People might be wondering what is this UNANG YAKAP program by the DOH.

The Unang Yakap is a special program being implemented in the delivery or operating room during child birth. It refers to the Essential Intrapartum Newborn Care sequential procedures that needs to be carried out for the optimal welfare of the newly born baby. It has four components, namely 1. 2. 3. 4. provision of warmth, drying and stimulating the baby; uninterrupted skin-to-skin contact (between the mother and the baby); delayed or properly-timed cord clamping; and initiation of breastfeeding. Immediately upon the birth of the baby, the obstetrician/nurse/midwife wipes the baby dry. This will remove the amniotic fluid that can be a cause heat loss via evaporation. The baby is also stimulated to breath or cry during the process of drying especially if baby hasnt cried yet. This is done while umbilical cord still isnt cut. After which, baby is now placed prone onto the mothers bare abdomen/between the breasts/chest. Baby is also still naked during this time. The beanie is place on the babys head to prevent heat loss. Theuninterrupted skin-to-skin contact simply means that theres no physical barrier between the mothers and babys skins. A blanket is then placed over the baby to keep him/her warm. This step during the delivery procedure has been shown by studies to bring about several benefits: 1. helps baby to regulate his/her temperature normally; 2. allows baby to swallow normal bacteria from the mothers skin that will colonize his/her intestines and aid baby fight against infection. These bacteria also stimulates intestinal cells and delays onset of allergic disorders; 3. helps correct abnormality of blood gas analysis; and 4. helps baby maintain normal blood sugar. The third step is now the clamping and cutting of the umbilical cord without milking it. This delay in clamping allows additional blood to transfuse from the placenta to the baby and thus an extra iron depot for the baby. It has been shown that babies who are exclusively breastfed (no receipt of milk formula) will usually have drop in blood iron levels by six months, a condition known as iron-deficiency anemia. A slight delay in cord clamping (1-3 minutes after baby is born) decreases this incidence and save the baby from iron supplementation at the said age. The last step is the initiation of breastfeeding. This step usually is appreciated at about 20 to 30 minutes from birth, maybe earlier for more term babies. Studies have underscored the benefits of early breastfeeding. In studies done in Uganda and Ghana, babies who were

exclusively breastfed were protected from pneumonia and diarrhea by about 19-fold and 11fold, respectively, compared to those who were given milk formula. Furthermore, those who were breastfed immediately had better protection vs those who were breastfed only several hours after birth. This is because breast milk contains protective antibodies (derived from the mothers armory of antibodies she produced during her exposures to her own infections and vaccines) that the baby can not produce yet until exposure to infection. This sequence of events may not be done entirely if during assessment the baby needs additional help to breath. The sequence may also be a little modified from hospital to hospital depending on the hospitals policy. (Acknowledgement: My mentors Drs Mianne Silvestre and Blas Mantaring III for pioneering on this endeavor) ================= Addendum: Bathing of babies is done after at least 6 hours from birth so baby can maximize assimilating the maternal bacterial flora into his system.

UNANG YAKAP protocols of DOH Objective 1: Dry and provide warmth and prevent hypothermia.

Double gloves before delivery. USe clean, dry cloth to thoroughly dry the baby. Do a quick check on breathing while drying. Do not put the baby on cold or wet surface. Do not bathe earlier than 6 hours after delivery. Put in a warm safe place close to the mother. (if the baby is to be separted from the mother) Objective 2: Facilitate bonding between the mother and baby through skin-to-skin contact to reduce likelihood of infection and hypoglycemia.

Place the baby prone on the mothers abdomen or chest. Cover the babys back with blanket; head with bonnet. Put an ID band on babys ankle. If possible, do not separate the baby to the mother. Objective 3: Reduce incidence of anemia in term newborns andintraventricular hemorrhage in preterm newborns by delaying cord clamping.

Remove first set of gloves immediately prior to cord clamping. Clamp the cord after pulsation have stopped (1-3 minutes). Do not milk toward the newborn. Clamp 2cm and 5 cm from the newborns abdomen and cut the cord between the 2 clamps. Administer 10 iu of oxytocin to the mother. Objective 4.1: Facilitate initiation of breastfeeding.

Observe newborn for feeding cues: opening of mouth, tonguing, licking and rooting. Encourage newborn to move towards the breast. Objective 4.2: Proper eyecare and immunization procedures.