WHO - World Health Organization Regional Office for The Western Pacific

11/16/2022 | News release | Distributed by Public on 11/15/2022 22:55

Early essential newborn care delivers better health for higher-risk babies

Early Essential Newborn Care (EENC), a set of simple WHO-recommended and cost-effective interventions, is a proven life-saving practice that benefits all mothers and newborns. The core steps of EENC include drying the baby immediately after birth, beginning immediate skin-to-skin contact for no less than 90 minutes, clamping the cord when pulsations stop and cutting it with a sterile instrument, and initiating exclusive breastfeeding. All babies benefit from EENC including those who are born preterm (before 37 weeks of gestation), sick or by caesarean section.

However, EENC is not a standard practice in all health facilities in the WHO Western Pacific Region. For higher-risk births, including those by caesarean section, it is still routine practice to separate mothers and babies for 6 hours or more, missing the critical first 90 minutes of life to initiate breastfeeding.

To learn whether EENC could improve health outcomes for babies born via caesarean section, a recently published study in the BMJ Open Quality journal examined the health outcomes of nearly 17 000 babies born via caesarean section before and after EENC was implemented.

The study concluded that when EENC was implemented, cases of sepsis and hypothermia, as well as admissions to the neonatal intensive care unit (NICU), massively declined while exclusive breastfeeding and kangaroo mother care in the NICU nearly doubled.

"Early Essential Newborn Care, including skin-to-skin contact, can be applied in operating rooms and drastically improves health and outcomes," says Dr Howard Sobel, WHO Representative to the Solomon Islands and co-author of the study. "As caesarean sections are very common in countries in our Region, this is a particularly important study to ensure babies get the best possible care."

To attest to the life-saving power of EENC, WHO staff member Rosemarie Urquico shares her experience after the birth of her daughter Mimi.

Ⓒ WHO/R.Urquico

Tell us about the birth of your daughter

I had some complications after my caesarean section, although my baby Mimi was born without too much fuss. We attempted skin-to-skin contact right after her birth. The nurse placed Mimi on my chest with a lot of fanfare! This was pre-COVID, so there was a huge crowd in the room, and people were cheering. But my blood pressure suddenly dropped, and they had to put me to sleep.

The story behind this photo: "Mimi was hospitalized in the neonatal intensive care unit for sepsis 10 days after she was born. It was a really harrowing time for her, and I think we almost lost her. Her care team was wonderful though. She had to be placed in an incubator, and I wasn't able to breastfeed her. When she was stable enough, the NICU nurses restarted skin-to-skin contact to help us bond, and to get my breastmilk flowing again. It was also part of the healing process, since I would go to the NICU and spend time with her daily."

How did you and your baby benefit from skin-to-skin contact?

Skin-to-skin contact really reaffirmed our bond and helped my breastmilk to come back in. It had stopped during her stay in NICU because I was so tired and traumatized. For her, I think it helped her recovery and healing because she was able to have me there with her.

Unfortunately, the hospital I was in didn't allow us to "room in" (i.e. stay in the same room). All newborns had to stay in the NICU up to 28 days, if needed, per hospital policy. Being able to practice skin-to-skin with her really helped me realize that she was pulling through it all, and that she was getting better.

Why do you think that skin-to-skin contact is important to early initiation of breastfeeding?

Skin-to-skin really is amazing. The feeling of closeness, and the feeling of having your baby next to your heart is just so natural and wonderful. It kind of completes this hormonal cycle and kickstarts the oxytocin and all the wonderful hormones that come with breastfeeding.

I do admit breastfeeding was a huge struggle for me. It didn't come naturally, and we had issues because of my breast size and the delay with my milk due to the caesarean section. Mimi also had a difficult time latching at first. Then when she had to stay in the NICU it became even more of a struggle.

However, I was determined to resume breastfeeding after she was discharged from the NICU. They had supplemented her with formula during her stay in the NICU because my milk was simply not enough. I couldn't pump enough. Later, I found out that sometimes that's the case - you just don't pump enough milk. But by practising skin-to-skin contact daily in the NICU and then after at home, I was able to re-establish my supply. We did mixed feeding at first, but in a few weeks, we were back to full breastfeeding.

I credit my paediatrician, a licensed IBCLC (International Board-Certified Lactation Consultant),who did some home visits and my doulas for helping us. It is possible to start breastfeeding again even after your milk has "dried up". It just takes support and effort. I want moms to know that it can be done, and mixed feeding can really help take the pressure off, especially if your baby is sick or the situation isn't ideal.