EINC 2022 PDF

Essential Intra-partum & Newborn Care (EINC) ANNALIE R. DOŇA RN., MAN. UNANG YAKAP or THE FIRST EMBRACE is the tagline for Essential Intrapartum and Newborn Care or EINC Mission To improve maternal and newborn health care services in the Philippines through evidence-based and time-bound...

Essential Intra-partum & Newborn Care (EINC) ANNALIE R. DOŇA RN., MAN. UNANG YAKAP or THE FIRST EMBRACE is the tagline for Essential Intrapartum and Newborn Care or EINC Mission To improve maternal and newborn health care services in the Philippines through evidence-based and time-bound protocol essential to the survival of the mother-infant dyad. Intermediate goals are MDG 4&5.  It is a basic component of the Department of Health’s Maternal, Newborn and Child Health and Nutrition (MNCHN) strategy as an expression of the national commitment to achieve United Nations Millennium Development Goals (MDG) 4 and 5 by the year 2015. Millennium Development 4 & 5 MDG 4 – to reduce child mortality by 2/3 between 1990 and 2015 the under five mortality rate MDG 5 - Target 5A: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio. Target 5B: Achieve, by 2015, universal access to reproductive health  3.4 million pregnancies occur every year 11 mothers die of pregnancy - related causes everyday Leading cause of maternal deaths: PPH HPN Abortion related complications Obstructed labor  NATIONAL POLICIES FOR MATERNAL AND NEWBORN CARE The Philippine government, along with the international community, has made legislative efforts to ensure that care of a certain standard is accessible to all mothers and babies. most current and of the highest standard such that in providing care, the dignity of every mother and child is respected and maintained, and when receiving care, all women and children, regardless of social or economic status, are treated equally. HEALTH POLICIES FOR ESSENTIAL INTRAPATUM AND NEWBORN CARE (EINC) The Department of Health has issued directives to ensure the highest quality of care for mothers and their newborns. DOH policies describe methods for providing standard maternal and newborn care to the general population and demand that monitoring and evaluation systems be put in place for these strategies. DOH POLICIES Revitalization of the Mother-Baby Friendly Hospital Initiative in Health Facilities with Maternity and Newborn Care Services Administrative Order No. 2007- 0026  Main objective is to transform all health institutions with maternity and newborn services into facilities that fully PROTECT, PROMOTE AND SUPPORT rooming – in, breastfeeding and mother-baby friendly practices. DOH POLICIES Implementing Health Reforms for the Rapid Reduction of Maternal and Neonatal Mortality Administrative Order No. 2008- 0029  Issued on September 9, 2008. End GOAL is to rapidly reduce maternal and neonatal death. 3 major pillars in reducing MNM: Emergency obstetric care Skilled birth attendants Family planning DOH POLICIES Adopting New Policies and Protocol on Essential Newborn Care Administrative Order No. 2009- 0025  Issued on December 7, 2009 Outlines specific policies & principles to follow for all health care providers involved in newborn health care.  4 steps to save newborn lives: Immediate and thorough drying of the newborn Early skin-to-skin contact b/n mother & newborn Properly timed cord clamping and cutting Non-separation of newborn and mother for early breastfeeding.  40, 000 newborns die each year from causes that are most preventable such as complications of: Prematurity (41%) Birth asphyxia (15%) Severe infection (16%) DOH POLICIES The Aquino Health Agenda: Achieving Universal Health Care for All Filipinos Administrative Order No. 2010-0036  Millennium Development Goal – 8 international development goals that all 193 United Nation Member have agreed to achieve by the year 2015. WORLD HEALTH ORGANIZATION (WHO) GUIDELINES Pregnancy, Childbirth, Postpartum and Newborn Care: A Guide for Essential Practice Integrated Management of Pregnancy and Childbirth, 2006  Aims to provide evidence-based recommendations to guide health care professionals in giving high-quality care during pregnancy, delivery and in the postpartum period, thereby making pregnancy and childbirth SAFER. WORLD HEALTH ORGANIZATION (WHO) GUIDELINES WHO Recommendations for the Prevention of Postpartum Hemorrhage, 2006 1. Active management of the 3rd stage of labor should be offered by skilled attendants; 2. Use of oxytocin for prevention of PPH; 3. Cord should not be clamped earlier than is necessary 4. Delivery of placenta by controlled traction. WORLD HEALTH ORGANIZATION (WHO) GUIDELINES Newborn Care until the First Week of Life Clinical Practice Pocket Guide, 2009  adopted in September 2015 at an historic UN Summit build on the success of the Millennium Development Goals, aiming to go further by ending all forms of poverty, fighting inequalities and tackling climate change  apply to low, middle and high income countries alike governments are expected to take ownership and establish national frameworks for achieving the goals the clock already started on January 1, 2016 What is Sustainable Development? meets the needs of the present without compromising the ability of future generations to meet their own needs call for concerted efforts toward building an inclusive sustainable and resilient future for people and planet  relies on three interconnected elements that are crucial to the well being of individuals and societies, economic growth, social inclusion and environmental protection requires eradicating poverty in all its forms and dimensions Health & Nutrition in the UN 2030 Sustainable Development Goals MDGs to SDGs - the unfinished business of the MDGs- MDG 1, 4 & 5 MDGs SDGs 1 - Eradicate extreme poverty and hunger 2 - End hunger achieve food security and improved nutrition and promote sustainable agriculture underweight IUGR stunting LBW wasting underweight 4 - Reduce child mortality stunting under-five mortality rate wasting infant mortality rate 3 - Ensure healthy lives and promote well being for 5 - Improve Maternal Health all ages maternal mortality ratio maternal mortality ratio skilled birth attendant under-five mortality ratio contraceptive prevalence rate new-born mortality rate Global strategies Global Strategy for Women's, Children's and Adolescent Health 2016- 2030 Committing to Child Survival: A Promise Renewed Global and Regional Action Plan for New-born Health  Pregnancy/Prenatal = 270 days first 6 months of life of an infant = 180 days from 6 months up to 2 years = 550 days ________________ total of 1,000 days SDGs Public Health Nursing and MCH Nursing Global Goals # 1, 2 and 3 are the 3 of the 17 sustainable development goals related to health and nutrition most specially of women, children and adolescents.  Goal # 1 - No Poverty. Prioritizing the health needs of the poor. Goal # 2 - Zero Hunger Addressing the cause and consequence of all forms of malnutrition, underweight, stunting, wasting, micronutrient deficiencies, overweight/obesity, NCD related disease.  supporting High Quality Education for All to Goals # 4 - Quality Improve Health and education Health Equity Goal # 5 - Gender Equality Fighting Gender Inequalities, including Promoting Health violence against women Employment as a driver Goal # 8 - Decent Work and for economic growth Economic Growth  Goal # 10 - Reduced Inequalities Ensuring Equitable Access to Health Services through Universal Health Coverage based on stronger Primary Care Goal # 17 - Partnership for the Goals Mobilizing Partners to monitor and attain Health - Related SDGs EINC Recommendation on Prenatal Care Before pregnancy taking of folic acid 2 months before pregnancy. Prenatal visit of 8 for primigravida 4-6 visits for multi-gravida Used of FeSo4 supplements to treat early signs of Anemia Used of Anti-Natal Steroids for mothers’ at risk for delivering preterm babies : Dexamethasone 12 mg IM every 24 hours to complete 24mg Betamethasone 6mg IM every 12 hours to complete 24 mg. Recommended Practice During Labor based on EINC Recommended Active phase of 1. Admission to Practices based labor labor room when ✓2-3 contractions the parturient is on EINC already in the in 10 mins. active phase. ✓Cervix is 4 cm dilated Admit Less need for Cesarean Section when the by 82% parturient No difference in need for labor augmentation is already in ACTIVE No difference in neonates with APGAR scores 100 ml Cord Traction by 24% No difference in rates of maternal mortality or serious morbidity and need for additional uterotonics Uterine Massage after Placental Delivery Lower mean blood loss Less need for uterotonics  Administration of uterotonics within Active one minute of delivery of the baby. Management of Controlled cord traction with the Third Stage counter traction on the uterus (AMTSL) Uterine massage  Physiologic Active (AMTSL) (Expected) Uterotonic Not GIVEN before GIVEN within 1 min Approaches in placenta is delivered of baby’s birth the Mgt of the Signs of Placental separation WAIT DON’T WAIT rd 3 Stage of Delivery of the By gravity with CCT with counter Labor placenta maternal efforts traction on the uterus Uterine massage After placental is After placental is delivered delivered  1. Perineal massage in the 2nd stage of labor. Intervention Based on the review, there is a clear that are NOT benefit (less 3rd -4th degree tears) and Recommended no clear harm (no difference in 1st and 2nd degree tears, vaginal pain, blood during Delivery loss) Commonly noted complications in practice (perineal edema, wound infection and wound dehiscence) were not evaluated. Fundal pressure during the 2nd 2 stage of labor.  NOT RECOMMENDED RECOMMENDED CARE Coaching the mother to ✓Upright position DURING push during delivery DELIVERY Perineal massage in the 2nd stage of labor ✓Selective episiotomy ✓Use of prophylactic Fundal pressure during oxytocin for mgt of the 2nd stage of labor 3rd stage of labor ✓Delay cord clamping ✓Controlled cord traction with counter- traction to deliver the placenta ✓Uterine massage POSTPARTUM NOT RECOMMENDED RECOMMENDED Manual exploration of the ✓ Routine inspect the birth CARE uterus canal for lacerations Routine use of icepacks over ✓ Inspect the placenta & the hypogastrium membranes for Routine oral completeness methylergometrine ✓ Early resumption of feeding (