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.