THE DOCTOR SPEAKS

The Science of Unang Yakap

http://www.youtube.com/watch?v=5hCP7rYHrwA

(Please click the video clip link above to understand the succeeding discussion. Thank you)

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. provision of warmth, drying and stimulating the baby;
2. uninterrupted skin-to-skin contact (between the mother and the baby);
3. delayed or properly-timed cord clamping; and
4. 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 hasn’t cried yet. This is done while umbilical cord still isn’t cut.

After which, baby is now placed prone onto the mother’s bare abdomen/between the breasts/chest. Baby is also still naked during this time. The beanie is place on the baby’s head to prevent heat loss. The uninterrupted skin-to-skin contact simply means that there’s no physical barrier between the mother’s and baby’s 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 mother’s 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 11-fold, 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 mother’s 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 hospital’s policy.

(Acknowledgement: My mentors Drs Mianne Silvestre and Blas Mantaring III for pioneering on this endeavor)

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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.