A prospective cross-sectional analysis on the adherence to the four time-bound interventions of the essential intrapartum and newborn care program (EINC) in a private tertiary hospital in Metro Manila / Philippine Journal of Obstetrics and Gynecology

ABSTRACT

BACKGROUND: The fourth Millennium Development Goal set out by the United Nations in 2000 aims to reduce under five-mortality globally, of which major contributor is neonatal mortality. Aside from the direct causes of neonatal deaths, newborns may die due to lack of access to the basic care. The World Health Organization started Essential Intrapartum and Newborn Care (EINC), an evidenced-based program that adapts safe and quality care for newborns and mothers. In response to this call, The Philippine Department of Health under Administrative Order 2009-0025, instituted Unang Yakap, a protocol compromised of four time-bound interventions. These are immediate drying, uninterrupted skin-to-skin contact, delayed cord clamping and early initiation of breastfeeding. This should be performed immediately and sequentially upon birth up to the 1st  hour of life.OBJECTIVE: It is the aim of the study to assess the adherence of the obstetricians to performing these time-sensitive interventions during deliveries and to uncover substandard practices.METHODS: This prospective, cross-sectional, single-center study was conducted for 1 year. The birthing process was observed from pushing up to the 1st  hour after birth. The timing and sequence of each newborn care intervention was recorded in a standardized assessment tool as they were performed. Other inventions not specified in the tool were also recorded.RESULTS: The steps of EINC were performed in 100% of deliveries. However, total adherence to the 4 time-bound interventions was less than 50%.CONCLUSION: This direct observational study shows that obstetricians were compliant to EINC in all the deliveries but adherent to the protocol in less than half only. Unnecessary interventions were observed although substandard practices were not demonstrated. The compliance of all birthing events to the protocol implies that EINC is a simple and uncomplicated procedure. Full adherence can be accomplished if physicians are re-oriented to the benefits of EINC.