We are seeing of late a push to save more of our babies that are being born. This is because experts see a risk that newborn mortality, which has been on the level at 17 deaths per 1,000 since 1998, may revert upwards and ultimately affect our Millennium Development Goals for 2015.
Studies have shown that newborns are at the highest risk during the first two days of their lives. In fact, country statistics say that 50 percent of newborns die during this critical time. This adds up to about 20,000 babies a year.
The sad fact is that the death of these newborns can easily be prevented, only if simple obstetric and pediatric procedures are followed. And this is what the Department of Health has recently been busy studying and preparing for.
At the Quirino Memorial Medical Center, which many of us still refer to as the Labor Hospital, a tight watch on birthing procedures is currently being observed. This is something that our health workers feel will drastically bring down newborn mortality figures.
Changing old habits
The newly introduced newborn protocols are surprisingly simple, easy steps that deal with essential interventions during the baby’s first hours of life. Many of these are simple changes in the current procedure, and only require undoing of what had been taught to our doctors, nurses and midwives in the past.
For example, it has always been the practice to bathe a newborn right after its umbilical cord is clamped and cut. Dr. Bella Vitangcol, who currently heads the program at Quirino, had specifically instructed her staff that no newborn be given a bath until after six or more hours.
They observed that newborns that are only rubbed dried, and then given to the mother to physically hold and hug, acquire greater immunity against hypothermia, which is a major reason for a number of infections.
When the newborn is also immediately delivered to the mother’s arms and maintained in skin-to-skin contact (no clothing barriers between mother and child) for a prolonged period, chances of longer and successful breastfeeding is achieved.
Skin-to-skin contact, especially if the baby has been given to the mother immediately after birth, has been known to trigger the crawling reflex where the newborn on its own seeks out the mother’s breasts to latch on and start to suckle and feed.
Breastmilk is best
It seems that babies that are immediately “separated” from their moms after birth (to accommodate such clinic or hospital procedures as bathing, weighing, footprinting, and others) lose the crawling reflex, and display a prolonged loss of interest to breastfeed.
The breastfeeding campaign continues to be a tough cookie where our government is concerned, not just because of the many advertisements in the past that glamorized bottle-feeding and formula use, but also because generations of mothers have lost the instinct to naturally nurture their newborns.
Breast milk, especially the first expression, is known to contain irreplaceable antigens that give babies immeasurable protection against many infections for life. Newborns that immediately breastfeed have likewise been observed to survive the first critical two days of life.
Mothers that start to breastfeed at the first hour of a child’s life usually also continue to breastfeed for at least the next two or more months, depending on the support condition that is going to be present when the baby is brought home.
Delayed cord clamping
Another procedure that is being introduced is the delay in clamping and cutting of the umbilical cord. The standard practice today is to immediately clamp and cut the cord, ostensibly to facilitate the flow of child delivery especially in hospitals with busy maternal wards.
By waiting one to three minutes, or until the pulsations of the cord stop, a newborn is spared of iron-deficiency anemia, a condition that has been determined to have the cause of many sickly conditions such as anemia in infants and young children.
All these simple procedures are in line with world health standards currently being espoused by the World Health Organization. The Department of Health has been involved with this initiative since last year, and is currently training its relevant hospital personnel all over the country in the new procedures.
Barriers to implementation
The biggest stumbling block to the adopting these simple, life-saving newborn care protocols is breaking age-old habits. Many, especially old, obstetrician-gynecologists have been uncooperative because it would mean more of their time in the delivery room.
This is the same concern of nurses and midwives who want mothers and babies out of the delivery room as quickly as possible. The no-bathing rule, for example, will mean that the nurse will still have to go back to the mother after six or more hours to have the baby bathed.
Lastly, formula feed companies will not want an early initiation to breastfeeding because this will mean totally writing off their multi-billion peso business in the country.
The campaign has a better chance of success if mothers are empowered to demand that they receive this essential newborn care package. Let’s hope that the health department
will mount a nationwide information campaign after hospital personnel training is completed.
Otherwise, it will just become like the breastfeeding campaign – almost forgotten and neglected. –Rey Gamboa (The Philippine Star)
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