tag:blogger.com,1999:blog-50185326565892232002024-03-12T20:55:47.430-07:00EINC BulletinEINC Bulletinhttp://www.blogger.com/profile/12010405013897827470noreply@blogger.comBlogger31125tag:blogger.com,1999:blog-5018532656589223200.post-74485193320167120412011-09-29T01:47:00.000-07:002011-09-29T02:16:57.663-07:00EINC Recommended Practices in Intrapartum Care: Hand Hygiene, Partograph Use and Active Management of the Third Stage of Labor (AMTSL)<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: 15px;"><b><br />
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</div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><b style="mso-bidi-font-weight: normal;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Hand Hygiene</span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif; font-size: 11pt;"><o:p></o:p></span></b></div><div class="separator" style="clear: both; text-align: center;"><a href="http://2.bp.blogspot.com/-4X37sS8U0wU/ToQwSqX2AAI/AAAAAAAAAFE/Eshr4vRK_I4/s1600/How_To_HandWash_Poster.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="400" src="http://2.bp.blogspot.com/-4X37sS8U0wU/ToQwSqX2AAI/AAAAAAAAAFE/Eshr4vRK_I4/s400/How_To_HandWash_Poster.jpg" width="282" /></a></div><div style="margin-bottom: .0001pt; margin: 0in; text-indent: 31.5pt;"><br />
</div><div style="margin-bottom: 0.0001pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; text-align: justify;"><span style="font-size: 11pt;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Hand hygiene is perhaps the single most important and effective measure to prevent nosocomial infections and antimicrobial resistance in hospital settings. It is a general term that refers to either handwashing, antiseptic handwash, antiseptic handrub, or surgical hand antisepsis. Despite substantial evidence that it reduces the incidence of infections, adherence to hand hygiene by health-care workers’ remains low at an average of 40 %. Contributing factors are dryness and irritation caused by handwashing agents, inconveniently located sinks, lack of soap and paper towels, lack of time, understaffing and overcrowding, and the patient needs taking priority. Thus, easy, timely access to both hand hygiene and skin protection is necessary for satisfactory hand hygiene behavior. Alcohol-based hand rubs may be better than traditional handwashing as they require less time, act faster, are less irritating and contribute to sustained improvement in compliance associated with decreased infection rates. All institutions should prioritize improving hand hygiene by providing appropriate administrative support and financial resources to this end. Strategies that are both multimodal and multidisciplinary should be utilized to improve compliance.<o:p></o:p></span></span></div><div style="margin-bottom: .0001pt; margin: 0in;"><br />
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Sources: Pittet D. Improving Adherence to hand Hygiene Practice: A Multidisciplinary Approach. Emerging Infectious Diseases, Vol. 7 No. 2, March-April 2001, pp.240. Guideline for Hand Hygiene in Health Care Settings. MMWR 2002; vol. 51 no. RR16: 1-44.</span> <br />
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</b></span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><b>Partograph Use</b></span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif; font-size: 11pt; font-weight: bold;"><o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><br />
</div><div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span style="font-size: 11pt;">The partograph is a tool that can be used to assess the progress of labor and to identify when intervention is necessary. Studies have shown that using the partograph can be highly effective in reducing complications from prolonged labor for the mother (postpartum hemorrhage, sepsis, uterine rupture and its sequelae) and for the newborn (asphyxia, infection, death). </span><span style="font-size: 11pt;">As part of the safe motherhood initiative, the World Health Organization (WHO) promoted and produced a partograph w<span class="apple-style-span">ith a view to improving labor management and reducing maternal and fetal morbidity and mortality. </span></span><span style="font-size: 11pt;">Partograph use was recommended by Wall as one of the simple, affordable and effective approaches to reduce intrapartum-related neonatal deaths in low-resource settings. Mathai in 2009 stated that when used with defined management protocols, the partograph can effectively monitor labor and prevent obstructed labor. <o:p></o:p></span></span></div><div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;"><br />
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Sources: Wall SN et al. Reducing intrapartum-related neonatal deaths in low- and middle-income countries – what works? Semin Perinatol 2010 Dec: 34(6): 397-407. Review. <br />
Mathai M. The partograph for the prevention of obstructed labor. Clin Obstet Gynecol 2009 Jun: 52 (2): 256-69.</span> <br />
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</span></b></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><b style="mso-bidi-font-weight: normal;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: large;">Active Management of the Third Stage of Labor (AMTSL)</span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif; font-size: 11pt;"><o:p></o:p></span></b></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><b style="mso-bidi-font-weight: normal;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: large;"><br />
</span></b></div><div class="separator" style="clear: both; text-align: center;"><a href="http://1.bp.blogspot.com/-j5i0smQcFNI/ToQv9sXV_SI/AAAAAAAAAFA/zpK6lGWJ7_A/s1600/AMSTL.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="530" src="http://1.bp.blogspot.com/-j5i0smQcFNI/ToQv9sXV_SI/AAAAAAAAAFA/zpK6lGWJ7_A/s640/AMSTL.jpg" width="640" /></a></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><br />
</div><div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span style="font-size: 11pt;">Postpartum hemorrhage is one of the leading causes of maternal mortality, and active management of the third stage of labor (AMTSL) has been promoted as an effective intervention in preventing excessive bleeding among facility-based deliveries. </span><span style="font-size: 11pt;">The usual components of AMTSL include administration of uterotonic agents, controlled cord traction and uterine massage after delivery of the placenta. <o:p></o:p></span></span></div><div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify; text-indent: 0.5in;"><br />
</div><div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span style="font-size: 11pt;">In a 2010 Cochrane systematic review by Begley et al, AMTSL was more effective than expectant management in preventing blood loss, severe postpartum hemorrhage </span><span lang="EN-PH" style="font-size: 11pt;">(RR 0.34, 95% CI 0.14 - 0.87), low maternal hemoglobin after birth (RR 0.50, 95% CI 0.30 - 0.83) </span><span style="font-size: 11pt;">and prolonged third stage of labor. </span><span lang="EN-PH" style="font-size: 11pt;">There was no identifiable difference in Apgar scores less than 7 at 5 minutes. </span><span style="font-size: 11pt;"> However, there were reported adverse effects in the mother such as increases in diastolic blood pressure, </span><span lang="EN-PH" style="font-size: 11pt;">after-pains, use of analgesia and more women returning to hospital with bleeding. There was also a decrease in the baby's birthweight with active management, reflecting the lower blood volume from interference with placental transfusion. It is important to note that in this review, immediate cord clamping was practiced rather than the properly timed cord clamping after the cessation of cord pulsations that is part of the EINC protocol. It is now recommended that use of ergots be avoided and immediate cord clamping be deferred to prevent hypertension and decrease in the baby’s blood volume. The Bristol and Hinchingbrooke trials concluded that with physiologic management there is an increased risk of PPH and an increased need of blood transfusion; with active management there was no increase in the entrapment of the placenta, with oxytocin as the drug of choice. <o:p></o:p></span></span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><br />
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<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: xx-small;">Sources: Prendiville et al, The Bristol third stage trial: active versus physiological management of the third stage of labor. BMJ 297: 1295-1300. <br />
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Begley CM et al. Active versus expectant management for women in the third stage of labor. Cochrane Database of Systematic Reviews 2010, Issue 7. Art. No.: CD007412.</span>EINC Bulletinhttp://www.blogger.com/profile/12010405013897827470noreply@blogger.com1tag:blogger.com,1999:blog-5018532656589223200.post-66566050913895210892011-09-29T01:36:00.000-07:002011-09-29T02:19:36.393-07:00Frequently Asked Questions regarding Essential Intrapartum and Newborn Care<script>
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<div class="MediumGrid1-Accent21" style="margin-bottom: .0001pt; margin: 0in; mso-add-space: auto;"><i style="mso-bidi-font-style: normal;"><span style="font-size: 11pt;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">We’ve compiled some of your most frequently-asked questions and provided answers based on expert observations and evidence-based practices to help you in your EINC –Unang Yakap Advocacy.</span></span></i></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><br />
</div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 11pt;"><br />
</span></b></span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><div style="text-align: justify;"><b><span style="font-size: 11pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Non-separation of newborn from mother for breastfeeding initiation</span></span></b><span style="font-family: Georgia, 'Times New Roman', serif; font-size: 11pt;"><o:p></o:p></span></div></div><div style="margin-bottom: .0001pt; margin: 0in; vertical-align: baseline;"><div style="text-align: justify;"><br />
</div></div><div style="margin-bottom: .0001pt; margin: 0in; vertical-align: baseline;"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 11pt;">Q:</span></b><span style="font-size: 11pt;"> Won’t the baby have an increased risk of falling when he is left alone with the mother who is still fatigued or sleepy after the delivery?<o:p></o:p></span></span></div></div><div style="margin-bottom: .0001pt; margin: 0in; vertical-align: baseline;"><div style="text-align: justify;"><br />
</div></div><div style="margin-bottom: .0001pt; margin: 0in; vertical-align: baseline;"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 11pt;">A:</span></b><span style="font-size: 11pt;"> Falls may occur most especially in the period following delivery but what needs to be emphasized is that we should institute measures aimed at eliminating or monitoring the most common circumstances under which these falls occur. In multicenter studies done in the United States, the incidence of in-hospital neonatal falls was estimated at 1.6-4.14/10,000 live births. After studying the circumstances surrounding the incidents, preliminary recommendations made by a </span><span style="font-size: 11pt;">committee to reduce newborn falls included monitoring mothers more closely, improving equipment safety (such as reducing gaps between hospital bed railings, or between the mattress and the guard rails; integrating the bassinet into the design of the maternal bed so that it can be attached alongside it) and increasing awareness about newborn falls.</span><span style="font-size: 11pt;"> Data from the East Avenue Medical Center from 2008 to 2010, a period before EINC Program implementation, showed that the local incidence of falls ranged from 4.9-11.7/10,000 live births. The most frequent circumstance of an infant falling on the floor occurred when a mother, seated on a chair, falls asleep while breastfeeding her infant. In response to this finding, EAMC’s EINC Working Group designed a sling or <i style="mso-bidi-font-style: normal;">salumbata </i>so that the risk of falling will be significantly reduced and reorganized their staff for mother-infant dyad monitoring and education . Other project sites in the EINC scale-up project have innovated with their own sling designs for this purpose. Across the 11 Scale-up EINC Project sites, the incidence of falls has not increased.<o:p></o:p></span></span></div></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><div style="text-align: justify;"><br />
</div></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 11pt;">Q</span></b><span style="font-size: 11pt;">: Does being in skin-to-skin contact with the mother put the baby at risk for suffocation ?<o:p></o:p></span></span></div></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><div style="text-align: justify;"><br />
</div></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 11pt;">A</span></b><span style="font-size: 11pt;">: </span><span style="font-size: 11pt;"> There is no evidence that skin to skin contact alone puts a newborn at risk of sudden deterioration due to possible suffocation. A neonatal apparent life-threatening event (ALTE) or sudden unexpected death during the first 2 hours of life is rare. A 2008 study by Dageville done in Provence, France on 62,968 presumably healthy term neonates showed an overall rate of neonatal apparent life-threatening events and unexpected deaths of 0.032 per 1000 live births. A similar study by Poets done in Germany in 2010 on unexpected sudden infant deaths (SID) and severe apparent life-threatening events (S-ALTE) that occurred within 24 hours of birth yielded an incidence of 0.026 in 1000 live births. Another sub-group of sudden, unexpected infant deaths is caused by accidental suffocation and strangulation in bed (ASSB) which is a leading category of injury-related infant deaths. Events seem often related to a potentially asphyxiating position while the parents may be too fatigued or otherwise are not able to assess their infant's condition correctly, consistent with the potential risk factors for ALTE identified in the Dageville study, namely skin-to-skin contact, a first-time mother and mother and baby alone in the delivery room. With the introduction of EINC as a new protocol, it is very easy to fall into the trap of blaming the program for any untoward incidents that occur while it is being introduced. Since we know that close interactions between the mother and baby during the immediate postpartum period is beneficial, these events should not lead us to reconsider skin-to-skin contact but instead make us focus on prevention efforts that include more vigilant monitoring of a skin-to-skin infant left alone with its mother during these hours, and helping parents and caregivers provide safer sleep environments.<o:p></o:p></span></span></div></div><div class="MediumGrid1-Accent21CxSpFirst" style="margin-bottom: .0001pt; margin: 0in; mso-add-space: auto;"><br />
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</div><div class="MediumGrid1-Accent21CxSpLast" style="margin-bottom: .0001pt; margin: 0in; mso-add-space: auto;"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 11pt;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></span></b></div><div class="MediumGrid1-Accent21CxSpLast" style="margin-bottom: .0001pt; margin: 0in; mso-add-space: auto;"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 11pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Care Prior to Discharge</span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><o:p></o:p></span></span></b></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><div style="text-align: justify;"><br />
</div></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 11pt;">Q</span></b><span style="font-size: 11pt;">: Should alcohol be applied to the umbilical cord stump?<o:p></o:p></span></span></div></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><div style="text-align: justify;"><br />
</div></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 11pt;">A</span></b><span style="font-size: 11pt;">: No. It is not advisable to use alcohol on the cord because studies have shown that it doesn’t have as much of a protective effect against infections over simply allowing an umbilical cord to dry on its own (dry cord care). Compared with the use of antiseptics, dry cord care also leads to earlier separation of the cord after birth, as seen in separate studies by Vural (dry care vs. human milk and povidone-iodine) and Dore (dry care vs. alcohol), and a Cochrane review by Zupan updated in 2004. With dry cord care, however, the cord should still be washed with soap and water when it becomes soiled, wiped with a dry cotton swab, and then allowed to air-dry. <o:p></o:p></span></span></div></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><div style="text-align: justify;"><br />
</div></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 11pt;">Q</span></b><span style="font-size: 11pt;">: Won’t dry cord care increase the chances of umbilical cord infection?<o:p></o:p></span></span></div></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><div style="text-align: justify;"><br />
</div></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 11pt;">A</span></b><span style="font-size: 11pt;">: A Cochrane review by Zupan updated in 2004, which included</span><span style="font-size: 11pt;"> </span><span style="font-size: 11pt;">twenty-one studies with 8959 participants assessed the effects of topical cord care in preventing cord infection, illness and death. There was </span><span style="font-size: 11pt;">n</span><span style="font-size: 11pt;">o difference demonstrated between cords treated with antiseptics compared with dry cord care or placebo. There was a trend to reduced colonization with antibiotics compared to topical antiseptics and no treatment. The use of antiseptics, however, reduced maternal concern about the cord. To date, there is limited research which has not shown an advantage of antibiotics or antiseptics over simply keeping the cord clean.</span><span style="font-size: 11pt;"> In all the 11 hospitals involved in the EINC scale-up project, there was no increase in the incidence of omphalitis observed with dry cord care.<o:p></o:p></span></span></div></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><br />
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</div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 11pt;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">Intravenous Fluid Infusion for Women in Labor</span></span></b></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><div style="text-align: justify;"><br />
</div></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span style="font-size: 11pt;">Intravenous (IV) therapy has been used routinely to hydrate women who were restricted from eating and drinking and to provide quick access in case of an emergency. However, researchers including Goer in 2007 have questioned the need for IVs in all women in labor since life-threatening emergencies are very rare in low-risk women</span><span class="MsoCommentReference"><span style="font-size: 8pt;"><a class="msocomanchor" href="http://www.blogger.com/post-create.g?blogID=5018532656589223200#_msocom_1" id="_anchor_1" language="JavaScript" name="_msoanchor_1">[RA1]</a> </span></span><span style="font-size: 11pt;">. One study evaluated the probable risk of maternal aspiration mortality to be in the extremely low range of approximately 7 in 10 million births. Starting IVF routinely confers several disadvantages because having an IV line in place is painful and stressful, and disrupts the natural birthing process by hindering the woman’s freedom of movement in labor. There are also potential adverse effects of infusing</span><span class="apple-style-span"><span style="font-size: 11pt;"> glucose solutions to the mother will due to interference with glucose and insulin levels in both the mother and baby. Excessive insulin production in the fetus occurs when women receive more than 25 g of glucose intravenously during labor. This can result in neonatal hypoglycemia and increase serum lactate levels which effectively lower the umbilical arterial blood pH.</span></span><span style="font-size: 11pt;"> </span><span style="font-size: 11pt;">E<span class="apple-style-span">xcessive use of dextrose-only salt-free IV solutions can also cause a fall in serum osmolality and result in hyponatremia in both the mother and the fetus. Thus, the use of IV glucose and fluids to prevent or combat ketosis and dehydration in the mother may have serious unwanted effects on both mother and baby. </span>Regardless of solution type, intravenous therapy does not ensure a nutrient and fluid balance for the demands of labor and predisposes women to immobilization, stress, increased risk of fluid overload. . <span class="apple-style-span">Other reported adverse effects include headache, nausea, slowing of labor and difficulty in establishment of breastfeeding.</span> It is not likely to be beneficial, and no studies have demonstrated that </span><span style="font-size: 11pt;">routinely placing an IV in low-risk laboring women prevents poor outcomes (Enkin et al., 2000; Goer et al., 2007)</span><span style="font-size: 11pt;">. For the normal, low risk birth in any setting, there is no need for restriction of food, except in situations where intervention is anticipated.</span><span style="font-size: 11pt;"> </span><span style="font-size: 11pt;"><o:p></o:p></span></span></div></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">---<o:p></o:p></span></div><br />
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<span class="Apple-style-span" style="font-size: xx-small;">Additional references:<br />
1. <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Helsley%20L%22%5BAuthor%5D">Helsley L</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22McDonald%20JV%22%5BAuthor%5D">McDonald JV</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Stewart%20VT%22%5BAuthor%5D">Stewart VT</a>, Addressing in-hospital "falls" of newborn infants. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21226386">Jt Comm J Qual Patient Saf.</a> 2010 Jul;36(7):327-3<br />
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2. <a href="http://pediatrics.aappublications.org/search?author1=Sherry+A.+Monson&sortspec=date&submit=Submit">Monson</a> SA, Henry E, Lambert DK, Schmutz N, Christensen RD, In-hospital falls of newborn infants: data from a multihospital health care system. Pediatr. Vol. 122 No. 2 August 1, 2008, pp. e 277 –e 280.<br />
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3. Annual Statistics, East Avenue Medical Center, 2008-2010. Unpublished data.<br />
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4. <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Dageville%20C%22%5BAuthor%5D">Dageville C</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Pignol%20J%22%5BAuthor%5D">Pignol J</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22De%20Smet%20S%22%5BAuthor%5D">De Smet S</a>, Very early neonatal apparent life-threatening events and sudden unexpected deaths: incidence and risk factors. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18482167">Acta Paediatr.</a> 2008 Jul; 97(7):866-9. Epub 2008 May 14.<br />
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5. <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Poets%20A%22%5BAuthor%5D">Poets A</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Steinfeldt%20R%22%5BAuthor%5D">Steinfeldt R</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Poets%20CF%22%5BAuthor%5D">Poets CF</a>, Sudden deaths and severe apparent life-threatening events in term infants within 24 hours of birth. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21444593">Pediatrics.</a> 2011 Apr;127(4):e869-73. Epub 2011 Mar 28.</span><br />
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6. Shapiro-Mendoza CK, Kimball M, Tomashek KM, Anderson RN, Blanding S, US infant mortality trends attributable to accidental suffocation and strangulation in bed from 1984 through 2004: are rates increasing? Pediatr. Vol. 123, No. 2, February 2009: 533-539.<br />
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7. <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Vural%20G%22%5BAuthor%5D">Vural G</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Kisa%20S%22%5BAuthor%5D">Kisa S</a>, Umbilical cord care: a pilot study comparing topical human milk, povidone-iodine, and dry care. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16466360">J Obstet Gynecol Neonatal Nurs.</a> 2006 Jan-Feb; 35(1):123-8.<br />
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8. <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Dore%20S%22%5BAuthor%5D">Dore S</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Buchan%20D%22%5BAuthor%5D">Buchan D</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Coulas%20S%22%5BAuthor%5D">Coulas S</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Hamber%20L%22%5BAuthor%5D">Hamber L</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Stewart%20M%22%5BAuthor%5D">Stewart M</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Cowan%20D%22%5BAuthor%5D">Cowan D</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Jamieson%20L%22%5BAuthor%5D">Jamieson L</a>, Alcohol versus natural drying for newborn cord care. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9836156">J Obstet Gynecol Neonatal Nurs.</a> 1998 Nov-Dec; 27(6):621-7.<br />
</span></div><div><span class="Apple-style-span" style="font-size: xx-small;">9. Zupan J, Garner P. Omari AA, Topical umbilical cord care at birth. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15266437">Cochrane Database Syst Rev.</a> 2004; (3):CD001057.<br />
</span></div><div><span class="Apple-style-span" style="font-size: xx-small;">10. Lothian JA, Amis D, Crenshaw J, Care Practice #4: No Routine Interventions. J Perinat Educ. 2007 Summer; 16(3): 29–34. doi: <a href="http://dx.crossref.org/10.1624%2F105812407X217129">10.1624/105812407X217129</a>.<br />
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11. Enkin M, Keirse M, Neilson J, Crowther C, Duley L, Hodnett E, A guide to effective care in pregnancy and childbirth. 2000 et al. New York: Oxford University Press, pp. 261-2.<br />
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12. Goer H, Leslie M. S, Romano A. The Coalition for Improving Maternity Services: Evidence basis for the ten steps of mother-friendly care. Step 6: Does not routinely employ practices, procedures unsupported by scientific evidence. J Perinat Educ. 2007;16 (Suppl. 1):32S–64S.<br />
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13. Sleutel M, Golden S, Fasting in labor: relic or requirement. J Obstet Gynecol Neonatal Nurs. 1999; 28: 507-512,.</span></div>EINC Bulletinhttp://www.blogger.com/profile/12010405013897827470noreply@blogger.com1tag:blogger.com,1999:blog-5018532656589223200.post-86790236510218273002011-09-29T01:18:00.000-07:002011-09-29T01:20:51.944-07:00Kuwentong Unang Yakap: Ella & Mika’s Miracle<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><i>Kuwentong Unang Yakap chronicles the first-hand experiences, inspiring testimonial and personal anecdotes of doctors, health professionals, patients and other healthcare providers narrating their “Unang Yakap” stories. </i></span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"> </span><br />
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</b></span></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">by: Dr. Pinky Imperial <a href="http://www.blogger.com/post-create.g?blogID=5018532656589223200#_ftn1" name="_ftnref" style="mso-footnote-id: ftn;" title=""><span class="MsoFootnoteReference">[1]</span></a> <o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">My family and I came back in May 2010, and we had barely settled down when I began to have hyperacidity, nausea and eventually vomiting, which in my experience signified only one thing – that I was pregnant again! After 3 sons, my husband and I were not really planning on adding to the family, but the 2 pregnancy tests that I took proved my suspicions to be all too true. I knew that I was already a high-risk patient since I was now an elderly multigravid. Not wanting to leave anything to chance, I immediately consulted a perinatologist in the hospital nearest our home. In the week following our return, the ultrasound done showed that I was pregnant with twins! And thus began the steady uphill climb that would characterize the course of my pregnancy. <o:p></o:p></span></div></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">I usually had excessive vomiting bouts during the first trimester of all my pregnancies, but this time around, the very high hCG levels in a twin pregnancy amplified my vomiting even more. When I reached my fifth month and the vomiting had just started to abate, I had my second ultrasound which showed that we were expecting girls. My husband and I were ecstatic at the thought of having girls this time around, but the joy dimmed considerably when my doctor told me that there was a “double bubble” sign in the first twin, accompanied by polyhydramnios, which were both signs that she had some form of gastrointestinal obstruction. I knew that her condition could only be remedied by surgery, and I started to become fearful of the possible outcome when the twins were delivered. Another few weeks went by and my blood pressure, which hovered in the higher limits of normal, became persistently elevated and I had to be maintained on anti-hypertensive medications. By the sixth month, I had already developed edema in my legs, which was quite early compared to my previous pregnancies. Laboratory tests done also showed mild hypothyroidism. Subsequent ultrasound tests showed persistence of the double bubble sign, progression of the polyhydramnios and beginning discordance in the weights of the twins. My perinatologist maintained a calm demeanor but by this time she was asking me to return more frequently for check-ups and by my 32<sup>nd</sup> week she already advised me to have a course of betamethasone injected in the event that a combination of all the existing conditions would trigger premature labor. It slowly began to sink in that the babies would, in all probability, be born early, so I informed my doctor that I had planned for EINC to be done when I gave birth. It was still the pre-EINC period in the hospital and she acknowledged my request but replied that it would really depend on the twins’ condition upon delivery. <o:p></o:p></span></div></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">A few days after I had my betamethasone injections, I came in for check-up and while my non-stress test showed that at 33 weeks age of gestation the babies were fine, I had to be confined for blood pressure control. Soon I was being treated for pre-eclampsia, and after 3 more days my OB made the decision to do emergency cesarean section due to non-reassuring fetal heart rate patterns. Having previously delivered all my sons by NSD, I was terrified at the thought of undergoing surgery this time around, and I was crying as they wheeled me into the operating room. My anesthesiologist gently reminded me that crying would hinder my breathing and advised me to calm down. I composed myself and asked her not to sedate me because I wanted to be awake when the girls were delivered and placed on skin-to-skin contact with me. When my OB came in, I again asked her if we could do properly timed cord clamping and she assured me that she would discuss this with the neonatologists attending the delivery. She started the procedure, and a little while later the first twin came out, and after drying and cord clamping, she was placed on my chest. I knew she was the one with the problem but was relieved to see that she looked stable and was comfortable. Then soon enough the second twin came out and she joined her sister on my chest. After a short while my OB gently asked me if the twins could be taken to the NICU already and I nodded, knowing that they had to be worked up and referred ASAP. They were 35 weeks by pediatric aging, and weighed 1.49 kg and 1.62 kg. Neither of them had any breathing difficulty.<o:p></o:p></span></div></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
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<tr><td style="text-align: center;"><a href="http://4.bp.blogspot.com/-bWu_e2bm-yg/ToQpjNEeQ2I/AAAAAAAAAE8/7Wv-a9s1m4k/s1600/Twins+reunited.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="480" src="http://4.bp.blogspot.com/-bWu_e2bm-yg/ToQpjNEeQ2I/AAAAAAAAAE8/7Wv-a9s1m4k/s640/Twins+reunited.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: xx-small;">Mika and Ella together again</span></td></tr>
</tbody></table><div class="separator" style="clear: both; text-align: center;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"></span></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
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</span></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">After spending some time in the Recovery Room, I was finally wheeled back into my room. It was a good thing that the NICU nurse started to bring Ella, the second twin, to my room to breastfeed, and I would do this every 3 hours or when the baby would demand to be fed. After the first 24 hours, they could no longer bring her to the room as a matter of hospital policy, and I had to go to the NICU for the breastfeeding. So despite still having an IV line and a urinary catheter I continued to go to the NICU regularly for feeding. It was the following evening that the pediatric surgeon finally made rounds on Mika, the first twin. The x-ray done showed massive pneumoperitoneum, certainly one of the worst ones I have ever seen in all my years of practice. I instantly knew the risks my baby faced, and I burst into tears as the surgeon explained to my husband and my siblings that immediate surgery was indicated. We requested for a priest to come and the baby was baptized prior to the contemplated procedure. Mika was stable and did not look distressed, which was totally incompatible with the ominous x-ray picture. She was prepared for surgery, and our family and dear friends started storming the heavens for a miracle.<o:p></o:p></span></div></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
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</div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><div style="text-align: justify;">After the surgery, the doctor came back into my room with good news – he repaired the gastric perforation, and did not find any obstruction. We thanked God for the strength He gave Mighty Mika, and the miracle of a second chance for her. She remained stable and seemed fine every time I would sit with her when I would go into the NICU for Ella’s feeding. On the 2nd hospital day, Mika developed a heart murmur, labored breathing and poor perfusion, and was referred to a pediatric cardiologist. Because of her small size, he suggested transferring Mika to another institution which had a better 2-D echocardiography machine that would yield better diagnostic results. We then prepared for the transfer, which was facilitated by midnight. Early the next morning, the pediatric surgeon at the second hospital saw Mika and the repeat x-ray again showed a significant re-accumulation of free air in the abdominal cavity. He offered us two options – he could insert an abdominal drain at bedside to relieve the pneumoperitoneum (air leak) or do another exploratory laparotomy to look for the obstruction which he believed was the cause of the perforations. We immediately agreed to the surgery, and true enough the exploration revealed an annular pancreas as the root cause of all the complications. The surgery went well and Mika finally seemed on her way to recovery.<o:p></o:p></div></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><div style="text-align: justify;">Back at the first hospital, 3-day old Ella was still maintained in an incubator and had an IV line for calcium supplementation. She settled into a regular feeding schedule of every 2-3 hours and I would immediately go to the NICU as soon as she showed signs of being hungry. After one particular feeding, however, the nurse called me back because the baby was crying again. It was just an hour after the feeding and I was wondering why she was agitated. I went to the NICU and as soon as I held her in my arms she stopped crying and promptly went to sleep. The nurse remarked that maybe she just wanted to be held. This made me resolve to have her roomed-in right away despite all the contraindications that traditionally dictated that low birth weight premature babies should remain in the Nursery/NICU. I requested the neonatologist to already remove the IV fluids of Ella because since birth she was able to breastfeed well, and I also asked that they start weaning her from the incubator. I kept pestering the nurses on duty to remind the neonatologist about the IV and weaning, and after another day, Ella’s IV line was finally removed and she was transferred to a bassinet. That night I asked that she be roomed-in because I planned to take her home the next day when I was due to be discharged. So she was brought to me and we spent the night on skin-to-skin contact to ensure that she would not become hypothermic. The next morning, the neonatologist made rounds and I assured her that I would monitor my baby very closely at home and make sure that she is always thermoregulated. She looked at me with some uncertainty because Ella was only a few days old, was still losing weight (she was now down to 1.44 kg) and had been out of the incubator for only half a day. She reluctantly agreed despite the baby’s weight because she was reassured by the fact that I was also a neonatologist. I heaved a sigh of relief because I couldn’t bear to leave her alone in the hospital after all the time we spent together breastfeeding.<o:p></o:p></div></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><div style="text-align: justify;"><br />
</div></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><div style="text-align: justify;">When we got home, I was delighted to have Ella with me but then the realization that I brought home a tiny baby who was 1.4 kg and not quite 4 days old hit me and I began to have doubts if I made the right decision. It was one thing to absolutely refuse to leave her with strangers but caring for her at home was an entirely different thing altogether. Our first few days together revealed what a truly complicated situation I had gotten myself into. As a neonatologist, I had gotten used to just taking for granted the orders I wrote on the charts of my "growers:" strict thermoregulation, feeding with increments every 3 hours, supplementation of feeding and daily weighing. With Ella, I was now doing all these things myself and I developed a renewed appreciation for the NICU nurses who did these things routinely, day in and day out. Everything that was being given to Mika in the NICU, Ella was also getting at home. Aside from breastfeeding Ella I would also be pumping out my milk several times each day, then would measure out the multivitamin drops, virgin coconut oil or be adding human milk fortifier to the expressed breast milk and would feed this to her by cup or by syringe. We struggled with the supplemented feeding at first, but after some time, she got the hang of it and was able to do syringe feeding effortlessly. There was one time that the NICU nurse texted us that Mika’s milk supply was running low, and then she also asked how Ella was being fed at home. I said that aside from breastfeeding she preferred being fed by syringe and the nurse replied that Mika, too, preferred the same method of feeding. I smiled at the thought of the invisible bond between the twins being evident even that early. <o:p></o:p></div></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><div style="text-align: justify;"><br />
</div></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><div style="text-align: justify;">In the NICU, Mika was tolerating her feedings already and the volume was gradually increased. I had to pump out more milk for the two of them and when it was not enough, we had to get from the milk banks of 2 large tertiary hospitals, and were lucky if it was available. Mika’s doctor also referred me to her previous patient who had established a milk bank of sorts in her home and was giving breast milk for free to those who needed it. Another pediatrician-friend referred me to the mother of her patient who was regularly storing her excess breast milk and on several occasions she gladly shared her milk with our twins. <o:p></o:p></div></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><div style="text-align: justify;"><br />
</div></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><div style="text-align: justify;">Mika continued to recover steadily, and was already tolerating full feeds for 2 weeks when she developed fecaloid vomiting due to post-operative adhesions. I slumped in my seat after hearing the news, and was worried that she might need to undergo surgery once more. Thankfully the obstruction resolved with medical management and after 2 days she was able to resume feeding again. She had a second bout of infection, and had to complete another course of antibiotics. She was also given a blood transfusion to correct anemia. Her hearing screening, cranial ultrasound and ophthalmologic evaluations were all normal, and she was gaining weight again. Ella at home was not gaining weight as rapidly, but remained in stable condition. At this time she seemed to be quite pale, but did not become symptomatic and did not require a blood transfusion. We continued with our prayers of thanksgiving that both girls were doing very well and asked that God grant us the continued strength to overcome all obstacles until such time that the twins were together once more.<o:p></o:p></div></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><div style="text-align: justify;"><br />
</div></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><div style="text-align: justify;">Finally, after 50 long days in the NICU, Mika was cleared by all her 6 doctors, and exactly a week before Christmas, she was discharged from the hospital. It was the best Christmas gift we could ever hope for, and once again we thanked the Lord for the blessing of having both girls safely home and into our warm Unang Yakap embrace.<o:p></o:p></div></div><div class="MsoNormal"><div style="text-align: justify;"><br />
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<hr align="left" size="1" width="33%" /><div id="ftn"><div class="MsoFootnoteText"><a href="http://www.blogger.com/post-create.g?blogID=5018532656589223200#_ftnref" name="_ftn1" title=""><span class="MsoFootnoteReference">[1]</span></a> <span style="font-size: 9pt;">Dr. Pinky Imperial is a neonatologist and <span class="msoIns"><ins cite="mailto:Maria%20Asuncion%20Silvestre" datetime="2011-09-08T15:07"></ins></span></span><br />
<span style="font-size: 9pt;"><span class="msoIns">Co-Convener of </span></span><br />
<span style="font-size: 9pt;"><span class="msoIns"><ins cite="mailto:Maria%20Asuncion%20Silvestre" datetime="2011-09-08T14:58">Team </ins></span>EINC <span class="msoDel"><del cite="mailto:Maria%20Asuncion%20Silvestre" datetime="2011-09-08T15:07">Co-</del></span><span class="msoDel"><del cite="mailto:Maria%20Asuncion%20Silvestre" datetime="2011-09-08T14:58">c</del></span><span class="msoDel"><del cite="mailto:Maria%20Asuncion%20Silvestre" datetime="2011-09-08T15:07">onven</del></span><span class="msoDel"><del cite="mailto:Maria%20Asuncion%20Silvestre" datetime="2011-09-08T14:58">o</del></span><span class="msoDel"><del cite="mailto:Maria%20Asuncion%20Silvestre" datetime="2011-09-08T15:07">r</del></span></span></div></div></div></span>EINC Bulletinhttp://www.blogger.com/profile/12010405013897827470noreply@blogger.com0tag:blogger.com,1999:blog-5018532656589223200.post-85452548399436534342011-09-21T06:17:00.000-07:002011-09-21T06:17:45.010-07:00NEWS | Cotabato embraces Unang-Yakap<!--[if gte mso 9]><xml> <o:DocumentProperties> <o:Template>Normal.dotm</o:Template> <o:Revision>0</o:Revision> <o:TotalTime>0</o:TotalTime> <o:Pages>1</o:Pages> <o:Words>431</o:Words> <o:Characters>2457</o:Characters> <o:Company>..</o:Company> <o:Lines>20</o:Lines> <o:Paragraphs>4</o:Paragraphs> <o:CharactersWithSpaces>3017</o:CharactersWithSpaces> <o:Version>12.0</o:Version> </o:DocumentProperties> <o:OfficeDocumentSettings> <o:AllowPNG/> </o:OfficeDocumentSettings> </xml><![endif]--><!--[if gte mso 9]><xml> <w:WordDocument> <w:Zoom>0</w:Zoom> <w:TrackMoves>false</w:TrackMoves> <w:TrackFormatting/> <w:PunctuationKerning/> <w:DrawingGridHorizontalSpacing>18 pt</w:DrawingGridHorizontalSpacing> <w:DrawingGridVerticalSpacing>18 pt</w:DrawingGridVerticalSpacing> <w:DisplayHorizontalDrawingGridEvery>0</w:DisplayHorizontalDrawingGridEvery> <w:DisplayVerticalDrawingGridEvery>0</w:DisplayVerticalDrawingGridEvery> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:Compatibility> <w:BreakWrappedTables/> <w:DontGrowAutofit/> <w:DontAutofitConstrainedTables/> <w:DontVertAlignInTxbx/> </w:Compatibility> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" LatentStyleCount="276"> </w:LatentStyles> </xml><![endif]--> <!--[if gte mso 10]> <style>
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<div class="MsoBodyText" style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">The Cotabato Regional and Medical Center (CRMC) completed a successful and festive EINC launch last August 18, 2011. It was attended by Mayor Japal Guiani, SOCCSKSARGEN CHD Director Dumama and ARMM DOH Secretary Dr. Sinolinding’s representatives, Medical Director Dr. Yambao, Dr.<span style="mso-spacerun: yes;"> </span>Mansilla, Dr. Macalawan together with CRMC’s nursing staff. The walls of their dedicated EINC corner have been permanently painted with Unang Yakap colors. The Unang Yakap logo was made ubiquitous by rendering onto labels that were stuck to water bottles, hand disinfectant containers, tissue holder, ballpens, and Unang Yakap kits. To cap it off, cupcakes with the UY logo were served together with scrumptious food.<span style="mso-spacerun: yes;"> </span>The highlight of the event was Mayor Guiani’s speech, in which he committed to issue an Executive Order implementing EINC in the barangays.</span></div><div class="MsoBodyText" style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div><div class="separator" style="clear: both; text-align: center;"><a href="http://4.bp.blogspot.com/-ttr9tmCXduQ/TnnjzL94zrI/AAAAAAAAAE0/EmSUZRBWWF8/s1600/CRMC_parentsbaby.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="424" src="http://4.bp.blogspot.com/-ttr9tmCXduQ/TnnjzL94zrI/AAAAAAAAAE0/EmSUZRBWWF8/s640/CRMC_parentsbaby.jpg" width="640" /></a></div><div class="MsoBodyText"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
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</span></div><div class="MsoBodyText" style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Meanwhile CRMC continues to make inspiring progress in the implementation of EINC, maintaining >95% performance of the four core steps of EINC in all deliveries as of the month of July. In addition to this, 98% of patients have already been delivering in a semi-upright position and 100% use of antenatal steroids for eligible patients is being observed. Equally impressive are the percentage of patients allowed to eat/drink and have companions of choice, from 40% in June to 95.8%. Likewise, not a single case of fundal pressure was reported for a month since a department policy has been issued to that effect.</span></div><div class="MsoBodyText" style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Improvements in Pediatric practices have also been reported with the performance of EINC steps even in tachypneic but vigorous newborns as properly timed cord clamping is now being observed prior to separation for additional respiratory support. Commendable too are the breastfeeding advocacy strategies done by the team at the Outpatient Department and wards.<span style="mso-spacerun: yes;"> </span>As result of the nursing staff ‘s effort to continue developing plans on improving sterility, asepsis and handwashing practices in critical areas of the hospital, steady decrease of sepsis rates have been observed with only 1 reported preterm death due to sepsis. Total mortality rate is very low at 2.9% and the ultimate low sepsis rate at 0.7% was achieved for the month of July.</span></div><div class="MsoBodyText" style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div><div class="MsoBodyText" style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">And still, some challenges remain—such as pushing for more discriminating criteria for NICU admission as there are still cases of newborn being admitted just for “observation” without any true medical indication; improvements in timely referral system as well as increasing access to antenatal and prenatal care in CRMC’s catchment areas; and lastly intervention in the high cases of post-partum hemorrhage due to inappropriate use of methergine.</span></div><div class="MsoBodyText" style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div><div class="MsoBodyText" style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">All, in all, CRMC is on its way to improving maternal and infant healthcare with the committed work it has put into making EINC the new standard of care. What with Mrs.<span style="mso-spacerun: yes;"> </span>Nimia Juanday’s very comprehensive MNCHN EINC HPC Action Plan, activities to further strengthen EINC and MBFHI protocols have been set all the way to January 2012.</span></div><!--EndFragment-->EINC Bulletinhttp://www.blogger.com/profile/12010405013897827470noreply@blogger.com0tag:blogger.com,1999:blog-5018532656589223200.post-51437768437721210902011-09-21T06:11:00.000-07:002011-09-21T06:11:32.379-07:00NEWS | ADPCN, APSOM to integrate EINC in nursing and midwifery curricula<!--[if gte mso 9]><xml> <o:DocumentProperties> <o:Template>Normal.dotm</o:Template> <o:Revision>0</o:Revision> <o:TotalTime>0</o:TotalTime> <o:Pages>1</o:Pages> <o:Words>397</o:Words> <o:Characters>2265</o:Characters> <o:Company>..</o:Company> <o:Lines>18</o:Lines> <o:Paragraphs>4</o:Paragraphs> <o:CharactersWithSpaces>2781</o:CharactersWithSpaces> <o:Version>12.0</o:Version> </o:DocumentProperties> <o:OfficeDocumentSettings> <o:AllowPNG/> </o:OfficeDocumentSettings> </xml><![endif]--><!--[if gte mso 9]><xml> <w:WordDocument> <w:Zoom>0</w:Zoom> <w:TrackMoves>false</w:TrackMoves> <w:TrackFormatting/> <w:PunctuationKerning/> <w:DrawingGridHorizontalSpacing>18 pt</w:DrawingGridHorizontalSpacing> <w:DrawingGridVerticalSpacing>18 pt</w:DrawingGridVerticalSpacing> <w:DisplayHorizontalDrawingGridEvery>0</w:DisplayHorizontalDrawingGridEvery> <w:DisplayVerticalDrawingGridEvery>0</w:DisplayVerticalDrawingGridEvery> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:Compatibility> <w:BreakWrappedTables/> <w:DontGrowAutofit/> <w:DontAutofitConstrainedTables/> <w:DontVertAlignInTxbx/> </w:Compatibility> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" LatentStyleCount="276"> </w:LatentStyles> </xml><![endif]--> <!--[if gte mso 10]> <style>
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<div class="MsoListCxSpFirst" style="margin-bottom: 0.0001pt; text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Academic institutions and midwives may have already shared EINC with their </span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">students in the form of seminars and conventions, but both the Association of Deans of Philippine Colleges of Nursing (ADPCN) and Association of Phillipine Schools Of Midwifery (APSOM) are truly embracing the Unang Yakap spirit: Both academic umbrella organizations are preparing for its systematic integration in the pre-service curricula through a series of workshops to be supported by the UNICEF component of the Joint Program on Maternal and Neonatal Health (JPMNH). This crucial component of the strategy to institutionalize EINC will ensure the transfer of knowledge so that future health professionals in government and private health facilities consistently perform the evidence-based steps and avoid the harmful practices in maternal and neonatal care.<span style="mso-spacerun: yes;"> </span></span></div><div class="MsoListCxSpMiddle" style="margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-indent: 0in;"><o:p><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
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<tr><td style="text-align: center;"><a href="http://1.bp.blogspot.com/-mUCYdJ2rC5g/TnniDScjw7I/AAAAAAAAAEw/wQjaymKojp8/s1600/APDCN.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="480" src="http://1.bp.blogspot.com/-mUCYdJ2rC5g/TnniDScjw7I/AAAAAAAAAEw/wQjaymKojp8/s640/APDCN.JPG" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><div style="color: #f4753e; font: normal normal normal 7px/normal 'Gill Sans'; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; text-align: left;"><b> </b><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: xx-small;">Commitment of APSOM and APDCN to integrate </span><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: xx-small;">EINC in nursing and midwife curriculum cements the goal of such precedent efforts such as the implementation of DOH Administrative Orders 2008-0029 and 2009-0025</span></div></td></tr>
</tbody></table><div class="MsoListCxSpMiddle" style="margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-indent: 0in;"><o:p><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></o:p></div><div class="MsoListCxSpMiddle" style="margin-bottom: .0001pt; margin: 0in; mso-add-space: auto; text-indent: 0in;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">APSOM and ADPCN plan to convene department and curriculum chairpersons in all their member-schools and –colleges to stage the plan nationwide. Implementation will be overseen by DOH, UNICEF, UNFPA, and WHO. The Technical Panels on Nursing and Midwifery Education of the Commission on Higher Education are also expected to be involved, as well as representatives from the Association of Nursing Service Administrators of the Philippines (ANSAP), Maternal and Child Nurses Association of the Philippines (MCNAP), Critical Care Nurses Association of the Philippines (CCNAP), and the Operating Room Nurses Association of the Philippines (ORNAP).</span></div><div class="MsoBodyText" style="text-align: justify;"><br />
</div><div class="MsoBodyText" style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Their commitment cements the goal of such precedent efforts such as the implementation of DOH Administrative Orders 2008-0029 and 2009-0025 which have to do with the transfer of knowledge on maternal and neonatal care to help curb both maternal and newborn mortality.<span style="mso-spacerun: yes;"> </span>Optimism should not be conflated with ease, however. While green lights seem to be flashing everywhere for the integration of EINC into the curriculum, integration is not without its challenges.<span style="mso-spacerun: yes;"> </span>The mismatch between actual environment and classroom theory is projected to be a hurdle they will need to leap over. Hospital policy reforms, for example, in line with the Mother-Baby-Friendly Hospital Initiative, Milk Code compliance, inclusion in regulatory and licensing requirements, and the scale-up of EINC implementation itself should all be happening simultaneously for optimum results. To compromise any of those is to compromise the whole of maternal and neonatal care. These projected problems do not seem to dampen their spirits, however, as the enthusiasm of the APSOM and ADPCN officers only seems to grow—they have even shown interest in followup activities they could bring to their respective nursing/midwifery chapters or base hospitals—with no indication whatsoever of waning.</span></div><!--EndFragment-->EINC Bulletinhttp://www.blogger.com/profile/12010405013897827470noreply@blogger.com1tag:blogger.com,1999:blog-5018532656589223200.post-49120362216566441842011-09-21T03:10:00.000-07:002011-09-28T22:13:04.307-07:00NEWS Feature | Essential Intrapartum and Newborn Care in San Juan, Batangas<div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">by Romelyn April P. Imperio, <i>Straight Intern in Family and Community Medicine, UP-PGH </i></span></div><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Dr. Beverly Lorraine C. Ho, <i>Project Staff, Team EINC</i></span><br />
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</span></div><div><div class="separator" style="clear: both; text-align: center;"><a href="http://1.bp.blogspot.com/-6y_RWKODwow/Tnm32DK9fOI/AAAAAAAAAEs/Wxw5nhXPpGI/s1600/sanjuan.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="428" src="http://1.bp.blogspot.com/-6y_RWKODwow/Tnm32DK9fOI/AAAAAAAAAEs/Wxw5nhXPpGI/s640/sanjuan.jpg" width="640" /></a></div><div class="MsoBodyText" style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div><div class="MsoBodyText" style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Through the auspices of the UP CDHP-San Juan Partnership and assistance of UP College of Medicine together with San Juan’s Municipal Health Office, EINC Training was held in San Juan, Batangas on February 18, 2011. The EINC Training was organized to broker the necessary path and support for the municipality’s rural health units, its staff and midwives to improve maternal and newborn health in the area.</span></div><div class="MsoBodyText" style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div><div class="MsoBodyText" style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Dr. Nestor Alidio, Municipal Health Officer of San Juan and Nurse Len Comia set up the logistics of the training invited all midwives working in the barangays. Meanwhile, DFCM Straight Intern Romelyn Imperio then communicated the training request to University of the Philippines College of Medicine alumni Dr. Beverly Lorraine Ho and project staff of Team EINC.</span><br />
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<a name='more'></a></div><h1 style="text-align: justify;"><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif; font-size: large;">Maternal Health Care in San Juan</span></h1><div class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">The municipality of San Juan has numerous lying-in clinics. Each lying-in </span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">clinic is equipped with a delivery bed and necessary equipment and </span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">supplies. These clinics provide antepartum, intrapartum and postpartum </span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">care as well as family planning services. The intrapartum care services in particular are handled by resident physicians and midwives. Furthermore, </span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">an Obstetrician and Gynecologist, Dr. Aileen Calalo-Lim supervises the lying-in clinic operations. The community holds the staff of the lying-in clinic in esteem and high regard as they entrust the lives of their wives, children, mothers and sisters, with the belief that their judgment and skills will bring the miracle of life to fruition.</span></div><div class="MsoBodyText" style="margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoBodyText" style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Dr. Calalo-Lim had her residency training at Dr. Jose Fabella Memorial Hospital. She believes in the importance of continuous medical education in order to render the best possible care to patients. Because she maintains close ties with her training institution, she became familiar with the Essential Newborn Care “Unang Yakap” Protocol. While on a discussion with the rotating interns, Dr. Calalo-Lim expressed that perhaps it is about time that the lying-in clinic midwives of San Juan undergo training on the new protocol.</span></div><h1 style="text-align: justify;"><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif; font-size: large;">EINC Training in San Juan</span></h1><div class="MsoBodyText" style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Dr. Maria Asuncion Silvestre, an esteemed neonatologist, consultant of the U.P.-Philippine General Hospital and Convener of Team EINC, led the team of neonatologists, obstetricians, pediatricians and general practitioners to conduct the training module to a group of 40 midwives, nurses and doctors of San Juan’s RHU and District Hospital.</span></div><div class="MsoBodyText" style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">The Team left Manila at dawn and arrived in San Juan at around 9 in the morning. Mayor Manalo and Dr. Alidio warmly welcomed the team and expressed their commitment to provide the people of San Juan with simple, effective, low-cost and evidenced-based medical care – precisely what EINC is all about. Likewise, he articulated the municipality’s desire to share in achieving to meet the Millennium Development Goals (MDG) for 2015, particularly in curbing maternal and child mortality.</span></div><div class="MsoBodyText" style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div><div class="MsoBodyText" style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">The training began with a team/project introduction facilitated by Dr. Ho. Then, project staff of Team EINC visiting from Cotabato and General Santos City presented a skit mirroring the usual scenario of a mother undergoing labor and delivery in the Philippines. This was followed by a Metacards session on prevalent intrapartum and immediate post-partum practices. Participants were asked to classify whether particular practices were done “Always,” “Sometimes” or “Never.” They were reminded to check out the list while the evidence lectures were being presented to see whether their current practices were in line with the evidence-based protocol. Dr. Cynthia Fernandez-Tan, an obstetrician from Dr. Jose Fabella Memorial Hospital and seasoned trainer of midwives and obstetricians through her work in the Philippine Obstetrical and Gynecological Society (POGS), gave a comprehensive lecture on intrapartum practices. She dispelled myths and misconceptions, and assured participants that going back to the basics of delivery is indeed the safer and more mother-friendly alternative. This heavyweight lecture was followed by Neonatologist Dr. Pinky Imperial’s eye-opening lecture on neonatal care in the first hours of life. The lecture, which featured overwhelming evidence that invalidate “popular” and widespread practices such as routine suctioning, immediate cord clamping, routine separation of newborn, alcohol-based cord care and even footprinting, was met with “oohs” and “ahhs.” Before lunch was served, everyone agreed on one thing – current practices were not so safe nor mother-baby friendly after all!</span></div><h1 style="text-align: justify;"><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif; font-size: large;">Mothers’ Breastfeeding Class</span></h1><div class="MsoBodyText" style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Meanwhile, Dr. Silvestre, together with Dr. Trinia Asuncion and Dr. Renee Tana were in another room, teaching about 25 mothers and a few barangay health workers (BHWs) the benefits of and principles behind successful breastfeeding. Breast models were utilized to educate mothers about the anatomy of the breast, and dolls were used for mothers to demonstrate the proper positioning. Mothers also sang to an educational karaoke session of breastfeeding-friendly songs “borrowed” from LATCH, a partner breasfeeding support group.<o:p></o:p></span></div><div class="MsoBodyText" style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div><div class="MsoBodyText" style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">After lunch, Dr. Silvestre shared the experiences of EINC’s pilot hospital, the Quirino Memorial Medical Center (QMMC). She highlighted how willpower truly changes things for the better as proven by the improved maternal practices, decreased NICU admissions and reduced sepsis rates in QMMC. She then continued with the EINC Step-by-Step lecture, outlining the necessary steps to implementing the EINC practices. The participants were then split into 8 groups of 4-5 participants each. Provided with dolls and instruments and with the guidance of a facilitator, they took turns in playing the role of the health care professional and the patient. Then, one member was asked to keep track of the time and evaluate the performance of his/her group mate.</span></div><div class="MsoBodyText" style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div><div class="MsoBodyText" style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Amidst initial qualms and uncertainties, optimism and determination was clearly felt among the participants. After the session, Mayor Manalo and Councilor Maalihan expressed their gratitude by awarding Certificates of Appreciation to the lecturers and facilitators. Furthermore, they reaffirmed their commitment to making Unang Yakap EINC a standard program of the municipality.</span></div><h1 style="text-align: justify;"><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif; font-size: large;">Post-Training Experiences</span></h1><div class="MsoBodyText" style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">One week later, Dr. Calalo-Lim ran into Dr. Cynthia Tan in Manila. The question of whether the EINC training was being applied was answered with smiles. The midwives shared their positive Unang Yakap experiences. The lying-in staff consciously followed the protocol, and the midwives were very pleased with their Unang Yakap experiences. Although they have acknowledged that there are hiccups along the way, these were not enough to make them feel discouraged. They believe that in time, EINC practices would be almost second nature. What is more encouraging is that no resistance was met from the mothers. A feedback session was conducted last April 8, 2011 by the straight interns as part of their final exit report.</span><br />
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<span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif; font-size: large; font-weight: bold;">Reflection</span></div><div class="MsoBodyText" style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">The EINC training methodology is impressive in its ability to change health worker behavior in the course of one day. At the same time, EINC is actually an activity by the people and for the people. Thus, there is much work to fully incorporate the EINC protocol into the healthcare practices in San Juan, Batangas. Perhaps the EINC should be formalized and incorporated as well into the training practice of those in Community Medicine. Moreover, closer and stricter monitoring and evaluation of and by the stakeholders is definitely in order to ensure its sustained execution and become the new norm.</span></div></div>EINC Bulletinhttp://www.blogger.com/profile/12010405013897827470noreply@blogger.com2tag:blogger.com,1999:blog-5018532656589223200.post-64298388082062864222011-09-21T01:58:00.000-07:002011-09-21T06:12:46.318-07:00FEATURE | General Santos City Hospital<div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div><div style="text-align: justify;"><a href="http://2.bp.blogspot.com/-6ZrMKCpA_Ss/TnmlICUwktI/AAAAAAAAAEg/kUianD9dM_s/s1600/GENSAN_lgu.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="281" src="http://2.bp.blogspot.com/-6ZrMKCpA_Ss/TnmlICUwktI/AAAAAAAAAEg/kUianD9dM_s/s400/GENSAN_lgu.JPG" width="400" /></a><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">The well-paved roads of General Santos City hint at its steady progress toward development. The city’s slogan, Magandang Gensan, strategically hoisted throughout various spots in the city and government buildings stand both as a constant reminder of the city’s collective desire for a good quality of life and testaments of the paths it has taken to get there. “The people of Gensan are very competitive but in a manner that is laid-back. It’s a paradox but perhaps this is why General Santos is a little bit more open to new practices,” Mayor Darlene Magnolia R. Antonino-Custodio. </span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
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</span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">This openness to change has been key to inroads made by EINC in the city of General Santos. Also worth mentioning is the local government’s commitment to Millenium Development Goals to reduce maternal and infant mortality by the year 2015 that has made EINC the new standard of care for mothers and their newborns in the city and nearby areas. Such that some mothers giving birth even at the lying-in centers proudly remark, “na-Unang Yakap ako.” After only four months since EINC training was held in General Santos City, the infant mortality rate at the General Santos City Hospital has already dropped to 0.96% as of July. </span></div><div style="text-align: justify;"><a href="http://1.bp.blogspot.com/-QeVpyzHRwn8/TnmlNm8TvaI/AAAAAAAAAEk/xbx-4hYzC9A/s1600/DRbenpresscon.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><br />
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</span></div><div class="separator" style="clear: both; text-align: center;"><a href="http://1.bp.blogspot.com/-QeVpyzHRwn8/TnmlNm8TvaI/AAAAAAAAAEk/xbx-4hYzC9A/s1600/DRbenpresscon.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="300" src="http://1.bp.blogspot.com/-QeVpyzHRwn8/TnmlNm8TvaI/AAAAAAAAAEk/xbx-4hYzC9A/s400/DRbenpresscon.jpg" width="400" /></a></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Upon training, the General Santos City Hospital (GSCH) immediately embraced the program. While it had to contend with the usual challenges of convincing the hospital’s private consultants, its staff and the whole hospital is eventually learning to imbibe a sense of ownership and pride in the program. Determined to set a precedent for the region, GSCH is working hard to maintain its >90% performance of complete EINC core steps in all of their deliveries. By end of July, 90.79% of all deliveries </span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">have been performed with complete EINC. </span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div><div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">The GSCH opened its doors in 1975 and became LGU-operated since 1991. A Level II hospital with tertiary functions, GSCH has a 100-bed authorized capacity but has 261 implementing beds. It caters to approximately 261 in-patients and 100 outpatients daily. Newborn deliveries comprise 22% of the total admissions in 2010. Being the only government hospital within “SoCCSKSaRGeN” (South Cotabato, Cotabato, Sultan Kudarat, Sarangani and General Santos) area with better facilities, it also caters to patients from other neighboring municipalities such as Sarangani Province, South Cotabato, Sultan Kudarat and Davao del Sur. Likewise, it also serves as a training facility for six affiliated nursing schools and six midwifery schools across the region. </span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"></span><br />
<a name='more'></a></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">“We embraced it (EINC) right away, the hospital has since been following the protocol. We’re having some difficulties in convincing our colleagues from the private practice but little by little, they are learning to embrace it too,” Dr. Charlie Alcaide head of the OB department shares. Dr. Connie Lu adds that it’s only normal to expect some resistance at the beginning since “you’re challenging their comfort zones.” But as soon as the benefits of EINC program were fully appreciated, the nurses, doctors, and midwives eventually learned to adjust. Dr. Alcaide adds, “You really need to convince them that what they’re doing is a serious matter.” </span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Since implementing EINC in April, new hospital policies, physical arrangements, staff reorganization and revised doctor’s orders have been put in place to reflect this new standard of care. For instance, wooden wedges have been custom-made and fitted under the delivery beds to allow mothers to comfortably deliver in semi-upright position. As a result, by end of July already 85.93% were able to deliver in semi-upright position. Despite the limited space of the labor room, 79.01 % of patients had position of choice during labor while 87.65% of the deliveries during the same period were allowed to have companions of choice during the 1st stage of labor. And if space were not an issue, companions would be allowed to join the patients even at the delivery room. Additionally, the cribs at the ward have all been put away as babies are now directly roomed-in with their mothers. </span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-family: Times;"><a href="http://2.bp.blogspot.com/-dnC-L8Fz6hU/Tnmh8_mEUzI/AAAAAAAAAEc/EX5mzkIwxaA/s1600/GENSAN_delivery.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="512" src="http://2.bp.blogspot.com/-dnC-L8Fz6hU/Tnmh8_mEUzI/AAAAAAAAAEc/EX5mzkIwxaA/s640/GENSAN_delivery.JPG" style="cursor: move;" width="640" /></a></span></span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Dr. Lu further adds that since EINC, the staff had been eased of some the tedious workload as unnecessary interventions such as cord-care with alcohol, routine prophylactic injections and bathing have all been done away with. As a result attention has now been reallocated to strengthen breastfeeding support and monitoring of the mother-baby dyad. </span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">“When EINC came, I was so relieved because it solved all ‘my problems’ with regard to enforcing </span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">breastfeeding in the hospital,” remarked Dr. Lu. While, GSCH has already been an advocate of mother-baby friendly practices prior to EINC, it was only after implementing the program did they manage to put this advocacy into practice. By simply following the time-bound and sequenced four core steps of the EINC, breastfeeding was easily and successfully enforced. In the past for instance, </span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Dr. Lu experienced difficulty in initiating early breastfeeding through skin-to-skin contact mainly due to uncoordinated procedures of the OB and Pediatrics Department. “We used to be on the passive, receiving end,” Dr. Lu adds but now with a better working relationship between our departments established, breastfeeding is easily enforced without much effort.” </span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div></div><div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Meanwhile, as notable improvements in the OB practices such as 100% IM administration of oxytocin and checking of placenta has been observed in all deliveries some challenges remain –growing pains when instituting change. “They say it’s easier to learn but harder to unlearn,” says Dr Alcaide, when asked of the challenges that they continue to face. Routine intravenous fluid administration is still commonly practiced; while hospital policies have already been issued to reserve its use only for true indications, midwives and private consultants have yet to internalize its benefit. As a mid-way strategy the Team EINC suggested the use of “heplocks” to ease the eventual non-routine IVF administration. Likewise, GSCH is also working on decreasing routine performance of episiotomies in deliveries. Dr. Alcaide hopes that eventually the staff would better appreciate the benefits of no episiotomies to the patient. </span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">The encouraging progress made by GSCH in implementing EINC would have not been possible if not for the strong commitment of the GSCH EINC Working Group, close supervision of Team EINC in General Santos, and more importantly the solid support given by the local government. Dr. Caksy Domingo and Dr Sheena Elago, Project Staff of Team EINC, share how pivotal the support of the LGU was in helping GSCH to comply with the recommended practices, “what’s good with the LGU set-up is the steady provision of EINC supplies… one reason why we were able to comply with use of antenatal steroids in managing preterm deliveries is because the hospital is well-stocked with dexamethasone. “Equally commendable is the LGU’s confidence in the capacity of its health practitioners in improving maternal and infant healthcare services. </span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div><div class="separator" style="clear: both; text-align: center;"><a href="http://2.bp.blogspot.com/-1hqUt_WXPJ0/TnmmzVbSOWI/AAAAAAAAAEo/xxpSuiS4LTU/s1600/GENSAN_all.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="435" src="http://2.bp.blogspot.com/-1hqUt_WXPJ0/TnmmzVbSOWI/AAAAAAAAAEo/xxpSuiS4LTU/s640/GENSAN_all.jpg" width="640" /></a></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">The results are so inspiring that hospital director Dr. Ben Pagarigan is bent on cascading the knowledge and program to the seven lyingin centers strategically spread across the city, which are also under his supervision. These lying-in centers (LIC), established by the city government, serve the primary health needs of people such as medical consultation, simple emergency cases, and simple diseases for observation and/or three day admission. Dr. Pagarigan reiterates that they also function as birthing centers applying principles of Basic Emergency Obstetric and Newborn Care (BEmONC). He adds that since these facilities are already present, it is but logical to utilize these also as extensions where EINC can be implemented, “by doing so we can ensure that our commitments to the MDG 4 & 5 are achieved and cascaded even outside the hospital setting.”</span></div></div>EINC Bulletinhttp://www.blogger.com/profile/12010405013897827470noreply@blogger.com0tag:blogger.com,1999:blog-5018532656589223200.post-30598002802300660552011-09-20T10:55:00.000-07:002011-09-20T10:55:54.574-07:00EINC Don’ts and Do’s:<span class="Apple-style-span" style="font-size: large;"><br />
<span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif;"><b>Unnecessary Intervention: </b></span></span><div><span class="Apple-style-span" style="font-size: large;"><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif;"><b>Early Amniotomy and Oxytocin Augmentation</b></span></span><div><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></span></div><div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Dystocia or prolonged labor especially in the nulliparous woman usually results in the mother undergoing cesarean section. Early amniotomy with early oxytocin augmentation is commonly employed in these cases with the aim of preventing operative delivery. A systematic review was done by Wei et al in 2009 which included 12 trials involving 7792 women. The unstratified analysis found early intervention with amniotomy and oxytocin to be associated with a modest reduction in the risk of cesarean section; however the confidence interval crossed 1 - compatible with no effect (RR 0.89, 95% CI 0.79-1.01). Although only a small number of women have been randomized in therapy trials, a trend toward a reduction in the rate of cesarean section with early intervention was seen in this group (typical OR 0.6, 95% CI 0.2-1.4). They further identified that early augmentation does not appear to provide benefit over a more conservative form of management in the context of care of nulliparous women with mild delays in the progress of labor. In the context of established delay in labor, an active policy of augmentation may reduce the risk of cesarean section. However, only three small trials have been performed and they do not provide conclusive evidence for firm conclusions to be drawn. </span></div><div><div><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: xx-small;"><i><br />
</i></span></div><div><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: xx-small;"><i><br />
</i></span></div><div><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: xx-small;"><i>Source: Wei S, Wo BL, Xu H, Luo ZC, Roy C, Fraser WD. Early amniotomy and early oxytocin for prevention of, or therapy for, delay in first stage spontaneous labour compared with routine care. Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD006794. DOI: 10.1002/14651858.CD006794.pub2 </i></span><br />
<br />
<div><br />
<div style="text-align: justify;"><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif; font-size: large;"><b>Recommended Practices: </b></span></div><div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif; font-size: large;"><b>Pain Relief in Labor and Use of Antenatal Steriods </b></span></div><div style="text-align: justify;"><br />
</div><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Pain relief plays a crucial role during labor. Epidural anesthesia is widely used but there are concerns that it is accompanied by adverse effects on both the mother and infant. A systematic review by Anim – Somuah last updated in June 2010 looked at the effects of all modalities of epidural anesthesia (including combined spinal epidural) on the mother and the baby, compared with non-epidural or no pain relief during labor. 21 studies involving 6664 women found epidural anesthesia to be better for pain relief than non-epidural anesthesia (weighted mean difference (WMD) -2.60, 95% confidence interval (CI) -3.82 to -1.38), but was associated with an increased risk of instrumental vaginal birth (RR 1.38, 95% CI 1.24 to 1.53). There was no evidence of a significant difference in the risk of cesarean delivery (RR 1.07, 95% CI 0.93 to 1.23), long term backache (RR 1.00, 95% CI 0.89 to 1.12), low neonatal Apgar scores at 5 minutes (RR 0.70, 95% CI 0.44 to 1.10), and maternal satisfaction with pain relief (RR 1.18 95% CI 0.92 to 1.50). </span></div><div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: xx-small;"><i><br />
</i></span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: xx-small;"><i>Source: Anim-Somuah M, Smyth RMD, Hoewll CJ. Epidural versus non-epidural or no analgesia in labour. Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD000331. </i></span></div><div style="text-align: justify;"><br />
</div></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><br />
</div><div><div style="text-align: justify;"><b><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif;"><span class="Apple-style-span" style="font-size: large;">Use of Antenatal Steroids</span> </span></b></div><div style="text-align: justify;"><br />
</div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Respiratory Distress Syndrome (RDS) is a serious and expensive complication among premature babies and the primary cause of early neonatal morbidity and disability. A systematic review by Roberts and Daziel done in 2006 included 21 studies involving 3885 women and 4269 infants. It was found that treatment with antenatal corticosteroids does not increase risk to the mother of death, chorioamnionitis or puerperal sepsis. </span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div><div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Treatment with antenatal corticosteriods is associated with a 31% overall reduction in risk of neonatal dea</span>th (RR 0.69, 95% CI 0.58 - 0.81) and a 34% reduction risk of dreaded RDS (RR 0.66, 95% CI 0.59 - 0.73). The risks of cerebroventricular hemorrhage (RR 0.54, 95% CI 0.43 - 0.69), necrotising enterocolitis (RR 0.46, 95% CI 0.29 - 0.74) and systemic in the first 48 hours of life (RR 0<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">.56, 95% CI 0.38 to 0.85). were approximately halved. Requirement for respiratory support and intensive care admissions were likewise significantly reduced (RR 0.80, 95% CI 0.65 - 0.99). Because of these strong evidence of benefit, antenatal corticosteroid use is indicated in women with premature rupture of membranes and pregnancy related hypertension syndromes. This study supports the continued use of a single course of antenatal corticosteroids to accelerate fetal lung maturation in women at risk of preterm birth. A single course of antenatal corticosteroids should be considered routine for preterm delivery with few exceptions. </span></div><div style="text-align: justify;"><br />
</div><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: xx-small;"><i>Source: Roberts D, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD004454 </i></span></div><div><br />
</div><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif;"><div style="font-weight: bold;"><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif;"><b><br />
</b></span></div><b><span class="Apple-style-span" style="font-size: large;"><div><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif;"><b><span class="Apple-style-span" style="font-size: large;"><br />
</span></b></span></div></span></b></span><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif;"><b><span class="Apple-style-span" style="font-size: large;">Continuous Support During Childbirth</span></b></span></div><div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif; font-size: large; font-weight: bold;"><br />
</span></div><div class="separator" style="clear: both; text-align: center;"><a href="http://4.bp.blogspot.com/-niUrCuLQ3vc/TnjS8w_Z2wI/AAAAAAAAAEY/i1HjeX4mk60/s1600/Gensan_nursing.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em; text-align: justify;"><img border="0" height="400" src="http://4.bp.blogspot.com/-niUrCuLQ3vc/TnjS8w_Z2wI/AAAAAAAAAEY/i1HjeX4mk60/s400/Gensan_nursing.jpg" width="297" /></a></div><div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">In today’s hospital setting, continuous support of women during labor has become the exception rather than the rule. In a 2007 systematic review by Hodnett et.al of 21 trials involving 15061 women, the effects of continuous one-to-one intrapartum support was compared with usual care wherein women are subjected to institutional routines which may have adverse effects on the progress of labor. Women who received continuous support were more likely to have a spontaneous vaginal birth (RR 1.08, 95% CI 1.04 to 1.12) and were more satisfied (RR 0.69, 95% CI 0.59 to 0.79), and were less likely to have intrapartum analgesia (RR 0.90, 95% CI 0.84 to 0.97). In addition the duration of labor was shorter (mean difference -0.58 hours, 95% CI -0.86 to -0.30). The likelihood of delivery via cesarean section (RR 0.79, 95% CI 0.67 to 0.92) or instrumental vaginal birth (RR 0.90, 95% CI 0.84 to 0.96), use of regional analgesia (RR 0.93, 95% CI 0.88 to 0.99), or delivering a baby with a low 5-minute Apgar score (RR 0.70, 95% CI 0.50 to 0.96) were all significantly reduced. There was no apparent impact on other intrapartum interventions, maternal or neonatal complications, or on breastfeeding. Subgroup analyses suggested that continuous support was most effective when provided by a woman who was neither part of the hospital staff nor the woman’s social network, and in settings in which epidural analgesia was not routinely available. Thus, continuous support during labor clearly has clinically meaningful benefits for women and infants and no known harm. </span></div><i><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: xx-small;"><br />
</span></i></div><div><i><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: xx-small;"><br />
</span></i></div><div><i><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: xx-small;">Source: Hodnett ED, et al. Continuous support for women during childbirth. Cochrane Database of Systematic Reviews 2011, Issue 2. Art. No.: CD003766.</span></i></div><!--EndFragment--></div></div></div></div></div></div>EINC Bulletinhttp://www.blogger.com/profile/12010405013897827470noreply@blogger.com0tag:blogger.com,1999:blog-5018532656589223200.post-70244140488500699442011-09-02T02:02:00.000-07:002011-09-20T10:34:10.528-07:00BREASTFEEDING TSEK!<div class="separator" style="clear: both; text-align: justify;"><span class="Apple-style-span" style="color: #333333; font-family: Georgia, 'Times New Roman', serif;">A public health education campaingn of the Department of Health (DOH) carrying the message BREASTFEEDINF TSEK! (Tama, Sapat at Eksklusibo) is a public health education campaign of DOH to encourage mothers to 'exclusively breastfeed' their babies and to educate them about the health benefits of breastfeeding. </span></div><div class="separator" style="clear: both; text-align: justify;"><span class="Apple-style-span" style="color: #333333; font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><div style="text-align: justify;"><span style="color: #333333;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">‘Exclusive breastfeeding’ means that mothers feed the baby nothing else but breast milk—no water, other liquid, infant formula, or food.<o:p></o:p></span></span></div></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><div style="text-align: justify;"><br />
</div></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><div style="text-align: justify;"><span style="color: #333333;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Called “Communication for Behavioral Impact (COMBI) on Exclusive Breastfeeding for six (6) months,” this comprehensive campaign was developed by DOH with the National Nutrition Council, the World Health Organization, the UNICEF, and other partner agencies. Breastfeeding from the first hour of life and exclusively until six months is one of the most effective strategies to prevent infant deaths. </span><span class="Apple-style-span" style="font-family: 'Times New Roman';"><o:p></o:p></span></span></div><div style="text-align: justify;"><span style="color: #333333;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></span></div></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><a href="http://2.bp.blogspot.com/-nuQ2CDLwWnQ/TmCamorWu2I/AAAAAAAAAEI/xuhqPB2hPgk/s1600/TSEKlistcover.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="460" src="http://2.bp.blogspot.com/-nuQ2CDLwWnQ/TmCamorWu2I/AAAAAAAAAEI/xuhqPB2hPgk/s640/TSEKlistcover.jpg" width="640" /></a></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="color: #333333;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><a href="http://3.bp.blogspot.com/-kMlekhGM4tY/TmCatJ3ra9I/AAAAAAAAAEM/7DdMB1LQtZo/s1600/TSEKlistinside.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="460" src="http://3.bp.blogspot.com/-kMlekhGM4tY/TmCatJ3ra9I/AAAAAAAAAEM/7DdMB1LQtZo/s640/TSEKlistinside.jpg" width="640" /></a></div>EINC Bulletinhttp://www.blogger.com/profile/12010405013897827470noreply@blogger.com3tag:blogger.com,1999:blog-5018532656589223200.post-88032571334641072282011-09-02T01:52:00.000-07:002011-09-02T18:39:56.676-07:00EINC Do’s and Don’ts:<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><b style="mso-bidi-font-weight: normal;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Unnecessary Intervention: Giving Pre-lacteals or Artificial Milk Substitutes</span></b></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">It is a common practice in Philippine hospitals to give pre-lacteals like glucose water as a trial of feeding to newborns, or to give artificial milk substitutes to babies while the mother’s milk flow is not yet established. This delays the mother’s breastmilk letdown, and the ease of feeding from the bottle decreases the newborn’s urge to suckle, two factors that will create a vicious cycle that causes caregivers to continue pre-lacteal feeding, thus undermining the success of breastfeeding. This practice also exposes the newborn to different types of infectious agents and challenges an already weak premature or immature gastrointestinal system. These were clearly evident in a study by Rashid done in rural Bangladesh, where 94.7 % of newborns were fed either honey, animal milk and sugar (non-exclusively). In these newborns, the overall mean time of initiating breastfeeding was 35.9 hours (SD ± 28.4). Pre-lacteal feeding delayed breastfeeding by 32.1 hours (p<0.0001), and more newborns fed honey (17.2%) experienced episodes of diarrhea in the first 3 months compared to those who were not fed pre-lacteals (13.77%) (RR 1.25, p<0.01). Giving artificial milk substitutes is a practice that has serious consequences on the baby’s health and wellbeing. <o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-align: justify; text-autospace: none;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: 12px;"><br />
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</div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><b style="mso-bidi-font-weight: normal;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Recommended Practice: Initiation of Breastfeeding<o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">The benefits of breastfeeding for the health and wellbeing of the mother and baby are well documented. WHO recommends initiation of breastfeeding within an hour after birth but in many countries, the rates of early initiation of breastfeeding remain low. In the Philippines, breastfeeding is initiated within the first hour of life in only 54% of deliveries. <o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">A recent trial by Edmond has shown that early initiation of breastfeeding could reduce neonatal mortality by 22%. In developing countries, early initiation of breastfeeding can reduce deaths due mainly to diarrhea and lower respiratory tract infections in children. <o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Dr. Natividad R. Clavano in a 1982 landmark study, followed a cohort of 9886 infants born at the Baguio General Hospital to assess the relationship of neonatal deaths and diarrhea with feeding patterns. Ninety per cent of the 138 infants with diarrhea were formula fed, 6% were on mixed and 4% on exclusively breastfeeding. Ninety six per cent of the 67 infant deaths were formula fed, 1% were mixed- and 3% were exclusively breastfed. After formal breastfeeding policies and rooming in practices were implemented, exclusive breastfeeding increased and deaths among clinically infected newborns dropped by 95.3%. In another prospective cohort study by Yoon et al, 9942 children in Cebu were followed using longitudinal data from 1988-1991. In the first six months of life, failing to initiate breastfeeding (or ceasing to breastfeed) resulted in an 8-10 fold increase in the rate of diarrheal death.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">In the 51-hospital observational study, newborns were washed at a median of 8 minutes, put to the breast at a median of 10 minutes of life but removed at 12 minutes. Thus only 2 minutes were allowed for their first colostrum feed. 272 (56.5%) were transferred to a nursery. They were weighed at a median of 13 minutes, examined at 17 minutes, taken to the nursery at 20 minutes, given eye prophylaxis at 20 minutes and Hepatitis B and vitamin K injections, the first of which at 22 minutes. They were reunited with their mothers at a median of 2 hours 35 minutes. 47 (9.8%) initiated breastfeeding after 2 hours but prior to discharge. From these studies, it is evident that institutional routines are depriving our newborns of the benefits of early breastfeeding. <o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify; text-indent: .5in;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Early initiation of breastfeeding may reduce neonatal mortality by decreasing the ingestion of infectious pathogens. Early breast milk also provides many immunocompetent factors, including immunoglobulins and lymphocytes that may stimulate humoral or cell-mediated immune systems), and it may also prime the gastrointestinal tract and decrease intestinal permeability and translocation of infectious pathogens, including HIV. <o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Edmond et al conducted an observational cohort study of 10,942 breastfed singleton neonates (born between 1 Jul 2003 and 30 Jun 2004 in rural Ghana), who survived to day 2, and whose mothers were visited in the neonatal period. Verbal autopsies were used to ascertain the cause of death in 130 neonates who died from day 2 to day 28. Ninety three died of infection and 47 of non-infectious causes. The risk of death as a result of infection increased with increasing delay in initiation of breastfeeding from 1 hr to day 7; overall late initiation (after day 1) was associated with a 2.6-fold risk (adjusted OR 2.61 95% CI 1.68, 4.04). Partial breastfeeding was associated with a 5.7-fold adjusted risk of death as a result of infectious disease (adj OR 5.73 95% CI 2.75, 11.91). <o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Such is the impact of early initiation of breastfeeding and healthcare providers and policy makers need to prioritize this simple preventive strategy. Factors that will promote breastfeeding initiation include: implementation of the Baby Friendly Hospital Initiative Ten Steps to Successful Breastfeeding; avoidance of the use of intramuscular narcotic analgesia, particularly near the end of the first stage of labor; not separating mothers and babies after birth for routine procedures; and routinely placing healthy newborns on their mothers’ chest/abdomen on skin-to-skin contact. </span><span class="Apple-style-span" style="font-family: 'Times New Roman';"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: xx-small;"><br />
</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><span class="Apple-style-span" style="color: #b45f06; font-family: Arial, Helvetica, sans-serif; font-size: xx-small;">Sources:<o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span class="Apple-style-span" style="color: #b45f06; font-family: Arial, Helvetica, sans-serif; font-size: xx-small;">Lauer JA et al, Deaths and years of life lost due to suboptimal breastfeeding among children in the developing world: a global ecological risk assessment. Public Health Nutrition 2006; 9: 673-685.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; tab-stops: 183.0pt; text-autospace: none;"><span class="Apple-style-span" style="color: #b45f06; font-family: Arial, Helvetica, sans-serif; font-size: xx-small;">The state of the world’s breastfeeding: report card. Initiation of breastfeeding within one hour. New Delhi: International Baby Food Action Network Asia. www.world breastfeedingtrends.org/reportcard/RC-IB.pdf/<o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span class="Apple-style-span" style="color: #b45f06; font-family: Arial, Helvetica, sans-serif; font-size: xx-small;">Clavano N. Mode of feeding and its effect on infant mortality and morbidity. J Trop Pediatr. 1982;28 :287 –293.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span class="Apple-style-span" style="color: #b45f06; font-family: Arial, Helvetica, sans-serif; font-size: xx-small;">Yoon PW, Black RE, Moulton LH, Becker S. Effect of not breastfeeding on the risk of diarrheal and respiratory mortality un children under two years of age in Metro Cebu, the Philippines. Am J Epidemiol.1996. 143:1142-1148.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span class="Apple-style-span" style="color: #b45f06; font-family: Arial, Helvetica, sans-serif; font-size: xx-small;">Edmond KM, Kirkwood BR, Amenga-Etego S, Owusu-Agyei S, Hurt LS. Effect of early infant feeding practices on infection-specific neonatal mortality: an investigation of the causal links with observational data from rural Ghana. Am J Clin Nutr. 2007; 86:1126-31.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span class="Apple-style-span" style="color: #b45f06; font-family: Arial, Helvetica, sans-serif; font-size: xx-small;">Brandtzaeg P. Mucosal immunity: integration between the mother and the breast fed infant. Vaccine 2003;21:3382–6. <o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span class="Apple-style-span" style="color: #b45f06; font-family: Arial, Helvetica, sans-serif; font-size: xx-small;">Goldman AS. The immune system of human milk: antimicrobial, antiinflammatory and immunomodulating properties. Pediatr Infect Dis J 1993;12:664–71. <o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span class="Apple-style-span" style="color: #b45f06; font-family: Arial, Helvetica, sans-serif; font-size: xx-small;">Goldman AS, Garza C, Nichols BL, Goldblum RM. Immunologic factors in human milk during the first year of lactation. J Pediatr 1982;100: 563–<o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span class="Apple-style-span" style="color: #b45f06; font-family: Arial, Helvetica, sans-serif; font-size: xx-small;">Goldman AS. Modulation of the gastrointestinal tract of infants by human milk. Interfaces and interactions. An evolutionary perspective in symposium: bioactivity in milk and bacterial interactions in the developing immature intestine. J Nutr 2000;130(suppl);426S–31S. <o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span class="Apple-style-span" style="color: #b45f06; font-family: Arial, Helvetica, sans-serif; font-size: xx-small;">Rollins NC, Filteau SM, Coutsoudis A, Tomkins AM. Feeding mode, intestinal permeability, and neopterin excretion: a longitudinal study in infants of HIV-infected South African women. J Acquir Immune Defic Syndr 2001;28:132–9.</span><br />
<span class="Apple-style-span" style="color: #b45f06; font-family: Arial, Helvetica, sans-serif; font-size: xx-small;">Rashid M et al. Prelacteal feeding delays breastfeeding initiation in rural Bangladesh, ICDDR,B Periodical</span><br />
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</span></span></span></div></div><div class="MsoNormal" style="color: black; font-family: Times; font-size: medium; line-height: normal; margin-bottom: 0in; text-align: justify;"></div></div>EINC Bulletinhttp://www.blogger.com/profile/12010405013897827470noreply@blogger.com0tag:blogger.com,1999:blog-5018532656589223200.post-65907151447797381202011-09-02T01:45:00.000-07:002011-09-20T11:00:23.419-07:00Kuwentong Unang Yakap<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><i style="mso-bidi-font-style: normal;"><span class="Apple-style-span" style="color: #a64d79; font-family: Georgia, 'Times New Roman', serif; font-size: large;">Kuwentong Unang Yakap chronicles the first-hand experiences, inspiring testimonial and personal anecdotes of doctors, health professionals, patients and other healthcare providers narrating their “Unang Yakap” stories. </span></i></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
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<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">by Dr. Donna Capili</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><div class="separator" style="clear: both; text-align: center;"><a href="http://3.bp.blogspot.com/-XCT58hFfjFI/TmCXa8O2iUI/AAAAAAAAAEA/P8BVYzlR4Ic/s1600/ER+door+2.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="310" src="http://3.bp.blogspot.com/-XCT58hFfjFI/TmCXa8O2iUI/AAAAAAAAAEA/P8BVYzlR4Ic/s400/ER+door+2.JPG" width="400" /></a></div><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Sept 13, 2010. It was almost half past one o'clock in the afternoon and my stomach grumbled its complaint. I just finished clinic and was set to see my in-patients, never mind my tummy. From a distance, I heard the siren. I didn't think any of it. I was on my way up to the patients' rooms on the second floor when the undeniable peal of the siren seemed very tangible...I retraced my steps downwards and saw that the ambulance was by the emergency room entrance. What could it be now?<o:p></o:p></span></div></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><div style="text-align: justify;"><br />
</div></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">The ambulance driver was shouting that his patient, a pregnant woman, was about to deliver her baby. He opened the back door and my eyes zeroed in on the crowning head. I yelled for sterile gloves, clamps and clean towels. It seemed like magic that a pair of gloves appeared in my hand. I told my resident doctor on duty (ROD) to put on his own pair of sterile gloves. Next thing I knew, I was doing perineal support -- my right thumb and index finger formed a C-shape, pressed inward and down – picturing Dra. Cynthia's demo in my head...I didn't do any of the massage nonsense. It was quite quick. Lucky me! I held out my hand to hold the baby's head down as he made his entry into the world. Baby out! I slipped him into the towel and put him on mom's tummy. The ROD started to dry and stimulate the baby. The baby then let out a scandalous cry and I knew he was going to be alright. The baby was positioned further up on mom's chest. Meanwhile, I felt for her uterus and started to massage -- no complicated digging movements but just nice and simple circular motions. A voice quipped that ice was on its way, to which I quickly added, "No ice. Don't need it." (Dr. Howard Sobel would have been so proud.)<o:p></o:p></span></div></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><div style="text-align: justify;"><br />
</div></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">What was the next step? Number 3: cut the cord. It was a good 3-4 minutes when that was done. Uh-oh, I hope he doesn't get too jaundiced. Now, where was I? Hmm, exclude second baby… It didn't seem like there was anyone else in there. I asked the mom if she was just expecting a singleton to which she replied “Yes.” Ok, so no second baby. Confidently I ordered to give her oxytocin 10 via IM please. (Thanks to our recent meetings, I appeared to know what I was doing)<o:p></o:p></span></div></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><div style="text-align: justify;"><br />
</div></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">I rolled the cord unto my clamp and applied traction and counter-traction steadily. At first, it felt like I was going to tear the placenta out of there but it didn't! I just needed to be patient. I examined the perineum and glad to see that there was no tear (vernacular: rat-rat)! I examined the placenta and its membranes and it was "clean", smooth. <o:p></o:p></span></div></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><div style="text-align: justify;"><br />
</div></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">When I finally raised my head, I saw that the baby was latched and suckling away. Yipee! A smart boy for a change! Time: about 30 minutes post delivery. He stayed with his mother and avidly breastfed. I told mom that'll be the only way we feed her baby in this (my) hospital.<o:p></o:p></span></div></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><div style="text-align: justify;"><br />
</div></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Oh, did I say, that all this happened at the back of the ambulance?<o:p></o:p></span></div></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><div style="text-align: justify;"><br />
</div></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Mother and baby were brought down and into the hospital. The ROD was already instructing for IV fluids. He looked stupefied when I said, "No IV." and I added, "we'll talk about the CPG for uncomplicated vaginal births later." <o:p></o:p></span></div></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><div style="text-align: justify;"><br />
</div></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><i>__________________________________________________________________</i></span></div><div style="text-align: justify;"><i style="mso-bidi-font-style: normal;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></i></div><div style="text-align: justify;"><i style="mso-bidi-font-style: normal;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: x-small;">** Mother was actually en route to a provincial hospital after being asked to leave another LGU-run hospital, citing that the baby will be born preterm and they have no incubator. (certainly, they need to know about KMC). Pediatric age was 36 weeks, birth weight 2450 grams. Both mother and baby are well and due home.**</span><o:p></o:p></span></i></div></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;"><i style="mso-bidi-font-style: normal;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
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<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif; font-size: x-small;">Dr. Donna Capili completed her subspecialty training at the Hospital for Sick Children in Toronto, Canada. She is a practicing Neonatologist in Bulacan and a Co-Convener of Team EINC.</span><span class="Apple-style-span" style="font-family: 'Times New Roman';"><o:p></o:p></span></i></b></div>EINC Bulletinhttp://www.blogger.com/profile/12010405013897827470noreply@blogger.com2tag:blogger.com,1999:blog-5018532656589223200.post-53901183420953707872011-09-02T01:41:00.000-07:002011-09-21T07:41:07.696-07:00Breastfeeding Checklist<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">by Dr. Francesca Tatad-To</span></div></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><div style="text-align: justify;"><br />
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</span></div></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">This breastfeeding monitoring form was developed when I was in private practice and needed a way to keep track of my patients’ breastfeeding progress. I realized then that nurses would simply note on the chart that the baby was ‘breastfed’ but not how many times a feeding occurred, or whether there were any feeding problems.</span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"> </span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Mothers were too tired to remember how many times they had breastfed in the last 24 hours, or how many times they had changed their baby’s diaper.</span></div></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">The mothers who did bother to write down the information were spending too much time recording too many details. With the use of this graphic chart, mothers simply had to tick off the right image each time they breastfed, changed a wet diaper, and every time their baby passed stool.<o:p></o:p></span></div></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">When Team EINC realized that the monitoring of well babies is a challenge in our hospitals, mainly due to the lack of health workers and the large number of patients, we translated the form into Filipino and offered it to our various centers as a monitoring tool. But this time, we added a column for danger signs, so that mothers themselves would be prompted to check their babies regularly for any signs that may indicate a severe illness or infection, and call the attention of their health worker.<o:p></o:p></span></div></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">The monitoring form was first used at the Jose Fabella Memorial Hospital’s Potentially-Septic Ward, where babies who are clinically well but have risk factors for sepsis are admitted together with their mothers. Every mother admitted to the area is provided with a copy of the form and instructed in how to fill it up. Initially there were concerns that the form would be too complicated for the mothers, or that it would take too much time to do, or that the forms would get lost. As it turns out, the mothers find the form a very useful tool and have taken on the task of reminding each other to fill up their forms regularly. Mothers are now more aware of how often they should be breastfeeding, and what signs to look for to know that breastfeeding is going well. Monitoring mother-infant dyads has become an easier task for the nurses, and doctors going on rounds review the information in the form as part of their routine examination. A big benefit of the tool is that infants who develop signs of illness are being referred earlier, and mothers are educated regarding the signs of severe illness in newborns, so that they can identify these even if they occur after discharge. One pleasant surprise to the staff the mothers hold on to the forms and do not lose or misplace them.<o:p></o:p></span></div></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><div style="text-align: justify;"><br />
</div><div class="separator" style="clear: both; text-align: justify;"><a href="http://3.bp.blogspot.com/-Fz6dp-dQrF8/TmCWoO6eG-I/AAAAAAAAAD8/o3aY9K6BnUY/s1600/breastfeeding+form%252Cjpg.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="640" src="http://3.bp.blogspot.com/-Fz6dp-dQrF8/TmCWoO6eG-I/AAAAAAAAAD8/o3aY9K6BnUY/s640/breastfeeding+form%252Cjpg.jpg" width="494" /></a></div></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">How to properly use this form:<o:p></o:p></span></div></div><div class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo1; text-indent: -.25in;"></div><ul><li style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Day 1 begins at the time of birth and ends 24 hours later, and so on.</span></li>
<li style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Instruct the mother to shade/check one breastfeeding image every time she breastfeeds, one wet diaper image every time her baby passes urine, and one soild diaper image every time her baby passes stool</span></li>
<li style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Heavy/darker images are mandatory - meaning a mother MUST breastfeed at least 8 times a day on day 2, for example. The lighter images are extras but within normal, meaning if a child has 8 soiled diapers istead of 2, this is still normal and should not be considered diarrhea.</span></li>
<li style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">If a mother and baby are able to fulfill all the “MUST Dos” for each 24 hour period, it is likely that breastfeeding is going well. If however, one or more is insufficient, the health worker should address this by closer monitoring, properly observing a feeding, and identifying underlying problems.</span></li>
<li style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Also instruct the mother to go through the list of danger signs at least once a day (more often if possible) and to call the attention of a health worker immediately should any of the danger signs be present. </span></li>
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</div></div>EINC Bulletinhttp://www.blogger.com/profile/12010405013897827470noreply@blogger.com2tag:blogger.com,1999:blog-5018532656589223200.post-37847806843245584692011-09-02T01:37:00.000-07:002011-09-02T01:48:55.042-07:00Special Section: Ten Steps to Successful Breastfeeding<div class="MsoNormal"><div class="separator" style="clear: both; text-align: center;"><a href="http://2.bp.blogspot.com/-LoaAdtmVVMQ/TmCYD_ZcGLI/AAAAAAAAAEE/7crUWmls038/s1600/breastfeeding2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="424" src="http://2.bp.blogspot.com/-LoaAdtmVVMQ/TmCYD_ZcGLI/AAAAAAAAAEE/7crUWmls038/s640/breastfeeding2.jpg" width="640" /></a></div><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
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<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif; font-size: large;">Every facility providing maternity services and care for newborn infants should:</span></div><div class="MsoNormalCxSpMiddle" style="line-height: normal; margin-left: .25in; mso-add-space: auto;"></div><ol><li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif; font-size: large;">Have a written breastfeeding policy that is routinely communicated to all health care staff.</span></li>
<li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif; font-size: large;">Train all health care staff in skills necessary to implement this policy.</span></li>
<li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif; font-size: large;">Inform all pregnant women about the benefits and management of breastfeeding.</span></li>
<li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif; font-size: large;">Help mothers initiate breastfeeding within half an hour of birth.</span></li>
<li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif; font-size: large;">Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants.</span></li>
<li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif; font-size: large;">Give newborn infants no food or drink other than breast milk, unless medically indicated.</span></li>
<li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif; font-size: large;">Practice rooming-in – that is allow mothers and infants to remain together – 24 hours a day.</span></li>
<li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif; font-size: large;">Encourage breastfeeding on demand.</span></li>
<li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif; font-size: large;">Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.</span></li>
<li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif; font-size: large;">Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.</span></li>
</ol><br />
<div class="MsoNormal"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: xx-small;">Source: <i>Protecting, Promoting and Supporting Breastfeeding: The Special Role of Maternity Services</i>, a joint WHO/UNICEF Statement published by the World health Organization.</span></div>EINC Bulletinhttp://www.blogger.com/profile/12010405013897827470noreply@blogger.com0tag:blogger.com,1999:blog-5018532656589223200.post-76270032023292104152011-09-02T01:32:00.000-07:002011-09-21T07:44:52.826-07:00FEATURE | Dr. Jose Fabella Medical Hospital: where optimism never runs dry<div class="separator" style="clear: both; text-align: center;"><a href="http://3.bp.blogspot.com/-3PyVbMcQ0dQ/TmCHriGGjAI/AAAAAAAAADo/JDYHnZ6g5C4/s1600/1.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="http://3.bp.blogspot.com/-3PyVbMcQ0dQ/TmCHriGGjAI/AAAAAAAAADo/JDYHnZ6g5C4/s320/1.jpg" width="292" /></a></div><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">One thing is for certain -- optimism never runs dry at the Dr. Jose Fabella Medical Hospital. Dubbed as one of the world’s busiest maternity hospital, seeing an average of 60-80 births a day, “Fabella” easily brings to mind images of crowded maternity wards, a cramped Neonatal Intensive Care Unit, delivering mothers coming and going like clockwork, and babies born one after another routinely depicted in local and international media channels. At one point, it has even been infamously tagged, albeit too conveniently, as “the baby-factory” owing to large portion of babies in Metro Manila being delivered there. </span><br />
<div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div><div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Its portrayal in the recent news has, to a certain extent, become the standard fare in representing the generally lamentable state of healthcare delivery and population development in the country. And yet despite this, Fabella unwaveringly maintains to be a competitive institution providing safe, quality and compassionate maternal and newborn care while promoting sound research and training practices in the field of women’s health. And while its crowded wards may somewhat tell a different story, this only proves how it has persistently weathered limited funds to provide quality service to mothers and newborns who otherwise could not afford it on their own. “We try our best to manage even though we have limited resources,” Assistant Chief Nurse Edna Solis candidly relates.<br />
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</span></div><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Notwithstanding the long list of challenges facing the hospital on a daily basis, enough to send anyone teary-eyed, Fabella continues to demonstrate remarkable resilience meanwhile pioneering efforts in implementing cost-effective clinical practice/s in caring for the mother and newly born. </span></div><div><br />
<div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">At Fabella, there is hardly any room for complacency. The hospital’s limited resources have never been an excuse to fall behind its mission. In fact, if any, it has only driven the medical and nursing staff to constantly be on their toes, innovatively “making do with what they have” while keeping the safety and welfare of their patients in mind.</span></div><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"> <br />
<span class="Apple-style-span" style="font-family: Times;"></span></span></div><div><a href="http://1.bp.blogspot.com/-wIx15g_Rsh0/TmCI_7KOd_I/AAAAAAAAADw/HBhoemoHHcM/s1600/drrubenflores.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="300" src="http://1.bp.blogspot.com/-wIx15g_Rsh0/TmCI_7KOd_I/AAAAAAAAADw/HBhoemoHHcM/s400/drrubenflores.jpg" width="400" /></a><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-family: Times;"></span></span></div><div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div></div><div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Hence, it comes as no surprise that EINC has found its way to Fabella or that Fabella found its way to EINC. “EINC complements the many other programs that we have,” shares Dr. Cynthia Fernandez-Tan, head of the Training Department. Dr. Estrella Olonan, Coordinator of Fabella's Human Milk Bank, further adds, “EINC reinforces breastfeeding because skin-to-skin contact helps initiate breastfeeding as soon possible and we know that the soonest the baby is able to feed there is a higher chance that the mother will continue breastfeeding.” Nurse Teresa Rallos also shares, “some of the EINC practices we were already doing before, like skin-to-skin contact, non-separation, no foot printing, because we are a breastfeeding hospital.” Dr. Olonan adds how having lesser episiotomies with EINC translate to more mothers being in better position to breastfeed immediately right after giving birth. </span></div></div><div><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div><div><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-family: Times;"></span></span></div><div class="separator" style="clear: both; text-align: center;"><a href="http://3.bp.blogspot.com/-RQXe857BhRs/TmCJJNffSpI/AAAAAAAAAD0/65LA8H_aCrE/s1600/bf1.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><br />
</a></div><div><a href="http://2.bp.blogspot.com/-Zwdne3hQtEc/TmCL1YOszDI/AAAAAAAAAD4/VUr7Q4bP4mY/s1600/breastfeeding.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="400" src="http://2.bp.blogspot.com/-Zwdne3hQtEc/TmCL1YOszDI/AAAAAAAAAD4/VUr7Q4bP4mY/s400/breastfeeding.JPG" width="266" /></a><a href="http://3.bp.blogspot.com/-RQXe857BhRs/TmCJJNffSpI/AAAAAAAAAD0/65LA8H_aCrE/s1600/bf1.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><br />
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</a><a href="http://3.bp.blogspot.com/-RQXe857BhRs/TmCJJNffSpI/AAAAAAAAAD0/65LA8H_aCrE/s1600/bf1.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><br />
</a><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">“Fabella is a strong advocate of breastfeeding,” Dr. Fernandez-Tan proudly remarks, “pioneering programs that promote exclusive and continuous breastfeeding.” The Milk Bank, provides human breast milk to those in need as well as clients from private hospitals. Another innovation is the Dental Obturator Program, where babies with cleft palate are fitted with dental obturators to allow them to breastfeed. Likewise, the Kangaroo Mother Care, a biologically sound and cost efficient method in caring for preterm babies practiced worldwide, was pioneered and institutionalized at Fabella in 2000, setting a good example for other hospitals in country. </span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"> Fabella is 700-bed capacity, DOH-retained hospital and Level IV tertiary medical center for obstetrics, gynecology, newborn care and pediatrics. It serves as a national referral facility for women’s and children’s needs, with the bulk of its patients coming in mainly from Manila, Quezon City, Caloocan and as far as Cavite. As lead institution for skills training in Basic Emergency Obstetric & Newborn Care (BEmONC) and training center for OB-GYN, Pediatrics and Neonatology with a School of Midwifery under its wing, implementing the EINC recommended practices was but a logical direction. </span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"> “As a BEmONC training center we were already doing some of the EINC practices, the only difference was that they were not time-bound and sequenced,” Dr. Fernandez-Tan said. Unnecessary interventions such as administering enema, perineal shaving, applying fundal pressure foot printing and routine bathing, have long been done away with at the hospital. Properly timed cord clamping using a sterile plastic clamp and dry cord care were already being practiced. ID tags were placed on the baby’s ankle. </span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"> Implementing EINC has enhanced their performance of the four core-steps in a properly sequenced and time bound manner. Before EINC training, immediate and thorough drying was performed less than 30 seconds after delivery in 92% of deliveries, with a median time of 7 seconds. Repeat assessment conducted by EINC project staff in May 2011, showed marked improvement in immediate & thorough drying which was performed less than 30 seconds after delivery in 100% of babies, with at median time of 2 seconds. Likewise, early skin-to-skin contact with the baby positioned prone on the mother’s chest or abdomen is already marked at mean time of 84 seconds with 100% of babies positioned at less than 5 minutes compared to pre-training time of 153 seconds and 95% at less than 5 minutes. Prior to training, 46% of babies were separated from their mothers for newborn procedures, which were done before their first breastfeed. After training, 70% of babies completed their first breastfeed before newborn procedures were performed. </span><br />
<div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div></div><div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Consequently, this has resulted to an improvement in breastfeeding </span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">support with 40% of babies delivered breastfeeding within an hour compared to only 4%, pre-training. </span></div></div><div><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div><div><a href="http://3.bp.blogspot.com/-RQXe857BhRs/TmCJJNffSpI/AAAAAAAAAD0/65LA8H_aCrE/s1600/bf1.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" src="http://3.bp.blogspot.com/-RQXe857BhRs/TmCJJNffSpI/AAAAAAAAAD0/65LA8H_aCrE/s320/bf1.jpg" width="242" /></a><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-family: Times;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Other notable improvements in newborn care that were observed since the hospital has implemented EINC include elimination of unnecessary suctioning, revision of criteria for admission to the potentially septic unit, and the use of self monitoring tool</span></span><span class="Apple-style-span" style="font-family: Times;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">s for roomed-in newborns -- elimination of air draft in the delivery area, reduction in separation of mother from baby from 46% to 20%, revision of criteria for NICU admissions as well as 50% decreased in its admissions, and use of self-monitoring tools for roomed-in newborns-- have also been Likewise, good results have also been achieved in the OB practices , most impressive of which are delivery in non-supine position and active management of the third stage of labor. An increase in deliveries without episiotomy was also observed. Dr. Fernandez-Tan notes that implementing non-routine IVF remains a challenge as most of their patients have complications, saying that 60% of deliveries in Fabella are considered abnormal In response, recommendations for heplock among mothers at risk has been suggested. Less than 10% of mothers had no IVF , were allowed to eat and drink and assumed a non-supine position during labor. The present set-up of the LR-DR Complex does not allow mobility and a companion of choice during labor and delivery An underutilized area, the Pay Labor/Delivery Room, will soon be designated as a pilot area where the patient can move around, have a companion and assume position of choice during labor. </span></span></span></div><div><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">While Fabella’s transition to EINC was not as drastic compared to other pilot sites, they still had to undergo a number of changes and adjustments. As the saying goes, ‘old habits die hard.’ Constant push and convincing had to done to ensure that the medical and nursing staff along with the consultants abide by the new protocol. Hospital memos, orientation and training of all hospital staff were done to ensure that complete implementation was achieved. “We saw to it that all attended. We had new residents who missed the sessions here at Fabella who went to Tondo Medical Center to attend the EINC trainings,” shares Dr. Fernandez-Tan. Nurse Rallos adds that “we include EINC in the orientation of our new residents, even nursing trainees, we orient them.” Students and volunteers from accredited schools were also required to attend the EINC training/orientation workshops</span></div><div><div class="separator" style="clear: both; text-align: center;"></div><div style="text-align: -webkit-auto;"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
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<div><a href="http://1.bp.blogspot.com/-UYHkV2_WMRE/TmCI5J0-yHI/AAAAAAAAADs/Cko-FaAUJjo/s1600/fabella_wedge.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="240" src="http://1.bp.blogspot.com/-UYHkV2_WMRE/TmCI5J0-yHI/AAAAAAAAADs/Cko-FaAUJjo/s320/fabella_wedge.jpg" width="320" /></a><a href="http://1.bp.blogspot.com/-wIx15g_Rsh0/TmCI_7KOd_I/AAAAAAAAADw/HBhoemoHHcM/s1600/drrubenflores.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="http://1.bp.blogspot.com/-wIx15g_Rsh0/TmCI_7KOd_I/AAAAAAAAADw/HBhoemoHHcM/s320/drrubenflores.jpg" width="0" /></a><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">With regards non-routine episiotomy, Dr. Fernandez-Tan shares, “We had to demonstrate that it could be done, even in primigravids, and when the residents saw it can be done they all followed…now they’re happy because [actually] it’s less work for them.” Affiliate clinical clerks were previously required to perform 15 episiotomies during their 15-day rotation in Obstetrics. Now they are required 15 deliveries with perineal support and controlled delivery of the baby’s head. Another aspect that needs vigilance is handwashing. While a glow germ activity revealed that the staff practice new proper handwashing techniques, it wasn’t done as regularly as it should be. Opportunities for contamination, likely due to large patient load assigned to each health worker and lack of supplies, has been observed during the delivery assessment. To this effect more sinks , soap dispensers , and hand dryers were installed in the wards, delivery and labor room, in the NICU and other key areas in the hospital. Nurse Edna Solis suggested the ringing of a bell in the LR DR Complex periodically to remind everybody to wash their hands. <br />
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Yet, one strength that Fabella prides itself is how despite its limited resources it has managed to custom-fit wooden wedges placed under the mattresses of their delivery beds so that mothers may deliver in semi-upright positions. Now all mothers are ensured that they will be able to deliver safely in the said position. Meanwhile further refinements in design and manufacture of the wooden wedges is currently being weighed and explored Overall, the implementation of EINC at Fabella has had positive results as indicated in the decrease in their term mortality with a reported 0.7% in June 2011 from 1.3% in December 2010. The same has been reported in term sepsis mortality going down to 4.9% in June 2011 from 20.7% in December 2010. Moreover, they’ve managed to reallocate “savings” in some supplies to address their other needs such as more supplies for gloves and disinfectants. </span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">While the challenge to lower mortality among those admitted in NICU remain, options for its temporary renovations and drafting a supplemental budget are currently being explored. “We are working on that…Dr Ruben Flores, Medical Center Chief mentioned that the NICU should be considered as a small hospital, because it’s really a critical unit. We are an end referral center, 30% of all livebirths are NICU admissions. Contractual nurses have been hired to augment the NICU nursing staff. Plans are underway to relocate the Potentially Septic Unit to a wider area in Ward 4. The Supplemental Budget for additional NICU supplies and equipment has been approved. </span></div><div><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
With such encouraging outcomes, combined with Fabella’s commendable tenacity in providing competitive and compassionate health care to mothers and newborn, the path towards achieving the country’s commitment to reduce infant and child mortality by 2015 is without doubt attainable. Their experience shows that even with such limited resources and challenging circumstances changes and improvements are always possible – it just takes a little bit more of creativity and lots of optimism. </span></div><div></div><div><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
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</span></div><div><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif; font-size: x-small;">by Donna Miranda & </span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif; font-size: x-small;">photos by Bernie Cervantes</span></div></div>EINC Bulletinhttp://www.blogger.com/profile/12010405013897827470noreply@blogger.com1tag:blogger.com,1999:blog-5018532656589223200.post-43855710350796141242011-09-02T00:12:00.000-07:002011-09-02T00:12:47.676-07:00FEATURE | Kangaroo Mother Care at Eastern Visayas Regional Medical Center<a href="http://4.bp.blogspot.com/-oU7NskX8dwA/TmCAHcjZpSI/AAAAAAAAADc/pgScWLHo3lQ/s1600/KMCgraduates.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><br />
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</a></div><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Upon the request of Dr. Aileen T. Riel-Espina, OIC and Chief of Hospital III of Eastern Visayas Regional Medical Center (EVRMC), in coordination with Team EINC, the Bless Tetada Kangaroo Mother Care Foundation (KMCF) conducted the KMC training program at the hospital last June 6 to 10. Participants were Nelita P. Salinas, MD, FPPS [Medical Specialist II (Pediatrics)], Ma. Gemma Ramos, MD, DPPS FPPS [Medical Specialist II (Pediatrics)], Audrey Santo, MD, DPPS [Medical Specialist I (Neonatology)], Dolores Casio, RN, MAN (Head Nurse, NICU), Lea Demetria, RN, MAN (Nurse Staff, NICU), Rachel Quilario, RSW (Social Worker II), Janet Galangue, RSW (Department Head, Social Worker Services), and Susana S. Merida, MD, FPOGS [Medical Specialist II (OB-Gyn)]. <br />
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Prior to the training proper, a KMC orientation was conducted, attended by about 35 </span><table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="http://4.bp.blogspot.com/-oU7NskX8dwA/TmCAHcjZpSI/AAAAAAAAADc/pgScWLHo3lQ/s1600/KMCgraduates.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="300" src="http://4.bp.blogspot.com/-oU7NskX8dwA/TmCAHcjZpSI/AAAAAAAAADc/pgScWLHo3lQ/s400/KMCgraduates.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: xx-small;">Graduates of KMC training</span></td></tr>
</tbody></table><div><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">medical and administrative officers of EVRMC and representatives of the local media. At Dr. Riel-Espina’s opening remarks, she stated that the institutionalization of the KMC at EVRMC to would help in better managing the problem of housing mothers with low birth-weight babies still undergoing medical interventions. She also hoped that with this training and the eventual implementation of KMC, EVRMC would be able to satisfy the accreditation requirement of the KMC Foundation. <span class="Apple-style-span" style="font-family: Times;"></span><br />
</span></div><div><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">At the press conference that followed, Dr. Socorro Mendoza, President of Bless-Tetada Kangaroo Mother Care Foundation-Philippines, and Dr. Espina were interviewed about the concept and benefits of Kangaroo Mother Care. Dr. Mendoza mentioned that, based on worldwide experiences and a large body of scientific evidence collected, the KMC program has contributed to the reduction in the risk of death among the low birth-weight babies; higher rates of breastfeeding among mothers; adequate infant growth, especially head circumference; better mother-child bonding; and reduction of costs incurred by families and hospitals. <br />
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Dr. Mendoza also gave a brief history of KMC in the Philippines. Initially institutionalized at the Dr. Jose Fabella Memorial Hospital in 2000, it then spread to Don Mariano Marcos Memorial Hospital in 2010, and Southern Philippines Medical Center in Davao City in May 2011. EVRMC is the fourth hospital to implement KMC and the first in the Visayas. Highlights of the press conference were broadcast over the local media. <br />
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At the end of the orientation and press conference, the Memorandum of Agreement (MOA) for the implementation of KMC in EVRMC was signed by Dr. Espina, representing EVRMC, and Dr. Mendoza, representing KMCF. Witnesses to the signing were Dr. Rhodora Angulo of EVRMC and Ms. Annabella Guerrero of KMCF. <br />
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The five-day KMC training was divided into four major modules composed of 1) history and technical aspects of KMC, 2) values encounter workshops, 3) data documentation and security, and 4) training the KMC trainers. The output of the training, a “Re-entry Action Plan” was prepared by the trainees, enumerating the milestones of their first-year implementation of the KMC program in the Medical Center. <br />
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The first day started with a leveling of expectations conducted by Dr. Mendoza. This was followed by a focus group discussion to better understand how EVRMC is dealing with incidences of premature and low birth-weight infants and other related information. An on-site inspection of the NICU and rounds of potential areas for a KMC ward followed. <br />
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The KMC technical lectures covered the history and origin of Kangaroo Mother Care, the KMC concept and protocol, enrolment of qualified infants to KMC, in-patient and out-patient KMC interventions, discharging protocol and home follow-ups. The topics were introduced with a lecture, followed by on-site visits at the NICU or pediatrics ward for hands-on experiences. A group discussion ensued to solicit concerns or anticipated problems on the topic. <br />
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The values encounter sessions tackled the importance of values in the delivery of quality healthcare, not just to their clients, but also to themselves and the other healthcare providers and staff. The workshops touched on the values of compassion, valuing self, cooperation, and peace in the workplace. <br />
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The data documentation and security portion of the training tackled the various medical charts and forms required to record the KMC intervention protocol. These were composed of the in-patient profile and chart, the ambulatory chart, the contract, and the evaluation of the preparedness of the mother and the family to adapt the KMC technique. <br />
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The training of KMC trainers underscored the need to develop skills to become competent trainers of other KMC medical professionals and social workers. Differences between traditional and output-oriented training cultures, training skills and overcoming fear of presenting, and evaluation of the effectivity of the training outcome were tackled. The participants were then asked to pick an aspect of the KMC program they would like to teach the other participants, demonstrating how they would undertake the training. <br />
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To prepare the trainees who would form the core team of KMC. Dr. Mendoza introduced the topic “Re-Entry Action Plan or REAP,” a planning tool for developing their annual implementation plans and program for institutionalizing KMC. The morning of the fifth day was devoted to discussing and identifying their first-year objectives, the corresponding activities, responsibilities, budget, output required, schedules/deadlines, monitoring, and evaluation. <br />
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The afternoon of the last day was devoted to presenting the core team’s REAP to Dr. Espina and other heads of the EVRMC administration and services, including Dr. Rama, the head of training. A lively discussion followed, participated in by all present to fine-tune or to suggest activities and output required. <br />
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All in all, the 5-day training course ended with a generous expression of thanks and good feelings for the achievement of the objectives identified on the first day. Dr. Espina closed the training session with high hopes for the implementation of the KMC program in the Medical Center, followed by the presentation of certificates of participation to the eight members of the KMC Core Team. Part of the commitment of the KMC Foundation is to provide guidance and expert advice to the KMC Core Team of EVRMC, by way of quarterly visits. </span></div><div></div><div><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span> </div>EINC Bulletinhttp://www.blogger.com/profile/12010405013897827470noreply@blogger.com0tag:blogger.com,1999:blog-5018532656589223200.post-25962251119870935052011-09-01T23:59:00.000-07:002011-09-02T02:06:00.248-07:00News | Breastfeeding under special conditions<br />
<div class="MsoNormal" style="line-height: normal;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">IPA/ICM/FIGO issues a joint statement on breastfeeding, including breastfeeding by HIV- infected mothers. In light of the changing evidence on transmission risks and recommendations on the use of anti retroviral drugs for treating pregnant women and preventing HIV infection in infants, we welcome the new recommendations on HIV and infant feeding: </span></div><div class="MsoNormal" style="line-height: normal;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div><div class="MsoNormal" style="line-height: normal;"></div><div class="MsoNormalCxSpFirst" style="line-height: normal;"></div><ol><li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Balancing HIV protection with protection from other causes of child mortality</span></li>
<li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Integrating HIV interventions into maternal and child health services. </span></li>
<li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Setting national or subnational recommendations, based on evidence, for infant feeding in the context of HIV. </span></li>
<li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Informing mothers known to be HIV infected about infant-feeding alternatives</span></li>
<li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Supporting mothers known to be HIV infected who wish to breastfeed so that they can do so safely. </span></li>
<li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Providing services to specifically support mothers to appropriately feed their infants. </span></li>
<li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Avoiding harm to infant-feeding practices in the general population.</span></li>
<li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Advising mothers who are HIV uninfected or whose HIV status is unknown. </span></li>
<li><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Investing in improvements in infant-feeding practices in the context of HIV.</span></li>
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<div class="MsoNormal" style="line-height: normal;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">IPA/ICM/FIGO welcome the recommendation that mothers known to be HIV infected should exclusively breastfeed their infants for the first 6 months of life, introducing appropriate complementary food thereafter, and continue breastfeeding for the first 12 months of life. Bottle feeding should be considered the best alternative only when specific conditions are met. The conditions under which bottle feeding is preferred are commonly referred to as AFASS—affordable, feasible, acceptable, sustainable, and safe—and are more specifically described in the new WHO recommendations.</span></div>EINC Bulletinhttp://www.blogger.com/profile/12010405013897827470noreply@blogger.com0tag:blogger.com,1999:blog-5018532656589223200.post-9936914725555701092011-09-01T23:40:00.000-07:002011-09-21T07:48:17.050-07:00EINC Don’ts & Do’s | Unnecessary Suctioning and Bathing & Properly Timed Cord Clamping<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="Apple-style-span" style="font-size: large;">DON’Ts Unnecessary Suctioning and Bathing</span> <br />
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</span></div><div><a href="http://4.bp.blogspot.com/-MRPOS0YXuXc/TmB4TcIBPtI/AAAAAAAAADY/tAryY5Bf3kY/s1600/unsuctioning.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em; text-align: justify;"><img border="0" height="320" src="http://4.bp.blogspot.com/-MRPOS0YXuXc/TmB4TcIBPtI/AAAAAAAAADY/tAryY5Bf3kY/s320/unsuctioning.jpg" width="258" /></a><b><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif; font-size: large;">Routine suctioning</span></b><br />
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<span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Routine suctioning has been the norm in newborn resuscitation because it was believed to be necessary to clear the baby’s airway and to stimulate him to breath. However in the presence of clear amniotic fluid especially in a baby who is crying and breathing at birth, routine suctioning has been associated with bradycardia, apnea, and delays in achieving normal oxygen saturations. It also causes mucosal trauma with an increased risk for infection. In a pilot implementation study of the Essential Newborn Care Protocol at a large government hospital in the National Capital Region, unnecessary suctioning of vigorous newborns increased the risk for sepsis (OR 4.49 95% CI 2.26-8.89), mortality (OR 8.75 95%CI 2.60 – 29.4) and severe disease (OR 4.44 95% CI 2.72 – 7.25). Routine suctioning of the newborn is a harmful practice that should be discontinued.</span><br />
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Velaphi S, Vidyasagar D. The pros and cons of suctioning at the perineum (intrapartum) and post-delivery with and without meconium. Semin Fetal Neonatal Med 2008 Dec: 13 (6): 375-82. Sobel HL, Silvestre MA, Vitangcol B, Mantaring JB 3rd, Nyunt-U S. The association between immediate newborn care practices and risk of neonatal mortality,sepsis and severe disease in a Philippine hospital. Unpublished </span><br />
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<div style="text-align: justify;"><b><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif; font-size: large;">Early Bathing and Washing </span></b></div><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><div style="text-align: justify;"><br />
</div></span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Bathing the newborn immediately after birth predisposes him to developing huypothermia. When hypothermia sets in, there is an increased risk of infection, coagulation defects, acidosis, delayed fetal-to-newborn circulatory adjustment, hyaline membrane disease, and intracranial hemorrhage. It also washes away the vernix caseosa, which has been shown in several studies to have antimicrobial properties similar to that of amniotic fluid and breastmilk. Antimicrobial proteins (lysozyme, lactoferrin, human neutrophil peptides 1-3 and secretory leukocyte protease inhibitor) are present in organized granules embedded in the vernix, and these immune substances were found to be effective in inhibiting the growth of common perinatal pathogens, including group B <i>Streptococcus</i>, <i>K. pneumoniae</i>, <i>L. monocytogenes</i>, <i>C. albicans</i>, and <i>E. coli</i>. Also, washing leads to the baby becoming disorganized, effectively hindering the crawling reflex which is present during the first hour of life. The WHO recommends that bathing be delayed for at least 6 hours after birth to minimize the risk of cold stress during the period of maximum physiologic transition of the newborn. </span> <br />
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<div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: xx-small;">Sources: </span></div><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: xx-small;">Darmstadt GL, Walker N, Lawn JE, Bhutta Z, Haws RA, Cousens S. Saving newborn lives in Asia and Africa:cost and impact of phased scale-up of interventions within the continuum of care. Health Policy and Planning. 2008. 23 (2):101. </span><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: xx-small;"> Akinbi HT et al. Host defense proteins in vernix caseosa and amniotic fluid, Am J Obstet Gynecol. 191(6), 2090-2096. 2004. </span><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: xx-small;"> World Health Organization. Thermal Protection of the Newborn: A Practical Guide. Geneva, Switzerland: World Health Organization; 1997.</span></div><div><div style="text-align: justify;"><span class="Apple-style-span" style="font-size: large;"><br />
</span></div></div><div><div style="text-align: justify;"><span class="Apple-style-span" style="font-size: large;"><b>DO’s Properly Timed Cord Clamping </b></span></div></div><div><div style="text-align: justify;"><br />
</div></div><div class="separator" style="clear: both; text-align: center;"><a href="http://2.bp.blogspot.com/-J8g-w1mmn1E/TmB4Sb_UJ6I/AAAAAAAAADU/D1nEpvMg5G4/s1600/cordclamping.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em; text-align: justify;"><img border="0" height="266" src="http://2.bp.blogspot.com/-J8g-w1mmn1E/TmB4Sb_UJ6I/AAAAAAAAADU/D1nEpvMg5G4/s400/cordclamping.jpg" width="400" /></a></div><div><div style="text-align: justify;"><br />
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<div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Immediate cord clamping has been traditionally been the standard in the country. In the observational study by Sobel et al of 481 births in 51 large government hospitals to evaluate the performance and timing of newborn care interventions, cords were clamped at a median of only 12 seconds with 476 (99.0%) within 60 seconds. Three (0.6%) with nuchal cords were cut prior to delivery. Research that has been done on delayed cord clamping has shown benefits to both full-term and preterm babies. Furthermore traditional practices such as “milking” the cord and using binders have only been proven to increase the risks for infection. Milking the cord towards the baby, for instance, can actually result in a bolus of blood being introduced suddenly into the baby’s system and may conceivably cause complications especially in preterms with fragile blood vessels in the brain. Binders on the other hand, when soiled and unchanged, may harbor germs that will cause infection. The binder can also rub against the skin and cause irritation. In lieu of avoiding the risk for infection, EINC recommends the use of plastic clamp to lessen subsequent cord handling (hence the risk of infection) and eliminate the need to replace the metal clamp with a plastic one later on with the first clamp applied 2 cm from the base of the umbilicus and second one at 5 cm from the base of the umbilicus. </span></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Effects on Full-term Infants </span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"> There are two meta-analyses evaluating the effects of delayed cord clamping on full term infants. The meta-analysis by Hutton and Hassan included all controlled trials whether randomized or not, while McDonald and Middleton excluded quasi-randomized trials and included also maternal outcomes in their meta-analysis. </span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"> Hutton and Hassan in their meta-analysis of 15 controlled trials (n=1912 newborns) found that delaying cord clamping of the umbilical cord in full term neonates for a minimum of 2 minutes following birth is beneficial to the newborn, extending into infancy. Benefits over ages 2-6 months associated with late clamping include improved hematocrit (WMD 3.7% 95% CI 2.0, 5.4%), ferritin concentration (WMD 17.89 95% CI 16.58-19.21), stored iron (WMD 19.0 95% CI 7.67- 32.13) and a significant reduction in the risk of anemia (RR 0.53 95% CI 0,40-0.70). There was a trend towards an increased risk for polycythemia though asymptomatic in the 2 high quality studies (n=281 infants) RR 3.91 95%CI 1.00-15.36. </span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"> McDonald and Middleton’s review of 11 trials (2989 mother-baby dyads) revealed significant increases in newborn hemoglobin levels in the late vs the early cord clamping (WMD 2.17 g/dl 95% CI 0.28, 4.06; 3 trials of 671 infants) although the effect did not persist beyond 6 months. Infant ferritin levels remained higher in the late vs the early clamping group at 6 months. There was a significant increase in infants requiring phototherapy for jaundice (RR 0.59 95% CI 0.38, 0.92; five trials of 1762 infants) in the late vs early clamping group. There were no significant differences seen for maternal postpartum hemorrhage in any of the 5 trials (n=2236 women) which measured this outcome (RR for postpartum hemorrhage of > 500 ml 1.22 95% CI 0.96, 1.55). </span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"> Effects on Preterm Infants </span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"> Data from a meta-analysis by Rabe et al from 7 randomized controlled trials (n=297 infants) with a maximum delay of 2 minutes (120 secs) revealed that delayed clamping was associated with fewer transfusions for anemia (3 trials, n=111 infants; RR 2.01, 95% CI 1.24 to 3.27, low blood pressure (2 trials, n=58 infants; RR 2.58 95% CI 1.17, 5.67) and less intraventricular hemorrhage (IVH) (5 trials, n=225 infants; RR 1.74, 95% CI 1.08, 2.81). In another study by Van Rheenen on a population of low birth weight/small for gestational age (SGA) infants, the search for both randomized and quasi randomized trials yielded no trials specifically reporting the effects of delayed clamping in SGA infants. Three trials were included, with 190 term and 40 preterm infants, a proportion of whom were SGA. Data showed higher hemoglobin levels in the term infants at follow-up [2 trials, n=127 infants, weighted mean difference WMD 9.17 g/L, 95% CI 5.94-12.40]. In preterm infants, the proportion who required a blood transfusion in the 1st 6 weeks after birth was lower after DCC (one trial, 38 infants, RR 0.56, 95% CI 0.34-0.94). </span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"> In a randomized controlled trial, Mercer and co-workers demonstrated that delayed cord clamping in very preterm neonates reduced the incidence of intraventricular hemorrhage and late-onset sepsis. Delayed cord clamping did not protect against the primary outcomes of interest, bronchopulmonary dysplasia and necrotizing enterocolitis. All these studies point to the facts that placental transfusion at birth brought about by properly timed cord clamping increases the infant’s blood volume and iron reserves, and reduces the incidence of iron-deficiency anemia in infancy. In preterm infants, it reduces the need for blood transfusions and decreases the incidence of life-threatening intracranial hemorrhages.</span></div><div><div style="text-align: justify;"><br />
</div><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: xx-small;">Sources: <br />
Sobel HL, Silvestre MA, Mantaring JB III, Oliveros YE, Nyunt-U S. 2009. Immediate newborn care practices delay thermoregulation and breastfeeding initiation. Acta Paediatrica 2011. DOI:10.1111/j.1651-2227.2011.02215.x. [Epub ahead of print]deprive newborns of natural protections: A minute-by-minute assessment of care in the first hour of life in fifty-one large Philippine hospitals. Unpublished. Available at <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1651-2227.2011.02215.x/pdf">http://onlinelibrary.wiley.com/doi/10.1111/j.1651-2227.2011.02215.x/pdf</a> Hutton EK, Hassan ES. Late vs early clamping of the umbilical cord in full-term neonates. Systematic review and meta-analysis of controlled trials. JAMA. 2007; 297:1241-1252. </span><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: xx-small;">McDonald SJ, Middleton P. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No. CD004074. DOI:10.1002/14651858.CD004074.pub2. Rabe H, Reynolds G and Diaz-Rossello. Early versus delayed umbilical cord clamping in preterm infants. Cochrane Database of Systematic Reviews 2004, Issue 4. Art. No. CD003248. DOI: 10.1002/14651858.CD003248.pub2. van Rheenen PF, Gruschke S, Brabin BJ. Delayed umbilical cord clamping for reducing anaemia in low birthweight infants: implications for developing countries. Ann Trop Paediatr. 2006 Sep;26(3):157-67.</span></div><div><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: xx-small;">Mercer JS, Vohr BR, McGrath MM, Padbury JF, Wallach M, Oh W. Delayed cord clamping in very preterm infants reduces the incidence of intraventricular hemorrhage and late-onset sepsis: a randomized, controlled trial. Pediatrics. 2006 Apr;117(4):1235-42.</span></div><div></div><div></div>EINC Bulletinhttp://www.blogger.com/profile/12010405013897827470noreply@blogger.com0tag:blogger.com,1999:blog-5018532656589223200.post-66761307372854845552011-09-01T19:53:00.000-07:002011-09-01T19:53:48.279-07:00FEATURE | San Lorenzo Ruiz Women’s Hospital: Providing a comforting, nurturing and safe environment for mothers and newborns in a hospital<div class="separator" style="clear: both; text-align: center;"><a href="http://4.bp.blogspot.com/-UA2ostYXUkU/TmA9jQGpRzI/AAAAAAAAADI/LYZfzPC6yqA/s1600/blogSLWH_cover.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="428" src="http://4.bp.blogspot.com/-UA2ostYXUkU/TmA9jQGpRzI/AAAAAAAAADI/LYZfzPC6yqA/s640/blogSLWH_cover.jpg" width="640" /></a></div><br />
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</span></span></b></div><div class="MsoBodyText"><span class="Apple-style-span" style="color: #444444; font-family: Georgia, 'Times New Roman', serif;"><b>I</b>ts discreet location, tucked at the far end of an almost unnoticeable alleyway along the national road, is certainly not comparable to the quality of care that San Lorenzo Ruiz Women’s Hospital (SLWH) in Malabon lives up to. We may be a very small hospital but we have managed to maintain a good reputation in delivering quality care and service to our patients. Hopefully, we want to have the same for EINC,” shares the charismatic Dr. Maria Isabelita “Happy” Estrella, hospital director and EINC Working Committee Chairman, that afternoon we dropped in for a visit.</span></div><div class="MsoBodyText"><span class="Apple-style-span" style="color: #444444; font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><span class="Apple-style-span" style="color: #444444;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Upon entering the premises, one senses that at SLWH things are done in a manner not quite typical of any government hospital. And yet its cozy atmosphere common of small town communities betrays the level of excellence </span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">that the hospital strives to achieve, for there is surely nothing “small town” about SLWH’s commitment to achieve the goals set by MDG 4 & 5. Their passion to constantly improve their compliance of the EINC practices while also soliciting the active involvement of their immediate community is noteworthy. Dr. Happy Estrella hopes that by involving the other health providers in Malabon and its nearby areas, the city of Malabon in their own “small way” can contribute to reducing the country’s maternal and infant mortality by 2015.</span></span></div><div class="MsoListCxSpFirst"><span class="Apple-style-span" style="color: #444444; font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div><div class="MsoListCxSpFirst"><span class="Apple-style-span" style="color: #444444;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">San Lorenzo Ruiz Women’s Hospital is a 10-bed capacity special First Level Referral hospital catering to the health needs of women and children residing in Malabon, parts of Valenzuela, Caloocan, Obando as well as </span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Tanza, Navotas. It is also Philhealth accredited as a secondary hospital. Normal spontaneous deliveries and obstetric cases remain the leading cause of admission.</span></span></div><div class="MsoBodyText"><span class="Apple-style-span" style="color: #444444; font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div><div class="MsoBodyText"><span class="Apple-style-span" style="color: #444444; font-family: Georgia, 'Times New Roman', serif;">While not solely a maternity hospital, Dr.Estrella remarks that there is that unavoidable impression “that is why adopting the EINC is an advantage to us” since the program will strengthen their capacity to meet the needs of both mother and baby during delivery and birth. She proudly adds that implementing EINC is, if not one of, their more important accomplishments for the year.</span></div><div class="MsoBodyText" style="margin-bottom: .0001pt; margin-bottom: 0in;"><span class="Apple-style-span" style="color: #444444;"><br />
</span></div><div class="MsoBodyText" style="margin-bottom: .0001pt; margin-bottom: 0in;"><span class="Apple-style-span" style="color: #444444; font-family: Georgia, 'Times New Roman', serif;">Seven months after its implementation, EINC has “now become part of the hospital” withcorresponding hospital guidelines and policies supporting already issued from staff assignments all the way to the revision of forms, scope of work and doctors orders. More importantly, the staff—from the doctors down to the midwives and nurses, even those not part of the Working Committee—has by now internalized the program.</span></div><div class="MsoBodyText" style="margin-bottom: .0001pt; margin-bottom: 0in;"><span class="Apple-style-span" style="color: #444444;"></span><br />
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</span></div><div class="MsoBodyText"><div class="separator" style="clear: both; text-align: center;"><a href="http://1.bp.blogspot.com/-z-45qVM1WB8/TmA-pLP7udI/AAAAAAAAADM/za8-C5VpopU/s1600/SLWH_father.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="http://1.bp.blogspot.com/-z-45qVM1WB8/TmA-pLP7udI/AAAAAAAAADM/za8-C5VpopU/s320/SLWH_father.JPG" width="262" /></a></div><span class="Apple-style-span" style="color: #444444; font-family: Georgia, 'Times New Roman', serif;">And in fact, already learning to devise creative solutions when not so ideal situations arise. Such as the time when they asked a father to do skin-to-skin contact in place of the mother who was unable to hold her baby because she was vomiting immediately right after delivery. “It was a very touching moment,” narrate the nurses and midwives. Chief of Clinic, Pediatrician Dr. Marilou Nery adds, “The father felt more involved in the process.” Furthermore, “(it) has brought out the creativity in us [as] the passion somewhat grows on you then you strive to be better each time.”</span></div><div class="MsoBodyText"><span class="Apple-style-span" style="color: #444444; font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div><div class="MsoBodyText"><span class="Apple-style-span" style="color: #444444; font-family: Georgia, 'Times New Roman', serif;">Change is indeed a concerted effort. That is to say that even a small hospital like SLWH, where administration and organization may deceptively seem simple, is still not exempt from a few uncoordinated practices that bigger hospitals experience.</span></div><div class="MsoBodyText"><span class="Apple-style-span" style="color: #444444; font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div><div class="MsoBodyText"><span class="Apple-style-span" style="color: #444444; font-family: Georgia, 'Times New Roman', serif;">Dr. Estrella narrates how it was initially challenging to convince the other midwives to carry out the program. Understandably, change is never an easy thing to do, most especially as this entails reconsidering “old and tried methods” and learning new ones. After much work, they’ve eventually come around—seeing the benefits of the program as well as appreciating their role in providing safe and quality healthcare to mothers and babies.</span></div><div class="MsoBodyText"><span class="Apple-style-span" style="color: #444444; font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div><div class="MsoBodyText"><span class="Apple-style-span" style="color: #444444; font-family: Georgia, 'Times New Roman', serif;">“You have to devise strategies that will challenge the staff to do better,” says Dr. Nery. Episiotomies for instance used to be routinely done by the midwives to avoid laceration, but has since been declining after persistent guidance and monitoring with 39% out of 18 normal deliveries from June 5-18. And while consistency in recording deliveries can still improve, there has been good compliance with the performance of full EINC in both normal and CS deliveries with 92.2% for May and 100.00% for the first half of June. Likewise, unnecessary interventions, such as fundal pressure, manual exploration of the uterus, unnecessary suctioning, and NPO have impressively gone down. The routine administration of intravenous fluid has also dramatically decreased with 66.7% of normal deliveries performed without IV fluids for the month of May and >80 % for the first half of June. Equally worth mentioning is 100% compliance in Oxytocin IM administration for the Active Management of the Third Stage of Labor.</span></div><div class="MsoBodyText"><span class="Apple-style-span" style="color: #444444; font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div><div class="MsoBodyText"><span class="Apple-style-span" style="color: #444444; font-family: Georgia, 'Times New Roman', serif;">It really is about creating a homely, comforting, nurturing but safe environment for the mother and the newborn. “When we started implementing the program, no sooner did we come to realize that EINC practices were relatively in tune with the reason(s) why some mothers opt for home births,” shares Dr. Estrella.</span></div><div class="MsoBodyText"><span class="Apple-style-span" style="color: #444444; font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><span class="Apple-style-span" style="color: #444444; font-family: Georgia, 'Times New Roman', serif;">With EINC, mothers feel more at ease and satisfied with the birthing experience as they are encouraged to assume a position of choice during labor, delivered in non-supine position, and even given the option to have a companion of choice during labor and delivery.</span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><span class="Apple-style-span" style="color: #444444;"><br />
</span></div><div class="MsoBodyText"><span class="Apple-style-span" style="color: #444444; font-family: Georgia, 'Times New Roman', serif;">They’ve since been receiving positive feedback from their patients, mostly of whom have expressed how much they enjoyed the (birthing) process compared to how it was before. Conversely, the staff and doctors equally feel satisfied. “We’ve learned to be more compassionate to patients. “Now we’ve come to appreciate better what mothers are going through and know how to support and care for them during the process,” says Dr. Estrella. Implementing the EINC has also made them realize how their previous “preventive” practices were bent more on assuaging their own fears for potential complications that may arise during delivery rather than a response to the patient’s needs. Dr. Nery for instance notes that performing the four core steps of newborn care have led them to more definitive diagnosis of sepsis which has partly contributed to the drop in reported cases, “before as soon as a patient is admitted, the newborn is immediately considered for sepsis, hence, the routine administration of antibiotic even without the confirmation of a blood culture.” True enough, the sepsis rates for May to June 2011 have gone down from 5.9% to 6.9% for the last week of June and first week of July 2011. </span><span class="Apple-style-span" style="color: #444444; font-family: Georgia, 'Times New Roman', serif;">Of course, these rates may yet change but with EINC implementation, the outlook is very optimistic. The use of drop light among newborns has also been done away with since skin-to-skin contact with the mother is already enough to keep these babies warm.</span><br />
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</span></div><div class="MsoListCxSpMiddle"><div style="text-align: left;"><span class="Apple-style-span" style="color: #444444; font-family: Georgia, 'Times New Roman', serif;">The key to SLWH’s success is constant communication between the midwives, </span><span class="Apple-style-span" style="color: #444444; font-family: Georgia, 'Times New Roman', serif;">pediatricians, obstetricians and patients. Midwives, for instance, have learned to become more open to the needs of their patients. Furthermore, they’ve begun to appreciate the integrated care needed by for mother and baby during delivery, inevitably requiring teamwork. “I used to be afraid of handling neonates, immediately handing the baby out to the pediatrician once I’m done delivering it. My thought then was “I’m only an OB and should have nothing to do with that.” But now, I make it a point to check on the babies I’ve delivered when I do my rounds,” Dr. Estrella shares. And while the hospital’s current floor plan has yet to truly reflect these new “discoveries,” plans for expansion are underway.</span></div></div><div class="MsoBodyText"><div style="text-align: left;"><span class="Apple-style-span" style="color: #444444; font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div></div><div class="MsoBodyText"><div style="text-align: left;"><span class="Apple-style-span" style="color: #444444; font-family: Georgia, 'Times New Roman', serif;">The enriching experience brought by implementing EINC in their hospital has undoubtedly inspired SLWH to reach out to their immediate community. Believing that these marked improvements need not be confined to walls of their hospital but must also be shared to the rest of the community, at least those within their reach. Capitalizing on their existing network of Breastfeeding Coordinators in the community, they’ve initiated a series of meetings to advocate and promote EINC beyond the hospital. Already, initial communications with RHU-based coordinators have been set-up to align delivery and care practices of private practitioners and home birth with EINC and other mother-baby friendly care practices. </span></div><span class="Apple-style-span" style="color: #444444; font-family: Georgia, 'Times New Roman', serif;"><br />
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<span class="Apple-style-span" style="color: #444444; font-family: Georgia, 'Times New Roman', serif;">While SLWH’s experience proves that more often than not it’s little details such as the simple warmth of a mother’s skin that matter, more importantly their experience only shows that being small is by no means an obstacle to thinking and aspiring big.</span></div>EINC Bulletinhttp://www.blogger.com/profile/12010405013897827470noreply@blogger.com4tag:blogger.com,1999:blog-5018532656589223200.post-33166164048878613682011-09-01T11:16:00.000-07:002011-09-01T23:04:14.315-07:00NEWS | 1st MNCHN EINC Advocacy Partners Forum held in Manila<div class="separator" style="clear: both; text-align: center;"><a href="http://2.bp.blogspot.com/-q-X9xbyQums/Tl_KuDu-NbI/AAAAAAAAADA/WmsBrc5rIo0/s1600/advocacyforum.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="188" src="http://2.bp.blogspot.com/-q-X9xbyQums/Tl_KuDu-NbI/AAAAAAAAADA/WmsBrc5rIo0/s640/advocacyforum.jpg" width="640" /></a></div><div class="MsoListCxSpFirst"><span class="Apple-style-span" style="color: #444444; font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div><div class="MsoListCxSpFirst"><span class="Apple-style-span" style="color: #444444; font-family: Georgia, 'Times New Roman', serif;">July 13 to 15 at the Century Park Hotel in Manila saw the realization of the first MNCHN (Maternal Child Health and Nutrition Policy) EINC (Essential Intrapartum and Newborn Care) Advocacy Partners Forum to meet the demand for EINC training by building up the pool of speakers for rapid scaling up efforts. The forum was carried out for the benefit of new EINC trainers who themselves require not only training but also updates on the Department of Health’s ongoing efforts in the Scale-Up Project. Their motto being “I commit to life”—it is the first declaration in their official Partners Pledge—the group by way of this forum also commits to keeping their advocacy alive by empowering their personnel with the expertise necessary for pursuing the quality of maternal child health they aspire for.</span><br />
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<span class="Apple-style-span" style="color: #444444; font-family: Georgia, 'Times New Roman', serif;">Funded by JPMNH and WHO, EINC has either trained or oriented approximately 9000 healthcare workers in the short timespan between May and October 2011–a testament to the ongoing demand for capacity building in EINC among various key medical institutions. Requests for training come from both private and public hospitals, some even outside the National Capital Region, no to mention a handful of LGUs and private institutions. This is possibly due to the effectiveness of the EINC social marketing plan and training methodology, where administrative circulars as well as technical and professional training are brought directly to facility-based healthcare workers, emphasizing the significance of a peer-to-peer system of learning. </span></div><div style="font: normal normal normal 8.5px/normal 'Adobe Caslon Pro'; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span class="Apple-style-span" style="color: #444444; font-family: Georgia, 'Times New Roman', serif; font-size: small;"><br />
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<span class="Apple-style-span" style="color: #444444; font-family: Georgia, 'Times New Roman', serif; font-size: small;">The course was designed to build up a speakers bureau comprised of of EINC advocates–the healthcare professionals who, after training, are committed to improving dominant hospital practices when it comes to caring for mothers and newborns–and dedicated to ginding even more advocates given the abovementioned demand for EINC training. The demand is expected to grow further once Philhealth goes public with its new packages meant to address issues of maternal and newborn healthcare–a demand to be met by the pool of advocacy partners in collaboration with DOH and its Centers for Health Development.</span></div><div style="font: normal normal normal 8.5px/normal 'Adobe Caslon Pro'; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span class="Apple-style-span" style="color: #444444; font-family: Georgia, 'Times New Roman', serif; font-size: small;"><br />
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<span class="Apple-style-span" style="color: #444444; font-family: Georgia, 'Times New Roman', serif; font-size: small;">After receiving their official IDs after completion of training, healthcare professionals maintain their status as EINC advocates by conducting workshops, the progress of which will be monitored via the EINC Advocacy Partners Forum website. The engagement of Advocacy Partners such as those coming from professional societies can also function as a kind of PPP mechanism of the Centers of Health Development, identifying specialists per region who can voluntarily lead orientations and trainings for the CHDs who will fund such venues for training. Besides the CHDs, the Advocacy Partners will also be working closely with DOH hospitals and their Health Education and Promotions Officer (HEPO), the DOH Family Health Office/NCDPC, the National Center for Health Promotions (NCHP), and the Local Government Unit (LGU).</span></div><div style="font: normal normal normal 8.5px/normal 'Adobe Caslon Pro'; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span class="Apple-style-span" style="color: #444444; font-family: Georgia, 'Times New Roman', serif; font-size: small;"><br />
</span></div><div style="font: normal normal normal 8.5px/normal 'Adobe Caslon Pro'; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span class="Apple-style-span" style="color: #444444; font-family: Georgia, 'Times New Roman', serif; font-size: small;">The feedback has been positive with participants excited to return to their communities and impart their new learning's. Dr. Catherine Torres-Jison of Bacolod, for instance has committed to conduct EINC trainings and workshops at The Corazon Locsin Montelibano Regional Hospital, Bacolod City Lying-In Clinis and at University of St. Las Salle. She shares "learning about the evidence-based practices has empowered us to push for the advocacy because we are confident that the safety and wellness of both mother and baby are always prioritized over everything else." Moreover, she is anticipating that "bringing EINC to medical schools" as the best way to promote EINC protocol that way "[future] doctors and other health professionals will no longer be confused."</span></div><div style="font: normal normal normal 8.5px/normal 'Adobe Caslon Pro'; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span class="Apple-style-span" style="color: #444444; font-family: Georgia, 'Times New Roman', serif; font-size: small;"><br />
</span></div><div style="font: normal normal normal 8.5px/normal 'Adobe Caslon Pro'; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span class="Apple-style-span" style="color: #444444; font-family: Georgia, 'Times New Roman', serif; font-size: small;"><br />
</span></div><div style="font: normal normal normal 8.5px/normal 'Adobe Caslon Pro'; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span class="Apple-style-span" style="color: #444444;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif; font-size: small;">The 70 “graduates” who have completed the </span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif; font-size: small;">training were enjoined to know by the heart the</span></span></div><div style="font: normal normal normal 8.5px/normal 'Adobe Caslon Pro'; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span class="Apple-style-span" style="color: #444444;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif; font-size: small;"><b>MNCHN EINC Advocacy Partners Pledge</b>, a </span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif; font-size: small;">simple oath comprised of seven lines that capture </span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif; font-size: small;">the essence of what EINC stands for:</span></span></div><div style="font: normal normal normal 8.5px/normal 'Adobe Caslon Pro'; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"></div><div style="font: normal normal normal 8.5px/normal Helvetica; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span class="Apple-style-span" style="color: #444444; font-family: Georgia, 'Times New Roman', serif; font-size: small;"><br />
</span></div><div style="font: normal normal normal 8.5px/normal Helvetica; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span class="Apple-style-span" style="color: #444444; font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;"> “<b>I commit to life. </b>/ From its earliest </span><span class="Apple-style-span" style="font-size: small;">stirrings in a mother’s womb, through</span></span></div><div style="font: normal normal normal 8.5px/normal Helvetica; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span class="Apple-style-span" style="color: #444444; font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;"> its intricate journey of development, </span><span class="Apple-style-span" style="font-size: small;">until the moment of birth. / I will </span><span class="Apple-style-span" style="font-size: small;">safeguard the </span></span></div><div style="font: normal normal normal 8.5px/normal Helvetica; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span class="Apple-style-span" style="color: #444444; font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;"> mother’s wellbeing, to </span><span class="Apple-style-span" style="font-size: small;">maintain a nurturing environment for </span><span class="Apple-style-span" style="font-size: small;">the life growing within. / I will</span></span></div><div style="font: normal normal normal 8.5px/normal Helvetica; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span class="Apple-style-span" style="color: #444444; font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;"> shield </span><span class="Apple-style-span" style="font-size: small;">this new life, and ensure it begins its </span><span class="Apple-style-span" style="font-size: small;">existence safely nestled in a mother’s </span><span class="Apple-style-span" style="font-size: small;">warm </span></span></div><div style="font: normal normal normal 8.5px/normal Helvetica; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span class="Apple-style-span" style="color: #444444; font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;"> embrace. / I will protect this </span><span class="Apple-style-span" style="font-size: small;">new life, and allow only milk from </span><span class="Apple-style-span" style="font-size: small;">a mother’s breast for</span></span></div><div style="font: normal normal normal 8.5px/normal Helvetica; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span class="Apple-style-span" style="color: #444444; font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;"> nourishment. </span><span class="Apple-style-span" style="font-size: small;">/ I will zealously preserve the bond </span></span><span class="Apple-style-span" style="color: #444444; font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;">between mother and child. / All these</span></span></div><div style="font: normal normal normal 8.5px/normal Helvetica; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span class="Apple-style-span" style="color: #444444; font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-size: small;"> things I hold sacred, and will form </span><span class="Apple-style-span" style="font-size: small;">my lifelong commitment.”</span></span></div><br />
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EINC Bulletinhttp://www.blogger.com/profile/12010405013897827470noreply@blogger.com0tag:blogger.com,1999:blog-5018532656589223200.post-24640191119208246412011-09-01T10:45:00.000-07:002011-09-01T10:45:24.718-07:00NEWS | Upcoming Technical Conference on EINC Best Practices <!--[if gte mso 9]><xml> <o:DocumentProperties> <o:Template>Normal.dotm</o:Template> <o:Revision>0</o:Revision> <o:TotalTime>0</o:TotalTime> <o:Created>2011-08-12T09:34:00Z</o:Created> <o:LastSaved>2011-08-12T09:34:00Z</o:LastSaved> <o:Pages>1</o:Pages> <o:Words>225</o:Words> <o:Characters>1287</o:Characters> <o:Company>..</o:Company> <o:Lines>10</o:Lines> <o:Paragraphs>2</o:Paragraphs> <o:CharactersWithSpaces>1580</o:CharactersWithSpaces> <o:Version>12.0</o:Version> </o:DocumentProperties> <o:OfficeDocumentSettings> <o:AllowPNG/> </o:OfficeDocumentSettings> </xml><![endif]--><!--[if gte mso 9]><xml> <w:WordDocument> <w:Zoom>0</w:Zoom> <w:TrackMoves>false</w:TrackMoves> <w:TrackFormatting/> <w:PunctuationKerning/> <w:DrawingGridHorizontalSpacing>18 pt</w:DrawingGridHorizontalSpacing> <w:DrawingGridVerticalSpacing>18 pt</w:DrawingGridVerticalSpacing> <w:DisplayHorizontalDrawingGridEvery>0</w:DisplayHorizontalDrawingGridEvery> <w:DisplayVerticalDrawingGridEvery>0</w:DisplayVerticalDrawingGridEvery> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:Compatibility> <w:BreakWrappedTables/> <w:DontGrowAutofit/> <w:DontAutofitConstrainedTables/> <w:DontVertAlignInTxbx/> </w:Compatibility> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" LatentStyleCount="276"> </w:LatentStyles> </xml><![endif]--> <!--[if gte mso 10]> <style>
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<div class="Pa0"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span class="A18">Almost a year has passed since Essential Intrapartum and Newborn Care (EINC) began “Unang Yakap” or “First Embrace,” its social marketing campaign, designed to transform hospitals with interventions aimed at the high-risk periods of labor, delivery, and immediate postpartum. Now that its practices have been established and are ready to be implemented in 11 DOH hospitals—thanks to the efforts not only of the EINC team but also of these hospitals, JPMNH, WHO Philippines, and the National Center for Disease Prevention and Control/Family Health Office—EINC is eager to share its experience with health stakeholders for adoption and replication on a national scale by way of a conference.</span><span style="color: #57585a;"><o:p></o:p></span></span></div><div class="Pa0"><br />
</div><div class="MsoNormal"><span class="A18"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">The MNCHN EINC Scale Up Project Technical Conference, to be held on September in Metro Manila, is meant to convene such stakeholders, including DOH Centers for Health Development and more hospitals who can surely benefit from EINC’s progressive methods and learnings. Heads of professional societies, key personnel from medical academies, as well as physicians, nurses, and midwives have been invited to attend. Expected presentations include a showcase of the results of the EINC Scale Up Project that mark improvements in the deployment of practices from baseline to project completion, an enumeration of the best practices carried out in model hospitals that are worth emulating, even a set of technical recommendations for the adoption of EINC in all health facilities across the entire nation in order to arrest maternal and newborn within this high-risk period.</span></span></div><!--EndFragment-->EINC Bulletinhttp://www.blogger.com/profile/12010405013897827470noreply@blogger.com0tag:blogger.com,1999:blog-5018532656589223200.post-22321814368655572492011-09-01T10:43:00.000-07:002011-09-01T10:44:15.927-07:00FEATURE | Dr. Honorata Catibog – Bringing Healthcare to Grassroots Level<br />
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<tr><td style="text-align: center;"><a href="http://1.bp.blogspot.com/-lHiysGUYzks/Tl-_9ZOpWUI/AAAAAAAAAC8/L7B9EkWhlog/s1600/Drcatibog.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="342" src="http://1.bp.blogspot.com/-lHiysGUYzks/Tl-_9ZOpWUI/AAAAAAAAAC8/L7B9EkWhlog/s400/Drcatibog.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span class="Apple-style-span" style="color: orange; font-family: Arial, Helvetica, sans-serif; font-size: xx-small;">For the tenacious Dr. Catibog advocacy is no lip service</span></td></tr>
</tbody></table><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">As Dr. Honorata Catibog, director of DOH’s Family Health Office, fondly recall the times she has spent </span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">as Municipal Health Officer and Provincial Board Member -- combing the remotest barrios of her native Western Samar -- one can’t help but grasp that her advocacy is not one that is compulsory of her office but is borne out of years of experience accompanied with the tireless dedication to bring healthcare to those hardest to reach. Her tenacity is easily noticeable in the personal anecdotes she readily shared during our brief afternoon interview: looking back at this one time when she had sea ambulances custom made to service several island municipalities under her jurisdiction, then as provincial board member of Western Samar. Such that Dr. Catibog’s remark about understanding the “difficulties of bringing healthcare to people at grassroots level” and importance of public policies in ensuring its success is certainly no lip service.</span><br />
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</span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">It is no secret that the success of any health reform lie not only in the merits and benefits of the program but equally relies on a sound and robust political strategy that shall guarantee its effective and timely implementation across a wide constituency. Dr. Catibog is one of the instrumental forces in championing maternal and infant health, having headed the Task Force for Rapid Reduction of Maternal and Neonatal Mortality. The task force was responsible for institutionalization and strengthening the implementation of the Maternal, Neonatal and Child Health and Nutrition (MNCHN) Strategy.</span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
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</span></div><div class="MsoBodyText"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">The MNCHN Strategy is formalized under the AO No. 2008-2009 otherwise known as Implementing Health Reforms for the Rapid Reduction of Maternal and Neonatal Mortality. This Order applies the <i>Four</i>mula One for Health (F1) approach instituted by then Health Secretary Francisco Duque III for the implementation of an integrated Maternal, Neonatal and Child Health and Nutrition (MNCHN) Strategy. This overarching strategy guides the development, implementation and evaluation of various programs aimed at women, mothers and children, with the ultimate goal of rapidly reducing maternal and neonatal mortality in the country. This goal is to be achieved through the provision and use of integrated MNCHN services, which refers to a package of services for women, mothers and children that cover known appropriate clinical case management services and cost-effective public health measures which are provided by the health system to reduce the risks of and prevent direct causes of maternal and neonatal deaths.</span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"> </span></div><div class="MsoBodyText"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div><div class="MsoBodyText"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Enclosed within this strategy are provisions to guide the engagement, assistance and empowerment of LGUs and other partners in providing an integrated package of services for mothers, babies and children. This includes organizing training sessions and capacitybuilding workshops for community health workers enabling them to respond to the evolving needs of their clients from prenatal to intrapartum and postpartum/postnatal care and interventions. Dr. Catibog further emphasizes that this integration reflects the paradigm shift cognizant that health workers and providers should be able to address and manage complications that may arise at any of the stages in a woman’s pregnancy. For instance, midwives, at the LGU level, shall be trained not only in evidence-based safe delivery practices but also trained in essential newborn care (ENC).</span></div><div class="MsoBodyText"></div><div class="MsoBodyText"></div><div class="MsoBodyText"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div><div class="MsoBodyText"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">In continuing efforts to rapidly reduce the number of newborn death in the Philippines, the DOH issued an administrative order to implement the ENC protocol last December 1, 2009. The <b>AO 2009-0025</b>, the whole hierarchy of the DOH and its attached agencies, public and private providers of health care and development partners implementing the Maternal, Newborn and Child Health and Nutrition Strategy and all health practitioners of maternal and newborn care were enjoined to adopt the policies and protocol on Essential Newborn Care. ENC was likewise incorporated into the Basic Emergency Obstetric and Newborn Care (BEmONC) Training. <b>Unang Yakap </b>is the social marketing campaign that was launched to spread the call to action to implement the Essential Newborn Care protocol. At advanced implementation sites, as the ENC scale-up program evolved into the Essential <i>Intrapartum </i>and Newborn Care protocol, <i>Unang Yakap </i>likewise became <i>Unang</i> <i style="mso-bidi-font-style: normal;">Yakap 4&5. </i></span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><br />
</div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Asked of what else is needed to further the aims in achieving the goals of MDGs 4 & 5, Dr. Catibog responds, “[I am hoping] that we can bring EINC implementation down to the <i>barangay </i>level with <i>barangay </i>health workers being equipped to carry out EINC protocol even at <i>barangay </i>health stations or perhaps even at home.” She quickly qualifies, “while the gold standard is facility-based, we should consider fallback options for areas where health facilities are not yet available…with the EINC protocol, we ensure the life of the mother and baby even when the mothers are forced to give birth at home.”</span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div><div class="MsoBodyText"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">In her closing remarks to the 1<sup>st</sup> MNCHN EINC Advocacy Forum held last July 13-15 at Century Park Hotel in Manila, Director Catibog underlines the crucial partnership of the public and private sectors as a significant step to achieving the country’s commitment to Millennium Development Goals 4 and 5: </span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">“With the birth of this new partnership with the private sector, we can successfully prevent the needless death of mothers and newborns in the country,” further adding that the private sector’s involvement is the yet largely untapped area ensuring that safe and essential intrapartum and newborn care is given to as many Filipino mothers and newborns as possible.</span></div>EINC Bulletinhttp://www.blogger.com/profile/12010405013897827470noreply@blogger.com0tag:blogger.com,1999:blog-5018532656589223200.post-53424417997830174642011-09-01T09:59:00.000-07:002011-09-20T11:05:26.757-07:00EINC Don’ts & Do’s | Stop Newborn Footprinting and Keep Newborns Safe<h1><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif; font-size: large;">Unnecessary Intervention:</span></h1><h1><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif; font-size: large;">Footprinting and Routine Separation</span></h1><div class="MsoBodyText"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
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</span></div><div class="MsoBodyText"><div class="separator" style="clear: both; text-align: center;"><a href="http://2.bp.blogspot.com/-_nmWsbs0psk/Tl-5aJ4zQtI/AAAAAAAAAC0/Ch9RnSONirI/s1600/footprint.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="300" src="http://2.bp.blogspot.com/-_nmWsbs0psk/Tl-5aJ4zQtI/AAAAAAAAAC0/Ch9RnSONirI/s400/footprint.jpg" width="400" /></a></div><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Footprinting of newborns is currently still a widespread practice in the Philippines as means of identification of newborns. In the first few minutes following delivery, the newborn’s feet are pressed into a common inkpad and later pressed onto an identification sheet. Not only is this practice is usually done by untrained personnel with variable results, but more importantly also increases the risk of crosscontamination among the babies. In 1988, the American Academy of Pedicatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG) stated that “individual hospitals may want to continue the practice of footprinting or fingerprinting, but universal use of this practice is no longer recommended.” In fact studies have demonstrated that the majority of infant footprints taken by hospital personnel prove inadequate for identification purposes, contending that DNA genotyping and human leukocyte antigen tests are better methods of identification. Moreover, the EINC practice of non-separation of newborn from the mother minimizes the risk of switching newborns.</span></div></div><div class="MsoBodyText"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Mostly importantly it has been proven that healthy newborns placed with their mother soon after birth transition more easilyto extrauterine life. They stay warm, cry less, are more likely to breastfeed and breastfeed sooner compared to babies separated from their mothers. Unnecessary separation of newborns from </span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">their mothers and the resultant postponement of latching on and rooming in and restrictions on breastfeeding seriously compromise colonization of the newborn with maternal skin flora, immunoprotection, milk production and eventual exclusive breastfeeding. Footprinting, should not interfere with the core steps </span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">that include skin-to-skin contact and non-separation of mother and baby from early initiation of breastfeeding.</span></div></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><br />
</div><h1><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif; font-size: large;">Recommended Practice:</span></h1><div class="separator" style="clear: both; text-align: center;"><a href="http://3.bp.blogspot.com/-FR_2jBE5MFQ/Tl-5ycIY-UI/AAAAAAAAAC4/EuqYhJGbD6Q/s1600/Dr.Mianne.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif; font-size: large;"></span></a></div><h2><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif; font-size: large;"><br />
</span></h2><h2><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif; font-size: large;">Skin-to-Skin Contact</span></h2><div class="MsoBodyText"><a href="http://3.bp.blogspot.com/-FR_2jBE5MFQ/Tl-5ycIY-UI/AAAAAAAAAC4/EuqYhJGbD6Q/s1600/Dr.Mianne.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em; text-align: justify;"><img border="0" height="300" src="http://3.bp.blogspot.com/-FR_2jBE5MFQ/Tl-5ycIY-UI/AAAAAAAAAC4/EuqYhJGbD6Q/s400/Dr.Mianne.jpg" width="400" /></a><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Skin-to-skin contact (SSC) is generally perceived to be an intervention for the provision of warmth and bonding. But its contributions to immunoprotection of the newborn and to the protection against hypoglycemia are not widely known and less appreciated. Furthermore, evidence from several studies show that skin-to-skin contact between mother and birth reduces crying, improves mother-baby interaction, keeps the baby warmer, aids in stabilizing the baby and helps women breastfeed successfully.</span></div><h3 style="text-align: justify;"><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif; font-size: small;"><br />
</span></h3><h3 style="text-align: justify;"><span class="Apple-style-span" style="font-family: 'Trebuchet MS', sans-serif; font-size: small;">Effects on Breastfeeding</span></h3><div class="MsoBodyText"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">A meta-analysis by Moore et all which included 30 randomized and quasi-randomized trials compared early SSC with usual hospital care involving 1925 mother-infant dyads. They reported statistically significant positive effects of early SSC on breastfeeding at 1-4 months post-birth (10 trials; 552 dyads; OR 1.82, 95% CI 1.08, 3.07), and breastfeeding duration (7 trials; 324 dyads; WMD 42.55, 95% CI -1.69, 86.79). Trends were found for improved summary scores for maternal attachment behavior (6 trials, 396 participants) (SMD 0.52%, 95% CI 0.072) and maternal affectionate love/touch during observed breastfeeding (4 trials; 314 dyads) (standardized mean difference (SMD) 0.52, 95% CI 0.07, 0.98) and with early SSC. SSC infants cried for a shorter length of time (one trial; 44 participants) (WMD -8.01, 95% CI -8.98, -7.04). Late preterm infants had better cardio respiratory stability with early SSC (one trial; 35 participants) (WMD 2.88, 95% CI 0.53, 5.23). No adverse effects were found.</span></div></div><h1 style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif; font-size: small;">Effects on the Infant’s Cardiorespiratory Stability</span></h1><div class="MsoBodyText"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">A study of Takahashi et al. compared the effects of different initiation and duration times of skin-to-skin contact on the stress port-birth in full-term infants. The first group began SSC 5 minutes or less after birth (birth SSC), while the second group began SSC after 5 minutes (ver early SSC). The birth of SSC group reached HR stability of 120-160 bpm significantly faster than very early SSC group by Kaplan-Meier analysis (p=0.001 by log-rank test). As for Spo(2) stability of 92% and 96%, no significantly between-group difference was found. Salivary cortisol levels were significantly lower between 60 and 120 minutes after birth in SSC group, continuing for more than 60 minutes compared with SSC group for 60 minutes or less after adjustment for salivary cortisol level at 1 minute besides infant stress factors (P=0.046). All these suggest that earlier SSC beginning within 5 minutes post birth and longer SSC continuing for more than 60 minutes within 120 minutes post birth are beneficial for stability of cardiopulmomary dynamics and the reduction of infant stress during the early period post birth.</span></div></div><h1 style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif; font-size: small;">Effect on Infant’s Body Temperature</span></h1><div class="MsoBodyText"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">In an early study, Christensson et al randomized 50 healthy, full-term, newborn infants to be kept either skin-to-skin with the mother (n=25 mother-baby pairs) or next to the mother in a cot “separated” (n=25 mother-baby pairs). The babies were studied during the first 90 minutes after birth. Axillary and skin temperatures were significantly higher in the skin-to-skin group. Babies kept in cots cried significantly more than those kept skin-to-skin with the mother.</span></div></div><h1 style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif; font-size: small;">Effect on Blood Sugar Levels</span></h1><div class="MsoBodyText"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">In the previously cited randomized controlled trial by Christensson et al., at 90 minutes after birth blood glucose levels were significantly higher and the return towards zero of the negative base-excess was more rapid in the skin-to-skin as compared to the “separated” group. The weighted difference WMC (fixed) was 11.07 95% CI [3.97. 18.17].</span></div></div><h1 style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif; font-size: small;">Effect on Immunoprotection</span></h1><div class="MsoBodyText"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Close skin-to-skin contact between the maternal-infant dyad may also stimulate the mucosa-associated lymphoid tissue system.</span></div></div><div class="MsoBodyText"><div style="text-align: justify;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div></div><div class="MsoBodyText"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: xx-small;"> </span></div><div class="MsoListCxSpFirst"><i><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: xx-small;">a. Moore E, Anderson G, Bergman N. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev. 2007 Jul 18;(3):CD003519.<o:p></o:p></span></i></div><div class="MsoListCxSpMiddle"><i style="mso-bidi-font-style: normal;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: xx-small;">b. Takahashi Y et al. Comparison of salivary cortisol, heart rate, and oxygen saturation between early skin-to-skin cointact with different initiation and duration times in healthy, full-term infants. Early Hum Dev, 2011 Mar, 87 (3):151-7.<o:p></o:p></span></i></div><div class="MsoListCxSpMiddle"><i style="mso-bidi-font-style: normal;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: xx-small;">c. Christensson K, Siles C, Moreno L, Belaustequi A, De La Fuente P, Lagercrantz H, Puyol P, Winberg J. Temperature, metabolic adaptation and crying in healthy full-term newborns cared for skin-to-skin or in a cot. 1992. Acta Paediatr. 1992 Jun-Jul;81(6-7):488-93.<o:p></o:p></span></i></div><div class="MsoListCxSpLast"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: xx-small;">d. Anderson GC, Moore E, Hepworth J, Bergman N. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev 2003;(2):CD003519.</span></div>EINC Bulletinhttp://www.blogger.com/profile/12010405013897827470noreply@blogger.com0tag:blogger.com,1999:blog-5018532656589223200.post-3463955604062772302011-09-01T09:46:00.000-07:002011-09-01T09:46:45.395-07:00HOSPITAL FEATURE | Tondo Medical Center: Commitments that Effect Change <!--[if gte mso 9]><xml> <o:DocumentProperties> <o:Template>Normal.dotm</o:Template> <o:Revision>0</o:Revision> <o:TotalTime>0</o:TotalTime> <o:Pages>1</o:Pages> <o:Words>269</o:Words> <o:Characters>1538</o:Characters> <o:Company>..</o:Company> <o:Lines>12</o:Lines> <o:Paragraphs>3</o:Paragraphs> <o:CharactersWithSpaces>1888</o:CharactersWithSpaces> <o:Version>12.0</o:Version> </o:DocumentProperties> <o:OfficeDocumentSettings> <o:AllowPNG/> </o:OfficeDocumentSettings> </xml><![endif]--><!--[if gte mso 9]><xml> <w:WordDocument> <w:Zoom>0</w:Zoom> <w:TrackMoves>false</w:TrackMoves> <w:TrackFormatting/> <w:PunctuationKerning/> <w:DrawingGridHorizontalSpacing>18 pt</w:DrawingGridHorizontalSpacing> <w:DrawingGridVerticalSpacing>18 pt</w:DrawingGridVerticalSpacing> <w:DisplayHorizontalDrawingGridEvery>0</w:DisplayHorizontalDrawingGridEvery> <w:DisplayVerticalDrawingGridEvery>0</w:DisplayVerticalDrawingGridEvery> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:Compatibility> <w:BreakWrappedTables/> <w:DontGrowAutofit/> <w:DontAutofitConstrainedTables/> <w:DontVertAlignInTxbx/> </w:Compatibility> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" LatentStyleCount="276"> </w:LatentStyles> </xml><![endif]--> <!--[if gte mso 10]> <style>
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<div class="MsoBodyText"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">by Donna Miranda | </span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">photos by Bernie Cervantes</span></div><div class="MsoBodyText"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
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</span></div><div class="MsoBodyText"><span class="Apple-style-span" style="color: #666666; font-family: Georgia, 'Times New Roman', serif; font-size: large;">These days the staff of Tondo Medical Center (TMC) can only recall with nostalgia what was once the harried and busy atmosphere of its Neonatal Intensive Care Unit, but not without relief.</span></div><div class="MsoBodyText"><span class="Apple-style-span" style="color: #666666; font-family: Georgia, 'Times New Roman', serif; font-size: large;"><br />
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<tr><td style="text-align: center;"><a href="http://1.bp.blogspot.com/-4wnVHY8PTl0/Tl-KFua8WeI/AAAAAAAAACk/qxfr-X_LyAg/s1600/Bornsm.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="486" src="http://1.bp.blogspot.com/-4wnVHY8PTl0/Tl-KFua8WeI/AAAAAAAAACk/qxfr-X_LyAg/s640/Bornsm.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><div style="font: normal normal normal 7px/normal 'Gill Sans'; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span class="Apple-style-span" style="color: #444444; font-family: Arial, Helvetica, sans-serif; font-size: xx-small;">At TMC newborn babies receive warmth from their </span><span class="Apple-style-span" style="color: #444444; font-family: Arial, Helvetica, sans-serif; font-size: xx-small;">mothers through immediate skin-to-skin contact</span></div></td></tr>
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</span></div><div class="MsoBodyText"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">In fact if there were anything noticeable, it was the great deal of pride, satisfaction and enthusiasm beaming from hospital director Dr.<span style="mso-spacerun: yes;"> </span>Victor de la Cruz who together with his hospital staff has managed to successfully initiate change within a short period of time. Nowadays the nurses at the NICU jokingly lament how awfully quiet it has become since NICU admissions have begun to dramatically decrease to 10.9 % of total deliveries from January to March 2011. In fact at the time of our visit, there were only two babies. The two nurses stationed at the NICU candidly inform us, “we don’t seem to have any use for that here anymore” pointing to the warmer where a queue would usually form to warm delivered babies.</span></div><div class="MsoBodyText"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div><div class="MsoBodyText"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">And indeed they don’t – since they’ve started implementing the EINC program in the hospital where the only warmth that babies receive mostly come from their mothers through immediate skin-to-skin contact.</span></div><div class="MsoBodyText"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"></span></div><a name='more'></a><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
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</span></div><div class="MsoBodyText"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">The staff also seemed much more satisfied now that some of the unnecessary workload such as cord care and routine bathing of the babies have been done away with. Instead more attention is being reallocated to breastfeeding support and monitoring. Not only was it reassuring to see that non-separation of mothers and babies conscientiously practiced but that it was also a relief to know that even those weighing between 1.5 to 1.8 kg who needed closer monitoring and care were kept with their mothers in the newly created EINC room right beside the NICU. Thanks to complete staffing realignment, mother-baby dyads are now closely monitored at least 9 times a day, ensuring that the sufficient support and care is given to mothers and during recovery.</span></div><div class="MsoBodyText"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</span></div><div class="MsoBodyText"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"> <!--[if gte mso 9]><xml> <o:DocumentProperties> <o:Template>Normal.dotm</o:Template> <o:Revision>0</o:Revision> <o:TotalTime>0</o:TotalTime> <o:Pages>1</o:Pages> <o:Words>1071</o:Words> <o:Characters>6108</o:Characters> <o:Company>..</o:Company> <o:Lines>50</o:Lines> <o:Paragraphs>12</o:Paragraphs> <o:CharactersWithSpaces>7501</o:CharactersWithSpaces> <o:Version>12.0</o:Version> </o:DocumentProperties> <o:OfficeDocumentSettings> <o:AllowPNG/> </o:OfficeDocumentSettings> </xml><![endif]--><!--[if gte mso 9]><xml> <w:WordDocument> <w:Zoom>0</w:Zoom> <w:TrackMoves>false</w:TrackMoves> <w:TrackFormatting/> <w:PunctuationKerning/> <w:DrawingGridHorizontalSpacing>18 pt</w:DrawingGridHorizontalSpacing> <w:DrawingGridVerticalSpacing>18 pt</w:DrawingGridVerticalSpacing> <w:DisplayHorizontalDrawingGridEvery>0</w:DisplayHorizontalDrawingGridEvery> <w:DisplayVerticalDrawingGridEvery>0</w:DisplayVerticalDrawingGridEvery> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:Compatibility> <w:BreakWrappedTables/> <w:DontGrowAutofit/> <w:DontAutofitConstrainedTables/> <w:DontVertAlignInTxbx/> </w:Compatibility> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" LatentStyleCount="276"> </w:LatentStyles> </xml><![endif]--> <!--[if gte mso 10]> <style>
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</style> <![endif]--> <!--StartFragment--> </span></div><div class="MsoBodyText"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">The mothers seemed to be pleased, as evident in the following quotations:</span></div><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"> <div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><i style="mso-bidi-font-style: normal;"><br />
</i></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><i style="mso-bidi-font-style: normal;"> Nakakapanibago po, kasi yung mga narakaraan kong panganganak di<o:p></o:p></i></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><i style="mso-bidi-font-style: normal;"> naman ganito ang ginawa…Pero para sa akin, maganda po ito sapagkat<o:p></o:p></i></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><i style="mso-bidi-font-style: normal;"> nakakasiguro ako na di mapalitan ang anak ko, kasi pag sa hospital ka<o:p></o:p></i></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><i style="mso-bidi-font-style: normal;"> nanganganak masarap po ang pakiramdam, kasi nakabonding ko na<o:p></o:p></i></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><i style="mso-bidi-font-style: normal;"> kaagad ang anak ko… -- </i>Marie Claire De Leon – 33 F, G7P3 NSD <o:p></o:p></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><br />
</div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><i style="mso-bidi-font-style: normal;"> Happy–happy ako, damang dama ko na anak ko talaga siya. Hindi siya </i></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><i style="mso-bidi-font-style: normal;"> napapalitan.—</i>Mrs. De Leon <i><o:p></o:p></i></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><br />
</div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><i style="mso-bidi-font-style: normal;"> Pakiramdam ko, relax ako. Masarap ang pakiramdam kasi namalayan ko nasa </i></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><i style="mso-bidi-font-style: normal;"> dibdib ko ang baby ko.—</i>Mary Ana Labayani – 25 F, G1P1 CS<o:p></o:p></div><div class="MsoBodyText"><br />
</div><div class="MsoBodyText">After only four months since the EINC Orientation Workshop conducted last January 2011, TMC has already made remarkable progress in reducing sepsis, preterm and maternal deaths reporting reporting zero cases in the last week of March.<span style="mso-spacerun: yes;"> </span>As early as eleven weeks after training and weekly supportive supervision meetings its performance of the 4 core steps of EINC has been >95% in their normal deliveries and >90% in their cesarean deliveries. Moreover, the rates of allowing mother to eat and walk without routine IVF placement (83%) and delivering in semi-upright position (97%) have been equally impressive. And while these numbers have yet to reflect the true statistical impact of EINC on outcome indicators, the consistent drop in TMC’s NICU admissions and increase in directly room-in babies hint at future improvement in the statistics if the EINC program is continually implemented as standard of care in hospitals.</div><div class="separator" style="clear: both; text-align: -webkit-auto;"><br />
</div><div class="MsoBodyText">The TMC in Manila is a tertiary public medical center established in 1971 operating under the supervision of the Philippine Department of Health (DOH). Currently, it has eight hospital departments, and a 200-authorized bed capacity, 60 of which is allotted to the OB-Gyne Department. Spontaneous vaginal deliveries is the leading cause of admission in TMC. In 2009, obstetric cases alone comprised 47% of the total admissions. Located at North Bay Boulevard, Balut, Tondo, Manila, TMC caters to the health needs of the residents of Tondo and CAMANAVA (Caloocan, Malabon, Navotas, Valenzuela) area.<span style="mso-spacerun: yes;"> </span></div><div class="MsoBodyText"><br />
</div></span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><a href="http://1.bp.blogspot.com/-6qi7dTpDVm0/Tl-xkgwuMrI/AAAAAAAAACo/T8I7s0aFxkg/s1600/drvictor.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="112" src="http://1.bp.blogspot.com/-6qi7dTpDVm0/Tl-xkgwuMrI/AAAAAAAAACo/T8I7s0aFxkg/s640/drvictor.jpg" style="cursor: move;" width="640" /></a></span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><div class="MsoBodyText"><br />
</div><div class="MsoBodyText">The early success of TMC is due to the strong leadership and openness of its medical director Dr. Victor de la Cruz. His “hands-on” management style – sitting in weekly implementation meetings, watching out for potentially conflicting clinical practices that may arise in carrying out the EINC—and his fervent support for the program has been instrumental in the rapid but fine-tuned implementation of the program. As well as making sure that the necessary changes are adapted according to the hospital’s available resources, needs and capacities. Already some significant changes in the hospital’s policy, physical environment and practice have been put in place such as the complete realignment of staffing that allows frequent monitoring of mother-baby dyads; construction of wooden wedges to allow mothers a semi-upright position during delivery; use of a unique EINC wrap for babies in skin-to-skin contact; revision of admission forms and doctors’ orders reflecting EINC practices; and promoting EINC awareness among patients by continuously showing the EINC video material at the outpatients waiting. Additionally, an EINC-friendly floor plan is already underway and included in the hospital’s next renovation budget.</div><div class="MsoBodyText"><br />
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<tr><td style="text-align: center;"><a href="http://3.bp.blogspot.com/-wRrbUBTv9Q8/Tl-yoT3248I/AAAAAAAAACs/G6pQAlRXsfA/s1600/ward1.JPG" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="206" src="http://3.bp.blogspot.com/-wRrbUBTv9Q8/Tl-yoT3248I/AAAAAAAAACs/G6pQAlRXsfA/s320/ward1.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><div style="color: #f4753e; font: 7.0px Gill Sans; margin: 0.0px 0.0px 0.0px 0.0px;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: xx-small;">Complete realignment of staffing has allowed close monitoring</span></div><div style="color: #f4753e; font: 7.0px Gill Sans; margin: 0.0px 0.0px 0.0px 0.0px;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: xx-small;">of mother-baby dyads at least 9 times a day</span></div></td></tr>
</tbody></table><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;">Surely change is never easy and Dr. De la Cruz is quick to remark that the process was not one without some resistances. But not enough reason to give up. In fact he proudly shares that “my strategy was to keep close to those who were most resistant (to the changes), constantly convincing them to give it a try. At first they were hesitant but unwavering persuasion eventually won them over.”</div></span><div class="MsoBodyText" style="font-family: Georgia, 'Times New Roman', serif;"><br />
</div><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">This tireless dedication and enthusiasm is something he says he has learned from the EINC Team whose supervised monitoring, committed support and guidance were crucial to TMC’s success.</span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><span style="mso-spacerun: yes;"> </span></span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Dedication he said is not only infectious but inspiring, “how can you think otherwise, when the evidence is indisputable and safety of patients always prioritized over everything else.”</span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"></span><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"> </span><div><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;"><br />
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</div><div style="text-align: right;"></div><div class="MsoBodyText">Dr. De la Cruz receives the same kind of esteem from his staff who considers his openness to change and all-out support for the program as pivotal factors contributing to TMC’s successful and timely implementation of EINC—attitudes that the staff now share with him.</div><div class="MsoBodyText"><br />
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<tr><td style="text-align: center;"><a href="http://1.bp.blogspot.com/-96FKe43TvIw/Tl-zZ3_pxdI/AAAAAAAAACw/PouG_xq5vFs/s1600/Drsharon.JPG" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="220" src="http://1.bp.blogspot.com/-96FKe43TvIw/Tl-zZ3_pxdI/AAAAAAAAACw/PouG_xq5vFs/s320/Drsharon.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><div style="color: #f4753e; font: 7.0px Gill Sans; margin: 0.0px 0.0px 0.0px 0.0px;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: xx-small;">Dr. Macasadia shares marked improvements in their OB & Pedia stats</span></div></td></tr>
</tbody></table><div class="MsoBodyText">“The changes were not done abruptly, every week we do our commitments and then commit to do doing better for the following week. The staff is challenged to give our commitments weekly,” shares Dr. Sharon Macasadia, OB, on how they’ve managed to carry out EINC practice at a steady pace in the hospital. She further says that because of this they’ve learned to value these “incremental changes” and see how it affects the big picture. For instance she proudly cites how the use of intravenous fluids among delivering mothers has markedly dropped from 83.65% in February to 39.92 % in the last week of June.<span style="mso-spacerun: yes;"> </span></div><div class="MsoBodyText"><br />
</div><div class="MsoBodyText">Adopting the EINC protocols has also made them appreciate the value of teamwork, pedia consultant Dr. Sheryl Joy Gracilla shares that “things are less departmentalized as we have learned to become more responsive in providing for the care of our patients.” Consequently, the non-departmentalization of care has resulted in better relationship between obstetricians and pediatricians, and of course, better satisfaction of its patients. Meanwhile the team is anticipating an even better working rhythm between the pediatrics and OB department as soon as the design of patients’ birth plan forms has been finalized.<span style="mso-spacerun: yes;"> </span></div><div class="MsoBodyText"><span style="mso-spacerun: yes;"><br />
</span></div><div class="MsoBodyText">And as if things were not looking bright enough, TMC has not only managed to reduce infant sepsis and mortality rates but also incur savings cost since they’ve adopted EINC at the beginning of the year.<span style="mso-spacerun: yes;"> </span>The NICU charges, for instance have dropped from P145.00 to P43.50 and delivery room charges from P345.50 to P83.50. The savings are being reallocated to provide patients with EINC-friendly facilities.<span style="mso-spacerun: yes;"> </span>Moreover, a “free blood culture” service has been initiated to created provide free blood CS to indigent patients who cannot afford outside lab (because TMC’s lab has no blood cultures). Upon approval of Dr.<span style="mso-spacerun: yes;"> </span>Dela Cruz part of rebates from this outside lab has been converted to “free blood cultures” to selected newborns of indigent mothers.” </div><div class="MsoBodyText"><br />
</div><div class="MsoBodyText">The benefits reaped by simple health worker behavior change were so impressive that TMC thought that EINC should not be confined within its walls. As a referral facility, TMC saw the need to share their experiences with other lower level facilities within their catchment area.<span style="mso-spacerun: yes;"> </span>In March 2011 TMC initiated an EINC training for 72 participants composed of nurses, pediatricians, obstetricians, administrators, clinical nurse instructors from Tondo’s catchment areas, including nearby Caloocan and Navotas, LGU-operated health units (Ospital ng Tondo, Pagamutan ng Bayan) and guests from tertiary medical centers (Gat Andres, VRPMC, Trinity, Delgado Hospital). The initiative to adopt EINC as the standard of care in all of these facilities is a manifestation of the system-wide effort to decrease the maternal and newborn mortality rates in the area.</div><div class="MsoBodyText"><br />
</div><div class="MsoBodyText">Dr. de la Cruz emphasizes, “We want to be part of the achievement of MDG 4 & 5, as I believe that focusing on MG 4 & 5 is a key step in solving the rest of the other MDGs.”</div><!--EndFragment--></span><br />
<!--EndFragment--></div>EINC Bulletinhttp://www.blogger.com/profile/12010405013897827470noreply@blogger.com0tag:blogger.com,1999:blog-5018532656589223200.post-5739622040800092102011-09-01T02:36:00.000-07:002011-09-02T18:34:52.383-07:00EBM Reviews | Myth Busters<div class="MsoNormal" style="margin-bottom: 0.0001pt;"><span style="color: #444444; font-family: Georgia, 'Times New Roman', serif;">by Louell L. Sala, MD</span><br />
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</span></span></div><div><div style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="color: #666666; font-family: Arial; font-size: large;">How sound are current practices on maternal and child care? In this section we take a look at some of these expert practices and recommendations comparing their evidences vis a vis methods used and conclusions drawn from related research and clinical observations.</span></div></div></div><div class="MsoNormal" style="font-family: Arial, Helvetica, sans-serif; margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="font-family: Arial, Helvetica, sans-serif; margin-bottom: 0.0001pt;"><b><span class="Apple-style-span" style="font-size: large;"><span style="font-family: Arial;">N</span><span style="font-family: Arial;">PO</span></span></b><span style="font-family: Times; font-size: 16pt;"><o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">Fasting in labor is common practice among our attending physicians as we always see the word NPO (short for nil per os) among patients going through labor. But is there really evidence to suggest that if fasting is not done during labor, patients will aspirate gastric contents during induction of anesthesia?<o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><br />
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</div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">The evidence does not support this common belief. In a systematic review done by Singata et al. at the University of Fort Hare/East London Complex, East London South Africa, and using the Cochrane Pregnancy and Childbirth Group Trials Register of 2009, the authors found that there was no benefit or harm done to these patients. Using randomized controlled trials (RCT) and quasi-RCTs, they identified 5 studies with a total population of 3130 women. All studies looked at women in active labor and at low risk of potentially requiring a general anaesthetic.<o:p></o:p></span><br />
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</span></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">One study looked at complete restriction versus giving women the freedom to eat and drink at will; two studies looked at water only versus giving women specific fluids and foods and two studies looked at water only versus giving women carbohydrate drinks. When comparing any restriction of fluids and food versus women given some nutrition in labor, the meta-analysis was dominated by one study undertaken in a highly medical oriented environment. There were no statistically significant differences identified in: cesarean section (average risk ratio (RR) 0.89, 95% confidence interval (CI) 0.63 to 1.25, five studies, 3103 women), operative vaginal births (average RR 0.98, 95% CI 0.88 to 1.10, five studies, 3103 women) and Apgar scores less than seven at five minutes (average RR 1.43, 95% CI 0.77 to 2.68, three studies, 2574 infants), nor in any of the other outcomes assessed.<o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">The study included only low risk women, consistent in the recommendation of the Philippine Obstetric Gynecology Society Clinical Practice Guideline 2009 that states that ordering NPO for women in labor is not justified. At present, there are no studies that looked specifically atwomen at increased risk complications.</span><span class="Apple-style-span" style="font-family: Georgia; font-size: 16pt;"><o:p></o:p></span></div><div class="MsoNormal" style="font-family: Arial, Helvetica, sans-serif; margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="font-family: Arial, Helvetica, sans-serif; margin-bottom: 0.0001pt;"><span style="font-family: Arial;"><span class="Apple-style-span" style="color: orange; font-size: xx-small;"><i>Sources: Sleutel, M., and Golden, S., Fasting in labor: relic or requirement. J Obstet Gynecol Neonatal Nurs, 28, 507-512, 1999 <o:p></o:p></i></span></span></div><div class="MsoNormal" style="font-family: Arial, Helvetica, sans-serif; margin-bottom: 0.0001pt;"><span style="font-family: Arial;"><span class="Apple-style-span" style="color: orange; font-size: xx-small;"><i>Philippine Obstetrical and Gynecological Society Clinical Practice Guidelines on Normal Labor and Delivery, 2009 <o:p></o:p></i></span></span></div><div class="MsoNormal" style="font-family: Arial, Helvetica, sans-serif; margin-bottom: 0.0001pt;"><span class="Apple-style-span" style="color: orange; font-size: xx-small;"><i><span style="font-family: Arial;">Singata et al., Restricting oral fluid and food intake during labour. Cochrane Database Systematic Review 2010; Issue 1. CD003930</span><span style="font-family: Times;"><o:p></o:p></span></i></span></div><div class="MsoNormal" style="font-family: Arial, Helvetica, sans-serif; margin-bottom: 0.0001pt;"><br />
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</div><div class="MsoNormal" style="font-family: Arial, Helvetica, sans-serif; margin-bottom: 0.0001pt;"><b><span style="font-family: Arial; font-size: 24pt;">Fundal Pressure </span></b><span style="font-family: Times; font-size: 16pt;"><o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">It is not known when the practice of fundal pressure in labor started. Then again, we were lead to believe that it helps the mother with the expulsion of the fetus. However, we also know that uterine rupture, fetal brachial plexus injuries, cord compression and spinal cord injuries are just some of the more common injuries encountered with this practice. We therefore have to ask ourselves if fundal pressure is really warranted. <o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">In a prospective cohort study by Simpson et. al. at the St. Johns Mercy Medical Center in Missouri it was suggested that a plan which includes risks, benefits and alternative use of fundal pressure should be reviewed by an interdisciplinary perinatal team. The data about maternal – fetal injuries related to fundal pressure were not published for medico-legal reasons; however anecdotal reports do suggest that these risks do happen.</span><span class="Apple-style-span" style="font-family: Georgia; font-size: 16pt;"><o:p></o:p></span></div><div class="MsoNormal" style="font-family: Arial, Helvetica, sans-serif; margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="font-family: Arial, Helvetica, sans-serif; margin-bottom: 0.0001pt;"><i><span style="color: #f0a62e; font-family: Arial;"><span class="Apple-style-span" style="font-size: xx-small;">Simpson KR and Knox E. Fundal pressure during the second stage of labor, MCN Am J Matern Child Nurs 2001 Mar-Apr; (26)2: 64-70. <o:p></o:p></span></span></i></div><div class="MsoNormal" style="font-family: Arial, Helvetica, sans-serif; margin-bottom: 0.0001pt;"><span class="Apple-style-span" style="font-size: xx-small;"><i><span style="color: #f0a62e; font-family: Arial;">Schulz-Lobmeyr, I., et.al., Use of fundal pressure during the second stage of labor: a prospective pilot study, Geburtshilfe und Frauenheilkunde, vol 59 no. 11: 558-561 1999</span></i><span style="font-family: Times;"><o:p></o:p></span></span></div><div class="MsoNormal" style="font-family: Arial, Helvetica, sans-serif; margin-bottom: 0.0001pt;"><br />
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</b></span></div><div class="separator" style="clear: both; text-align: center;"><a href="http://2.bp.blogspot.com/-NuCBuRzTIsA/Tl-CpzUPWQI/AAAAAAAAACg/6VYwQb3upZI/s1600/Blood+Pressure+SSC1.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="400" src="http://2.bp.blogspot.com/-NuCBuRzTIsA/Tl-CpzUPWQI/AAAAAAAAACg/6VYwQb3upZI/s400/Blood+Pressure+SSC1.JPG" width="265" /></a></div><div class="MsoNormal" style="font-family: Arial, Helvetica, sans-serif; margin-bottom: 0.0001pt;"><span style="font-size: 16pt;"><b>Maternal Position </b><span class="Apple-style-span" style="font-family: Times;"><o:p></o:p></span></span></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">In the 51-hospital observational study, all women delivered while lying flat on their backs. Is there merit to this practice? In a systematic Review done by Lawrence et al. in the Townsville Hospital in Queensland, Australia using the Cochrane Pregnancy Childbirth Group Trials Register (2008), the effects of encouraging women to assume different upright positions (including walking, sitting, standing and kneeling) versus recumbent positions (supine, semi-recumbent and lateral) for women in the first stage of labor in terms of length of labor, type of delivery and other important outcomes for mothers and babies were assessed.</span></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">With a population of 3706, which includes 21 randomized and quasi - randomized trials, they found no differences between 2 groups for outcomes including length of the second stage of labor, mode of delivery, or other outcomes related to the well – being of mothers and babies. Overall, the first stage of labor was approximately one hour shorter for women randomized to upright as opposed to recumbent positions (MD -0.99, 95% CI -1.60 to -0.39). For women who had epidural analgesia, there were also no differences between those randomized to upright versus recumbent positions for any of the outcomes examined in the review. However, little information on maternal satisfaction was collected, and none of the studies compared different upright or recumbent positions. <o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="margin-bottom: 0.0001pt;"><span class="Apple-style-span" style="font-family: Georgia, 'Times New Roman', serif;">In the absence of such complications and since there is no evidence that women in strict bed rest and supine position are better off in terms of length of labor and type of delivery, women should be allowed to assume whatever position they find most comfortable.</span><br />
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</span></div><div class="MsoNormal" style="font-family: Arial, Helvetica, sans-serif; margin-bottom: 0.0001pt;"><span class="Apple-style-span" style="font-size: xx-small;">Lawrence A, Lewis L, Hofmyer GJ, Dowswell T, Styles C. Maternal positions and mobility during first stage labour. Cochrane Database of Systematic Reviews 2009, Issue 2: Art. No.: CD003934.</span></div>EINC Bulletinhttp://www.blogger.com/profile/12010405013897827470noreply@blogger.com0tag:blogger.com,1999:blog-5018532656589223200.post-53667155582755817352011-08-31T12:07:00.000-07:002011-09-01T06:30:02.453-07:00NEWS | EINC-friendly Birth center to open at EAMC<div class="separator" style="clear: both; text-align: center;"><br />
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<div style="text-align: right;"><span class="Apple-style-span" style="color: #444444; font-family: Arial, Helvetica, sans-serif; font-size: x-large;"><b><span class="Apple-style-span" style="color: #444444; font-family: Arial, Helvetica, sans-serif; font-size: x-large;"><b></b></span></b></span></div><span class="Apple-style-span" style="color: #444444; font-family: Arial, Helvetica, sans-serif; font-size: x-large;"><b>T</b></span><span class="Apple-style-span" style="color: #444444; font-family: Georgia, 'Times New Roman', serif;">his July, <a href="http://www.doh.gov.ph/eamc/">East Avenue Medical Center (EAMC)</a></span><span class="Apple-style-span" style="color: #444444; font-family: Georgia, 'Times New Roman', serif;"> is slated to complete its Birthing Center. To be headed by Dr. Elenita Veloso, the Birthing Center now has a spacious examination room, a spacious EINC area to accommodate mother-baby dyads with 30 reclining beds, and an OR for emergency CS cases.<br />
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<div><span class="Apple-style-span" style="color: #444444; font-family: Georgia, 'Times New Roman', serif;">After touring the premises, the EINC working group has expressed its satisfaction with</span><br />
<span class="Apple-style-span" style="color: #444444; font-family: Georgia, 'Times New Roman', serif;">the Birthing Center’s steady development, forseeing further improvement in the OB Department’s already impressive statistics. Since EINC was implemented in April, performance of unnecessary practices have steadily gone down, and there has been very good compliance with performance of complete EINC, even in CS deliveries. From July 11-17, 2011, out of 123 normal deliveries, 58.5% had episiotomies and these were mostly young primigravid </span><span class="Apple-style-span" style="color: #444444; font-family: Georgia, 'Times New Roman', serif;">teenage mothers with tight perineums. 52.8% were not given IV fluids, and the remaining patients with IVs were OB complicated cases which comprise the majority of their admissions (65.7% of all admissions). </span><span class="Apple-style-span" style="color: #444444; font-family: Georgia, 'Times New Roman', serif;">The wall to wall stretchers in the DR don’t allow for patients’ mobility or having position of choice during labor, but 69.9% are able to deliver in the semi-upright position. More commendable is the 100% use of antenatal steroids, 100% EINC in CS deliveries, and performance of core steps 1-3 even in symptomatic patients. This ensures that all patients benefit from EINC even if they are eventually admitted to the NICU. </span></div><div><br />
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<tr><td style="text-align: center;"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><a href="http://1.bp.blogspot.com/-elPnVKfI21Q/Tl6FGyOF-OI/AAAAAAAAACI/tqJsn4wm5JI/s1600/DR.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="300" src="http://1.bp.blogspot.com/-elPnVKfI21Q/Tl6FGyOF-OI/AAAAAAAAACI/tqJsn4wm5JI/s400/DR.jpg" width="400" /></a></div></td></tr>
<tr><td class="tr-caption" style="font-size: 13px; padding-top: 4px; text-align: center;"><div style="color: #f4753e; font: normal normal normal 7px/normal 'Gill Sans'; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span class="Apple-style-span" style="font-size: xx-small;">With the new birthing center mothers can now deliver in non-supine position with these reclining beds</span></div></div></td></tr>
</tbody></table><span class="Apple-style-span" style="color: #444444; font-family: Georgia, 'Times New Roman', serif;">The Birthing Center, however, is not without room for improvement in its facilities. The EINC working group has suggested the addition of a sink in the IE room, the expansion of the labor room by way of converting the large area around the nurses’ station, the addition of handwashing stations in the delivery room, and the installation of exhaust fans. There remain many opportunities for the physical improvement of the space.</span><br />
<div><div></div></div></div></div></div></div></div>EINC Bulletinhttp://www.blogger.com/profile/12010405013897827470noreply@blogger.com0