Unang Yakap: Encouraging Breastfeeding from the Start

Saerrah and Khayri undergoing Unang Yakap, with the father Julius.
Photo courtesy of Saerrah Salazar

Quezon City – Saerrah Salazar, 34, first learned about Unang Yakap in 2016 from her obstetrician, Dr Teresita “Tetchie” Cadiz Brion. Saerrah was then pregnant with her second child, Khayri.

“I was briefed about it by my doctor during our prenatal visits,” Saerrah said.

Saerrah and Khayri belong to the many mother and baby tandems that have experienced Unang Yakap (First Embrace), a campaign of the Philippines’ Department of Health (DOH), in cooperation with the World Health Organization (WHO), to adopt the Essential Intrapartum Newborn Care (EINC) in the Philippines. EINC is a series of time-bound and evidence-based interventions for newborn babies and their mothers that ensure the best care for them.

The step-by-step interventions in EINC are (1) immediate and thorough drying of the baby, (2) early-skin-to-skin contact between the mother and the newborn, (3) properly-timed cord clamping, and (4) non-separation of the mother and baby for early breastfeeding initiation.

“The Unang Yakap or Essential Intrapartum Newborn Care was really conceptualized in order to have early initiation of breastfeeding. So how early is early? As early as delivery. The newborn is placed strategically on the mother’s breast so he will be able to feed immediately when he is hungry. What’s good about Unang Yakap is that it respects the readiness of the baby to breastfeed as manifested by feeding cues,” explained Dr Tetchie.

Saerrah’s nine-year old first-born, Rasheed, did not undergo Unang Yakap because the practice wasn’t as widespread in 2007. Public and private hospitals were first mandated to follow the Unang Yakap protocol in 2009 through an administrative order by the DOH. WHO supported the Philippine government in promoting safe and effective health care for mothers and babies including the development and implementation of the EINC protocols.

The Salazar family: Julius, Saerrah, Rasheed, and Khayri.
Photo courtesy of Saerrah Salazar

Dr Tetchie explained that when Rasheed was born, they were already practicing early latching where the baby was put to the breast and made to open the mouth to suckle on the breast. That was already interpreted as successful initiation of breastfeeding and so the baby was brought away from the mother for routine newborn care.

“But with Unang Yakap, we began to realize that we have to recognize the readiness of the baby to go to the breast. We don’t force the baby to latch but instead nudge him gently to his mother’s breast when feeding cues like tonguing, licking, and opening of the mouth are noted. We teach our mothers and our health workers to look out for those feeding cues when they encourage the baby to go to the breast. That is why it is very important that the mother and baby should be kept together on skin-to-skin contact on the breast for that first full breastfeed,” said Dr Tetchie.

Saerrah had several health issues when carrying her second child including gestational diabetes and preeclampsia, which increased the risk of her pregnancy. Despite this, Dr Tetchie decided that Saerrah should be a part of Unang Yakap.

“Unang Yakap is routine for low-risk births but I believe that babies of high risk pregnancies will actually benefit all the more from it. It should be routine for all births unless there are circumstances that prevent the full implementation of the four core steps like a non-breathing baby even after immediate and thorough drying,” said Dr Tetchie.

Focus on breastfeeding

The most important outcome of Unang Yakap is the promotion of breastfeeding. Since the baby is placed closely to the mother’s breast he becomes familiar with the breast as the source of food.

“Formula milk should not be given. There should be no teats or pacifiers to avoid nipple confusion. Mother’s breast should be the first and only source of food to ensure breastfeeding success,” explained Dr Tetchie.

Khayri smiles while being carried by her father Julius.
Photo: WHO/F. Tanggol

Saerrah and her husband, Julius, noticed the difference in giving birth to their first and second child.

“It felt like the baby [Khayri] was more comfortable,” said Julius.

“And Khayri became more familiar with me when we tried Unang Yakap. I had less worries as a mother when she was with me. Unlike with Rasheed, he was in a nursery room, I only visited him. He was also being given formula milk at that time because I was not yet breastfeeding successfully since I was advised to rest, being hypertensive and diabetic. This is in contrast with Khayri, who was strictly breastfed,” shared Saerrah.

Unang Yakap emphasizes the need to breastfeed within the first 60-90 minutes. It is during the early stage of breastfeeding when the protein and nutrient-rich colostrum is released. This gives the newborn baby protection against infections.

Working together for Unang Yakap

The promotion of breastfeeding continues to be a priority for the Philippine government. According to the DOH, 52 percent of babies 0-6 months are being breastfed exclusively within the first 3 months from birth in the Philippines. However, once the babies reach 4-5 months, exclusive breastfeeding rate drops to 28 percent. The DOH is working on improving breastfeeding rates in the Philippines through a number of interventions including the stronger implementation of Unang Yakap and breastfeeding initiatives and support at the community level and in workplaces.

Saerrah, together with her family, consults with Dr Tetchie. Photo: WHO/F. Tanggol
Photo: WHO/F. Tanggol

To ensure the success of Unang Yakap, Dr Tetchie highlights the importance of collaboration between and continuous training of all the health workers and volunteers involved in the care of mothers and newborns. Even doctors who are non-first liners from other specialties were trained for additional support.

“In any facility, there should be enablers of EINC and breastfeeding. Here we have a Mother Baby Friendly Hospital Initiative Group that formulate the policies , oversee their implementation and ensure that the protocols of nursing, anesthesia, obstetrics and pediatrics, are all EINC-compliant. Also strongly involved are the hospital administration and marketing unit. Unang Yakap should be a group effort to ensure that each mother and baby dyad is successful in breastfeeding,” said Dr Tetchie.

Saerrah is now six weeks pregnant with her third child and is consulting with Dr Tetchie regarding her pregnancy. She plans to still undergo with Unang Yakap when she gives birth again.

“Of course, I think it’s needed. Unang Yakap has a large impact on the babies and they become healthier,” Saerrah said.

By Faizza Tanggol