Essential intrapartum and newborn care
The evidence-based guidelines have already been incorporated in the BEmONC training curriculum. Initial experience of the EINC scale-up implementation program in 11 hospitals has documented positive outcomes, with admissions to the neonatal intensive care units dropping by 50% to 75% in some hospital sites. Neonatal sepsis rates were reduced by as much as 70%. There was a reduction in term newborn deaths by as much as 50% in many of the sites. Practice of the recommended steps in the proper sequence approached universality.
In one of the pilot hospitals, skin-to-skin contact was associated with lower mortality (OR 0.3 95% CI 0.1 – 1.1), sepsis (OR 0.3 95% CI 0.1 – 0.5), and severe disease (OR 0.4 95% CI 0.2 – 0.6). Non separation of mother and newborn led to successful initiation of breastfeeding and manifested in high exclusive breastfeeding rates: 90 to 100% upon discharge, 85% at day 7and 69% at day 28.
Although the sample is inadequate to reflect effects on maternal mortality ratios, safe maternal practices have been adopted in all participating hospitals. These are seen in soaring rates of practice of the Active Management of Third Stage of Labor (baseline 28% to 100% in one hospital), mobility and position of choice in labor (from 0% to 100% in most sites), partograph use (0% to 100% in one hospital), and antenatal steroid administration in preterm labor (from 0 to 100% in most of the pilot hospitals). Harmful or unnecessary practices such as application of fundal pressure and routine episiotomy were discontinued.
Both maternal and health staff satisfaction with the birthing experience are palpable. Simple cost saving computations by different hospitals have revealed substantial savings averaging almost PhP 500 (USD 12) per vaginal delivery. Monitoring the practices underscored the need for an enabling environment to be present in the health facility.