clamping: 1–3 minutes, after pulsations stop
Memory aid
Imagine the umbilical cord as a LOADING BAR on a phone screen — the kind that shows when a file is downloading. The placenta is the server and the baby is the phone. When the baby is born, the loading bar starts: iron-rich blood is TRANSFERRING from server (placenta) to phone (baby). If you cut the cord at ZERO seconds, you cancel the download and the baby receives only 50% of its iron stores. If you wait 1–3 minutes until the loading bar finishes (until pulsations stop), the baby gets the FULL download — more iron, less anemia, better health for months. The midwife's job is to WAIT for the download to finish before cutting the cable.
Why it works
Millennials and Gen Z students live with loading bars and download metaphors. The emotional frustration of a cancelled download creates a powerful 'do NOT cut early' memory. The 1–3 minute window maps perfectly to a typical short download.
Example usage
Question: 'When should the cord be clamped in EINC?' → Loading bar story → After pulsations stop, 1–3 minutes after birth, to complete the placental transfusion.
Recall trigger
Loading bar downloading iron from placenta to baby
Cord clamp placement: 2 cm from base (first clamp), 5 cm from base (second clamp)
Memory aid
Use the phrase: '2 for Baby, 5 for Placenta.' The first clamp is CLOSEST to the baby at 2 cm — think: baby is small, 2 is a small number, baby gets 2. The second clamp is farther from baby at 5 cm — think: placenta side, 5 fingers of the hand that holds the cord (your hand is about 5 units away from the baby). Cut BETWEEN the two clamps. Visualize: [Baby—|—2cm—CLAMP1—(CUT HERE)—CLAMP2—5cm—|—Placenta].
Why it works
Assigning 'small number to small baby' and 'big number to bigger placenta' uses a size-number congruence that the brain finds logical and easy to store. The bracketed diagram creates a mental spatial map.
Example usage
Question: 'Where should the first cord clamp be placed?' → 2 for Baby → 2 cm from the base of the cord at the baby's abdomen.
Recall trigger
2 for Baby, 5 for Placenta
Dry cord care — nothing applied to the cord stump
Memory aid
Remember this short rhyme: 'The cord stump is clean, keep it dry and serene — NO alcohol, NO dressing, NO antiseptic cream!' Sing it to the tune of a simple nursery rhyme or 'Bahay Kubo.' The rhyme is only three lines but covers all three things you must NOT apply to the cord. Dry cord care = clean, dry, exposed, and NOTHING ELSE.
Why it works
Rhymes activate the phonological loop in working memory, making them easier to rehearse internally. Setting it to a familiar Filipino nursery tune adds cultural resonance and further strengthens encoding.
Example usage
Question: 'What should the midwife apply to the cord stump after cutting?' → Hum the rhyme → NOTHING — dry cord care only; no alcohol, no antiseptic, no dressing.
Recall trigger
Bahay Kubo tune: 'The cord stump is clean...'
Non-separation: weigh, give vitamin K, eye care, BCG/Hep B — ALL deferred until after the first breastfeed
Memory aid
Use the acronym WEBI: W = Weigh, E = Eye prophylaxis, B = BCG/Hep B immunizations, I = Injections (Vitamin K). All WEBI procedures are DEFERRED until AFTER the first breastfeed. Think: 'WEBI waits.' Imagine a line of nurses holding a weighing scale, an eye dropper, BCG syringe, and Vitamin K — all standing OUTSIDE the room waiting patiently while baby breastfeeds. They can only enter AFTER the first full feed.
Why it works
Creating a visual scene of a waiting queue externalizes and dramatizes the sequence. The acronym WEBI is short and easy to rehearse. The emotional image of dutiful nurses waiting outside reinforces the 'after breastfeed' rule.
Example usage
Question: 'Which interventions are deferred until after the first breastfeed in EINC?' → WEBI waits → Weighing, Eye prophylaxis, BCG/Hep B, Injections (Vitamin K) — all deferred.
Recall trigger
WEBI nurses standing outside the room waiting
First breastfeed within the first hour — colostrum is the 'first vaccine'
Memory aid
Imagine Lola Caring, the wisest hilot in the barrio, holding a tiny golden vial labeled 'UNANG BAKUNA NG BUHAY' (First Vaccine of Life). She carefully opens it and pours it into the baby's mouth — but it is not a syringe, it is the mother's breast. That golden vial IS the colostrum. It is thick, yellow, and packed with immunoglobulins that protect the baby from infections no pharmaceutical vaccine can replicate in the first hours of life. Lola Caring says: 'Ang colostrum ay hindi pwedeng bilhin — libre at nasa nanay na.' (Colostrum cannot be bought — it is free and already in the mother.) The first hour is the window — miss it and the window closes.
Why it works
Lola Caring as a character is emotionally resonant in Filipino culture — she represents wisdom, tradition, and care. The golden vial image is vivid. The Tagalog quote adds cultural depth and makes the concept personal.
Example usage
Question: 'Why is early breastfeeding important in EINC?' → Golden vial story → Colostrum is the baby's first vaccine, rich in antibodies; breastfeeding must be initiated within the first hour of life.
Recall trigger
Lola Caring's golden vial labeled UNANG BAKUNA NG BUHAY
Vitamin K 1 mg IM — prevents hemorrhagic disease of the newborn (VKDB)
Memory aid
Picture a baby wearing a tiny superhero cape with a letter K on it. This is VITAMIN K-MAN, the baby's clotting superhero. Without Vitamin K, the baby's blood cannot clot and can bleed into the brain — the villain is VKDB (Vitamin K Deficiency Bleeding). The dose is 1 mg IM — think: ONE KICK from K-man stops the bleeding. 1 mg = 1 kick. For small babies (low birth weight/preterm), the kick is smaller: 0.5 mg. Given AFTER the first breastfeed, because even K-man must wait for Nanay's milk first.
Why it works
Superhero imagery is universally engaging and creates a strong visual anchor. Mapping the dose (1 mg = 1 kick) to an action creates numerical memory. The detail about LBW babies (0.5 mg) is embedded in the 'smaller kick for smaller baby' logic.
Example usage
Question: 'What is the dose and purpose of Vitamin K in EINC?' → K-man one kick → 1 mg IM phytomenadione to prevent hemorrhagic disease of the newborn (VKDB).
Recall trigger
Baby in a K-man superhero cape giving ONE KICK
First bath delayed at least 6 hours (many protocols say ~24 hours)
Memory aid
Think of the newborn's skin as a freshly painted wall. Nanay just painted the wall with a beautiful protective coat (vernix). If you wash the wall immediately, the paint dissolves, the wall is exposed, and it gets damaged. You WAIT at least 6 hours (or overnight — ~24 hours) for the paint to fully set before washing. The bath is like a pressure washer — powerful, but deadly if used too soon on fresh paint. '6-hour wall rule': never wash the paint before it sets.
Why it works
Home repair analogies are relatable in the Philippine context. The idea of ruining fresh paint by washing it early is intuitively WRONG — that emotional wrongness maps directly to 'do not bathe immediately.'
Example usage
Question: 'When should the newborn's first bath be given per EINC?' → Fresh paint wall → Delayed at least 6 hours (ideal ~24 hours) to preserve warmth and protective vernix.
Recall trigger
Freshly painted wall — do not wash for 6 hours
Seven harmful practices EINC eliminated
Memory aid
Use the acronym S-E-B-S-S-A-F: 'Seven Evil Birth Sins Surgeons Always Forget.' S = Suctioning routinely, E = Early cord clamping, B = Bathing immediately, S = Separation of mother and baby, S = Slapping/aggressive stimulation, A = Applying substances to cord, F = Footprinting that interrupts skin-to-skin. Seven letters, seven harmful sins. Think of a villain doctor with 7 bad habits — EINC fired him from the delivery room.
Why it works
Framing harmful practices as 'sins' and creating a villain character turns a dry list into a moral story. The acronym SEBSSAF may be unusual but is pronounceable as 'seh-bsaf' — unusual words are more memorable than common ones.
Example usage
Question: 'Which of the following is an eliminated practice under EINC?' → SEBSSAF villain → Routine suctioning of a normal breathing baby is an eliminated practice.
Recall trigger
Villain doctor with 7 bad habits: SEBSSAF
Routine suctioning is ELIMINATED — causes bradycardia, apnea, mucosal injury
Memory aid
Aling Rosa was a well-meaning midwife who always suctioned every baby 'just to be sure.' One day, she suctioned a healthy crying baby — and the baby stopped crying. Heart rate dropped. The room went silent. She had caused bradycardia and apnea with her 'routine' suction. The EINC trainer said: 'Aling Rosa, if the baby is BREATHING and CRYING with CLEAR fluid, the suction bulb STAYS IN YOUR BAG.' Now Aling Rosa's suction bulb is in a glass case on her wall labeled: 'Do Not Use on Normal Babies.' The END.
Why it works
A cautionary story with a named Filipino character creates an emotional memory trace — the story has conflict (baby stops breathing), resolution (lesson learned), and a vivid final image (suction bulb in a glass case). Narrative memory is one of the strongest memory formats.
Example usage
Question: 'When is routine oropharyngeal suctioning indicated in EINC?' → Aling Rosa story → NEVER for a normal breathing/crying baby with clear amniotic fluid — it is an eliminated practice.
Recall trigger
Aling Rosa's suction bulb in a glass case on the wall
EINC intrapartum care: companion of choice, freedom of movement, oral fluids, non-pharmacologic pain relief, partograph, no routine episiotomy/enema/IV/shaving
Memory aid
Use the acronym C-FOPS: 'Companion, Freedom, Oral fluids, Partograph, Support (non-pharm)' — pronounce it as 'SEE-FOPS.' These are the FIVE things EINC GIVES the mother in labor. Then remember what EINC TAKES AWAY with 'E-E-I-S': Enema, Episiotomy (routine), IV line (routine), Shaving. Pronounced 'EE-EE-IS' like someone recoiling in disgust — 'EEW, is this still done?!' Yes, in the past — but NOT anymore.
Why it works
Two mini-acronyms for the two categories (what EINC gives vs. what it removes) creates a clear contrast structure. The 'EEW, IS this still done?' emotional reaction creates aversion to the eliminated practices — aversion memory is very strong.
Example usage
Question: 'Which intrapartum practice is promoted under EINC?' → C-FOPS → Companion of choice, freedom of movement, oral fluids, partograph monitoring, non-pharmacologic pain support.
Recall trigger
C-FOPS (what EINC gives) vs EE-EIS (what EINC removes)
AMTSL — Active Management of the Third Stage of Labor: Oxytocin 10 IU IM within 1 minute of birth
Memory aid
Picture a STOPWATCH starting the moment the baby is born. You have EXACTLY 60 seconds — ONE MINUTE — to inject Oxytocin 10 IU IM into the mother's thigh. Think: '10-1-1': 10 IU, 1 minute, 1 injection site (thigh). Oxytocin is the 'PPH Bouncer' — it makes the uterus contract and close the door on postpartum hemorrhage. After the baby is out, the bouncer goes in immediately — within 60 seconds, no excuses.
Why it works
The stopwatch creates urgency and time-pressure memory. The '10-1-1' chunking reduces three separate facts (dose, timing, site) to one numerical pattern. The PPH Bouncer metaphor frames Oxytocin's role as active protection.
Example usage
Question: 'What is the first step in AMTSL per EINC?' → Stopwatch and 10-1-1 → Oxytocin 10 IU IM given within 1 minute of delivery of the baby.
Recall trigger
Stopwatch starts at birth: 10-1-1 (10 IU, 1 min, 1 thigh)
Warm Chain — keeping the newborn warm from birth to discharge
Memory aid
The Warm Chain is like a COLD CHAIN for vaccines — but in reverse. Vaccines must stay COLD to work; newborns must stay WARM to survive. Break any link in the cold chain and the vaccine is ruined. Break any link in the WARM chain — a wet cloth left on the baby, a cold surface, a drafty window, a delayed bath — and the baby gets hypothermia. The delivery room must be 25–28°C (think: slightly warmer than a comfortable Filipino classroom). Every person in the chain — midwife, nurse, transport driver — is a link. ONE broken link = hypothermia.
Why it works
Filipino health workers already know the vaccine cold chain — reversing the metaphor to a warm chain creates a vivid contrast that is easy to store. The idea that ONE broken link ruins everything creates vigilance motivation.
Example usage
Question: 'What temperature should the delivery room be maintained at for EINC?' → Warm chain analogy → 25–28°C, warm and draft-free, to maintain the newborn's warm chain.
Recall trigger
Vaccine cold chain — but WARM and in reverse
Newborn danger signs — when to refer immediately
Memory aid
Use the mnemonic: 'BGFC-TJY' — pronounced 'Big FC — TeJaY.' Each letter is a danger sign: B = Bad breathing (not breathing, gasping, very fast or slow), G = Grunting / chest in-drawing, F = Floppy / no movement, C = Convulsions, T = Temperature instability (too cold or too hot), J = Jaundice of palms and soles (severe), Y = 'Yummy' problem (poor feeding / cannot feed). Remember: 'Big FC — TeJaY' and the baby goes to the HOSPITAL, not back to the mother's chest.
Why it works
'Tejay' is a Filipino nickname — it sounds like a real person, making the mnemonic culturally resonant and memorable. Naming danger signs after something familiar reduces cognitive load when under exam pressure.
Example usage
Question: 'Which newborn finding requires immediate referral?' → BGFC-TJY → Convulsions are a danger sign requiring immediate referral to a higher-level facility.
Recall trigger
Big FC — TeJaY (the sick baby needs referral)
Revision game
I am a disco acronym. My four letters stand for the four EINC core steps. What am I, and what does each letter mean?
Answer
D-S-C-B (DiSCo Baby): D = Dry (~30 sec), S = Skin-to-skin, C = Cord clamp (1–3 min), B = Breastfeed (within 1 hour)
Memory link
A2 — Disco Ball in the Delivery Room
I am the Philippine DOH Administrative Order that made EINC the official standard of care. I was born in 2009 and my code number has two zeros. What is my full title?
Answer
DOH Administrative Order No. 2009-0025 (Adopting Policies and Guidelines on Essential Newborn Care)
Memory link
A1 — Red ZERO over a suction bulb
I am a villain doctor with seven bad habits. EINC fired me from the delivery room. Name my seven bad habits.
Answer
SEBSSAF: Routine Suctioning, Early cord clamping, Immediate Bathing, Separation of mother-baby, Slapping/aggressive stimulation, Applying substances to cord, Footprinting during skin-to-skin
Memory link
A13 — Villain Doctor with seven SEBSSAF habits
I am the baby's first vaccine. I am golden yellow in color. I must be given within 60 minutes of birth. I come from the mother's breast. What am I?
Answer
Colostrum — the first milk, rich in immunoglobulins/antibodies, given via breastfeeding within the first hour of life
Memory link
A10 — Lola Caring's golden vial labeled UNANG BAKUNA NG BUHAY
I am measured in centimeters. I come in two sizes: 2 and 5. I sit on an umbilical cord. Without me, the midwife cannot complete Step 3. What is the rule for my placement?
Answer
First clamp at 2 cm from baby's abdomen; second clamp at 5 cm from baby's abdomen; cut between. Rule: 2-5-CUT (2 for Baby, 5 for Placenta)
Memory link
A7 — 2 for Baby, 5 for Placenta
I am a group of four nurses waiting outside the delivery room door. My name is a four-letter acronym. I am only allowed to enter AFTER the baby has breastfed. Who am I and what do I do?
Answer
WEBI: Weigh the baby, Eye prophylaxis, BCG and Hepatitis B immunizations, Injection (Vitamin K 1 mg IM) — all deferred until after the first breastfeed
Memory link
A9 — WEBI nurses standing outside the room waiting
I am a superhero whose name is also a letter of the alphabet. I weigh 1 mg. I prevent newborns from bleeding into their brains. I am given after the first breastfeed. Who am I?
Answer
Vitamin K-man — Phytomenadione 1 mg IM (0.5 mg for LBW/preterm) — prevents Vitamin K Deficiency Bleeding (VKDB / Hemorrhagic Disease of the Newborn)
Memory link
A11 — Baby in a K-man superhero cape giving ONE KICK
I am Filipino for First Embrace. I am the popular name for EINC. My name captures the most important physical action in the entire protocol. What am I?
Answer
Unang Yakap — the Filipino name for EINC (Essential Intrapartum and Newborn Care), representing the first embrace of skin-to-skin contact between mother and newborn
Memory link
A1 and A5 — Living Incubator / Nanay's bio-thermostat
Formula mnemonics
Cord Clamping Timing: 1–3 minutes after birth (after pulsations stop)
Mnemonic
1–3 minutes = '1 to 3, wait and see — is the cord still talking to me?' If the cord is still pulsating (talking), it is still transferring blood. Wait until it stops.
When to use
Every normal delivery — clamp the cord only after pulsations stop, ideally between 1 and 3 minutes after birth.
What each part means
1 minute = earliest acceptable time; 3 minutes = upper end; 'pulsations stopped' = the actual criterion; 'not milking' = do not strip the cord as a shortcut
Cord Clamp Placement: Clamp 1 at 2 cm, Clamp 2 at 5 cm, cut between
Mnemonic
2-5-CUT: '2 for Baby (small number, small baby), 5 for Placenta (bigger number, bigger organ), CUT in between.' Say it like a countdown: '2...5...CUT!'
When to use
When cutting the cord at 1–3 minutes after birth in every normal delivery.
What each part means
2 cm = distance of first clamp from baby's abdomen; 5 cm = distance of second clamp from baby's abdomen; between = where sterile scissors/blade cuts
Vitamin K Dose: 1 mg IM for term baby; 0.5 mg IM for LBW/preterm
Mnemonic
BIG baby = 1 BIG mg. SMALL baby (LBW/preterm) = 0.5 HALF mg. Think: 'Full-term gets FULL dose; preterm gets HALF dose.' Picture a full slice of puto vs. half a slice — same puto, different sizes for different babies.
When to use
Administered to ALL newborns after the first breastfeed as part of EINC post-feed care.
What each part means
1 mg = standard term dose of phytomenadione; 0.5 mg = dose for low birth weight or preterm; IM = intramuscular injection; purpose = prevent VKDB (hemorrhagic disease of newborn)
Delivery Room Temperature: 25–28°C
Mnemonic
'25 to 28 — keep it warm, not late!' Think of a hot summer day in the Philippines (feels like 28–30°C outdoors) — the delivery room should feel that warm. Not air-conditioned cold, not boiling — a warm Filipino summer room.
When to use
Every delivery setting — RHU, BHS, lying-in, or home birth. Ensure room is prepared before the baby arrives.
What each part means
25°C = lower limit; 28°C = upper limit; range ensures the newborn does not lose heat to the environment by radiation, conduction, or convection
First Breastfeed: within the first 60 minutes (first hour) of life
Mnemonic
'Golden Hour = Golden Milk.' The first hour of life is the Golden Hour for breastfeeding, because colostrum (golden in color) must be given within 60 minutes. After 60 minutes, the window is still open but the baby's alertness and natural feeding drive begin to decline.
When to use
Every normal delivery — support the first breastfeed before any routine procedures (WEBI).
What each part means
First hour = window of highest newborn alertness and feeding instinct; colostrum = first milk, golden-yellow, rich in antibodies (IgA); 'breast crawl' = baby can self-attach if not separated
Quick recall chains
The Four EINC Core Steps in Sequence
Recall test
Cover this list and write the four EINC core steps in correct order with their timing. Can you name them all before the 'disco song' ends (within 30 seconds of reading the question)?
Memory chain
DISCO BABY rules the delivery room: D = Dry fast (30 seconds, no vernix wipe), S = Skin-to-skin (place prone on bare chest), C = Cord clamping (1–3 min, loading bar done), B = Breastfeed (within 1 hour, WEBI waits outside). The baby DANCES through life starting with the DISCO sequence. You cannot play the songs out of order — the playlist is locked.
Items to remember
- Step 1: Immediate and thorough drying (~30 seconds)
- Step 2: Early skin-to-skin contact
- Step 3: Properly-timed cord clamping (1–3 minutes, after pulsations stop)
- Step 4: Non-separation for early breastfeeding within the first hour
Seven Eliminated Harmful Practices (EINC Removes These)
Recall test
Without looking, list all seven harmful practices eliminated by EINC. Score yourself: 7/7 = excellent; 5–6 = review A13; less than 5 = re-read the villain story three times.
Memory chain
The VILLAIN DOCTOR with 7 bad habits (SEBSSAF): 'He Suctioned Every Baby, Separated them, Slapped them, Applied things to cords, and Footprinted them immediately.' EINC fired him. Every time you see his seven habits in an exam question, mark them as WRONG. Visualize the villain walking out of the delivery room in shame, each bad habit hanging off him like a placard.
Items to remember
- Routine suctioning of a normal breathing baby
- Early (immediate) cord clamping
- Immediate bathing
- Separation of mother and baby
- Aggressive stimulation (slapping, hanging upside down)
- Applying substances to the cord stump
- Footprinting during skin-to-skin
Post-Feed Care Sequence (WEBI + Bath Timing)
Recall test
In order: What is the acronym for the four deferred procedures? What is their trigger event? When is the first bath given? Three questions — three correct answers = mastery.
Memory chain
After baby's FIRST MEAL (breastfeed), the WEBI nurses waiting outside finally come in: W = Weigh, E = Eye care, B = BCG/Hep B, I = Injection (Vitamin K). They do their jobs and leave. The baby is dressed and keeps skin-to-skin. The BATH CREW arrives last — not until at least 6 hours later (the '6-hour wall rule'). The bath crew is the last to arrive and the last to leave.
Items to remember
- After first breastfeed: Weigh the baby
- After first breastfeed: Eye prophylaxis (erythromycin/tetracycline ointment)
- After first breastfeed: BCG and Hepatitis B birth dose immunizations
- After first breastfeed: Injections — Vitamin K 1 mg IM
- First bath: Delayed at least 6 hours (ideally ~24 hours)
Newborn Danger Signs — Detect and Refer (BGFC-TJY)
Recall test
Name all seven newborn danger signs. Remember: these are REFERRAL triggers, not management items for the midwife at the BHS/RHU level.
Memory chain
Remember 'Big FC — TeJaY.' Big FC = B (Bad breathing), G (Grunting), F (Floppy), C (Convulsions). TeJaY = T (Temperature), J (Jaundice), Y (Yummy/feeding problem). This baby is NOT safe in your lying-in clinic — Big FC TeJaY needs REFERRAL NOW. Picture a baby with those initials on a wristband being rushed to the hospital.
Items to remember
- Bad breathing (not breathing, gasping, very fast/slow)
- Grunting or severe chest in-drawing
- Floppy / no movement / lethargy
- Convulsions
- Temperature instability (too cold or too hot)
- Jaundice of palms and soles (severe)
- Yummy problem — poor feeding / cannot feed
AMTSL — Active Management of the Third Stage
Recall test
What are the three components of AMTSL? What is the dose and timing of Oxytocin? Can you state all three without looking? If the placenta is retained or bleeding is uncontrolled, what does the midwife do? (Refer!)
Memory chain
The '3-Step PPH Bouncer': Step 1 — INJECT (Oxytocin 10 IU IM within 60 seconds = 10-1-1 rule). Step 2 — TRACTION (controlled cord traction — pull the cord carefully while guarding the uterus). Step 3 — MASSAGE (massage the uterus fundus after placenta is delivered). Three steps: Inject, Traction, Massage = ITM. 'I TreM-bled when I saw PPH — so I used ITM and stopped it.' Note: If PPH still occurs, the midwife REFERS to BEmONC-capable facility.
Items to remember
- Oxytocin 10 IU IM within 1 minute of birth of the baby
- Controlled cord traction (CCT) — Brandt-Andrews maneuver
- Uterine massage after delivery of the placenta
Diagrams
EINC Four Core Steps — The DiSCo Baby Sequence
A step-by-step flowchart of the EINC four core steps from birth to the first bath. Shows decision points (breathing check, breastfeed completion), correct timing for each step, and the WEBI deferred care sequence. This is the master map of the entire EINC newborn protocol.
EINC Unang Yakap — Complete Concept Overview Mind Map
A comprehensive mind map of the entire EINC/Unang Yakap protocol, organized into six major branches: Intrapartum Mother Care, Four Core Steps (with the DiSCo Baby mnemonic), Warm Chain, Eliminated Practices (SEBSSAF), Post-Feed Care (WEBI), and Danger Signs (BGFC-TJY). Use this as a visual summary before the board exam.
EINC Time-Bound Steps — The First 24 Hours of Life
A chronological timeline of all time-bound EINC actions from 0 seconds to 24 hours after birth. This visual anchor helps students remember not just WHAT to do but WHEN — which is the most commonly tested aspect of EINC on the board exam.
Detect and Refer — Newborn Danger Signs Decision Tree
A decision tree flowchart for newborn assessment using the BGFC-TJY danger signs. Shows the midwife's assessment pathway: any danger sign found = stabilize and refer to BEmONC-capable facility. A normal newborn with no danger signs continues the EINC protocol at the BHS or lying-in clinic level.