Essential Newborn Care Protocol: a Must Know for Parents and Would-Be Parents

The current practice of handling newborns contributes to the high incidence of neonatal death and illnesses in the country. Doctors are introducing a new way of caring for newborns in the first few minutes of life, which could cut by almost half the number of newborn deaths estimated at 40,000 each year according to this report.

Important points in the new program of the Department of Health (DOH) and World Health Organization that should be imposed are as follows: 1) dry the newborn immediately after birth (instead of washing) to prevent hypothermia and the risks related to it, 2) initiate skin contact with the mother by placing the baby on the mother’s chest or abdomen to provide warmth, increase the duration of breastfeeding, and allow the “good bacteria” from the mother’s skin to infiltrate the newborn, and 3) delay the cord clamping by two to three minutes after birth (or wait until the umbilical cord has stopped pulsing) to increase the baby’s iron reserves, reduce the risk of iron-deficiency anemia and improve blood circulation. These are basically in line with the Essential Newborn Care (ENC) protocol.



When I read about this, I had mixed emotions. On one hand, I got disappointed for I know it was not strictly observed when I gave birth to my 4 children. On the other hand, I felt grateful that an effort is being directed towards its strict implementation. There are only three hospitals in the Philippines currently subscribing to the ENC protocol so far—Quirino Memorial Medical Center in Quezon City, and Fabella Memorial Medical Center and Philippine General Hospital in Manila.

In all of my childbirth experiences, the umbilical cord was immediately cut before the baby is placed on my tummy or my breast. Then my baby was only allowed to ‘kiss’ my nipple because we were not given long enough time for the baby to latch on. They wash the baby and when they bring the baby to the room to be with me (room-in as we always specify), I usually notice red spots are on my baby’s face. They said that it is the result of the cotton rubbed on my baby’s face and will wear away in time. True enough the spots were gone in few days. But with the ENC protocol this should not happen to newborn babies in the future.

Most babies do not experience hypothermia even when washed immediately after birth, but a lot end up staying in the nursery for days just to be heated by lamps. Isn’t it because they were washed even before they get acclimatized in their new environment? I am just wondering. When this happens initiation of breastfeeding is delayed, making the situation worse for both mother and baby. Delaying the start of breastfeeding by one day could make the newborn 2.6 times more prone to infection as also mentioned in that report.

I am posting this to help spread the information about the ENC Protocol. To those who are about to give birth, discuss this with your Obstetrician-Gynecologist (OB). Know the hospital policy on this as suggested in my previous blog on childbirth preparation. If they are not yet implementing the ENC protocol and you want it for your child, ask if they will accommodate your request.

This is also a good chance for me to highlight the various practices beneficial to the health and well-being of the child with less emphasis on cleanliness: (1) passing through the birth canal to get in contact with microorganisms necessary to prime his/her immune system and (2) allowing the child to play and get dirty as explained in my previous blog on natural immunity builders, (3) skin contact with mother for the good bacteria to infiltrate newborn, (4) delaying washing of the new born to prevent hypothermia as washing removes the vernix or baby’s skin protection. Apparently, too much emphasis on cleanliness is also detrimental to your child.

Director Honorata Catibog, head of the DOH task force on the rapid reduction of maternal and neonatal mortality, describes the new program to implement the ENC protocol as “paradigm shift”. I call it going back to basics...our natural survival strategy.

photo courtesy of stockvault.net