Posted in Unang Yakap

Unang Yakap, Part 3 (on Nonseparation of the Newborn and Mother)

Step 4 of the Unang  Yakap protocol is Non-separation of the newborn from mother for early breastfeeding.  It is probably the most difficult step to implement because it requires teamwork, a change in the general mindset surrounding the birthing process, and revising hospital policies.

Non-separation of the newborn and mother are crucial to the success of the Unang Yakap initiative, and of all 4 steps, this has the longest-lasting implications and the greatest benefit.

Scientific Data Supports Breastfeeding as an intervention for preventing newborn death

In 2003, the medical journal The Lancet published its Child Survival Series which identified 15 preventive interventions that together could prevent 60% of childhood deaths worldwide.  Breastfeeding topped this list, and it was projected that if 90% of mothers were to breastfeed exclusively for the first 6 months, 13% of worldwide deaths before the age of 5 could be prevented.

In 2008, a study by L. Mullany and peers involving 28,000 babies in Nepal  (published in the  Journal of Nutrition)  demonstrated that delaying the initiation of breastfeeding increases the risk of newborn death from infections.  Their findings showed that delaying the first breastfeed to anywhere from 1 hour of age to 24 hours of age resulted in a doubling of the risk of death from infection.  Waiting until 24-48 hours for the first breastfeed tripled this risk, and delaying the first breastfeed until 48-72 hours quadrupled the risk of death.  An earlier study from Ghana also showed similar findings.

A randomized control trial by J. Narayanan published in the Lancet almost 20 years ago examined the percent of serious illness among low birth weight infants (infants weighing less than 2500g at birth) who were randomly assigned to feed breast milk or formula.  Results showed that serious illnesses occurred 400% more frequently in infants fed formula alone compared to infants on raw expressed breastmilk alone.  Due to ethical considerations, this type of study cannot be repeated today.

Before and After

What is the traditional birth experience in a hospital in the Philippines without Unang Yakap?  The baby is delivered, the cord cut, the infant taken to a bassinet or warmer for drying, then wrapped in a blanket and briefly shown to its mother and father.  It is quickly spirited away to the nursery for weighing, measuring, a full physical examination, bathing, a Vitamin K shot and Hepatitis B vaccine administration.  The baby is kept in the nursery in a bassinet or incubator until the mother is ‘ready’ or the baby is ‘stable and cleared for rooming-in’ (deemed normal and well enough to be placed in the hands of its mother).  While awaiting this all-important reunion, the baby is fed a bottle of glucose water or formula every few hours.

What Step 4 proposes is that after the baby is dried, placed on its mother’s chest, covered in a bonnet and blanket; and after the cord is cut; that the baby be left in skin-to-skin contact with the mother until he/she is ready for the first breastfeed.  This means delaying weighing and measuring, delaying a full physical exam (a quick one is performed when the infant is being dried, and both mother and infant are regularly monitored every few minutes after birth), delaying the Vitamin K shot and any vaccines, until the first breastfeed has been completed.  Bathing should be delayed until the baby is at least 6 hours old or longer.

The goal of step 4 is to protect the first breastfeed, and to allow it to happen spontaneously at the appropriate time and in the appropriate manner.  Weighing, measuring, unnecessarily handling the baby, and performing painful procedures can all disrupt the infant’s natural instinct to locate the breast and begin feeding.  And while all these are important in newborn care, none of them are so important that they cannot wait until after the first breastfeed is complete.

The study by Dr. Sobel and colleagues that looked at hospital practices in the Philippines showed that most newborns were put to the breast by 10 minutes of age, but they were also removed from the breast a mere 2 minutes later.  The truth is, most babies are not ready to breastfeed until they are about 20-60 minutes old, and it is a process that happens gently and gradually.  The new baby who is placed on its mother’s chest begins to look around, lick its lips and will salivate.  He or she uses smell to localize the mother’s areola (which is why we shouldn’t ‘clean’ the mother’s nipples with alcohol or other substances), kicks gently and moves over to the breast, finds the breast and latches on.  A good first breastfeed can last 10, 20 or 30 minutes.  Sometimes it will last longer.
Once the first breastfeed is complete, measuring, weighing, examinations and injections can all be done at the bedside.  Mother and newborn should be treated as a single unit – they should be monitored together and transferred to the room together.
Mother and baby being transferred to their room together. Photo courtesy of the Essential Intrapartum and Newborn Care Team
Mother and baby being transferred to their room together. Photo courtesy of Team EINC and WHO Philippines
Soon-to-be parents who are hearing about non-separation for the first time often worry that being with the baby from the very beginning means they will be more tired and that the mom will have no opportunity to rest.   But feedback from mothers who have undergone the Unang Yakap experience, especially mothers who are giving birth for the 2nd or 3rd time, has been overwhelmingly positive.   Many have said that the experience is beautiful and joyful, and that they wish they had been able to do it with their previous births.  Nurses who were once concerned that monitoring babies and mothers together would be too taxing, have said that it is much easier to continue to assist mothers who were able to successfully breastfeed at the very beginning, rather than try to teach a mother how to breastfeed her baby who is already a day or 2 old.
Babies who are breastfed within the first hour of life have a lower risk of infection and death, and a higher chance of breastfeeding exclusively and for a longer period of time.  This translates to numerous long-term benefits including an increase in IQ, protection against gastrointestinal infections, allergic disease, obesity, diabetes, childhood leukemia and lymphoma, and SIDS (Sudden Infant Death Syndrome).  Breastfeeding benefits for the mother include decreased postpartum blood loss, improved child spacing, decreased risk for  postpartum depression, chid abuse or neglect, type 2 diabetes, rheumatoid arthritis, cardiovascular disease, and breast and ovarian cancer.  The economic benefits are significant as well.
Early reports from hospitals that have committed to the practice of Unang Yakap show that it does work – fewer babies are sick,  less babies are admitted to NICUs.  But in order to have the fullest impact, the program needs to be adopted by all. Ask your Obstetrician, Pediatrician or midwife about Unang  Yakap.  Talk to other parents and to your local health care providers about it and please help spread the word!
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Author:

I'm a trained Pediatrician and Neonatologist and now stay-at-home mom. I am thankful for this opportunity to spend time with my kids. I am a co-founder of L.A.T.C.H. Philippines and devote a lot of my time to breastfeeding support and education. I am also very interested in child development and my children are the happy subjects of my home experiments.

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