Saving newborn babies, one embrace at a time

A  mother’s first    embrace is her baby’s first breath. With these touching words, the World Health Organization Regional Office for the Western Pacific recently launched the “First Embrace” campaign for early essential newborn care in Manila, with health workers and policy makers promoting the recommendations in the Action Plan for Healthy Newborn Infants in the Western Pacific Region (2014-2020).

First embrace — this is probably the first time you’re hearing this. It simply refers to the skin-to-skin contact between the mother and her baby immediately after birth. It’s the first time the mother, having gone through the throes of heavy labor, happily lays her eyes on her newborn, holds her baby and feels the warmth of her baby’s embrace, those dainty little hands latched on to her while their hearts beat in perfect rhythm as one. It’s a feeling like no other — and no mother would trade it for the whole world.

As it promotes natural bonding between mother and child, skin-to-skin contact has life-saving benefits for babies and improves the condition of those born premature, sick or by Caesarean section.

“First Embrace is something, that if we get in place in this region, we can save 50,000 newborn lives a year and ensure a healthy start for the baby,” asserts Dr. Howard Sobel, WHO coordinator for Reproductive, Maternal, Newborn, Child and Adolescent Health. “And for every life saved, we’re also preventing 10 to 20 infections and other problems babies would have. So, we’re looking at literally half a million or even up to a million newborn lives every two minutes. This is about stopping that.”

But how do we stop that? The solution is simple, says Dr. Sobel. “A lot of things we can do are basically going back to the basics, getting rid of these practices that were introduced that medicalized care and taking advantage of the natural benefits of putting the baby in skin-to-skin contact with the mother.”

In his talk at the launch, Dr. Sobel reveals, “We were all trained in these practices, our mentors and their mentors before them. But thanks to new evidence, we know now that we need to do things differently.”

Dr. Howard Sobel and Dr. Maria Asuncion Silvestre: The First Embrace campaign hopes to save 50,000 newborn lives a year and ensure a healthy start for the baby.

“Our newborn mortality rates have been really worrisome,” notes Dr. Maria Asuncion Silvestre, pediatric neonatologist and president of Kalusugan ng Mag-Ina Foundation. “I think what triggered this current action was this outbreak of infection, and what we looked at when they were investigating the outbreak was why healthy babies would die in an outbreak; it made the news headlines. None of the babies at that time were breastfed. I’m not casting blame on anyone, but the practices at that time were wrong. So, what we’re doing is we’re standardizing practices and teaching health workers to sequence the practices properly.”

Dr. Silvestre can’t stress enough how crucial the sequence is. “First of all, don’t cut the umbilical cord before drying the baby. Within the first 30 seconds after the baby comes out, dry him first, take off the wet cloth and put him on the navel of the mother with the umbilical cord still attached because the cord pulsations are delivering the blood in the placenta to the baby. So while there’s skin-to-skin contact, the baby is warmed and receives oxygen. If you cut the cord right away, the baby has not breathed yet and you’re already depriving him of the oxygen he would have gotten from his mother. Sayang naman yung pabaon ni Mommy na oxygen! Lastly, you leave the baby and the mother together until the breastfeeding is completed (in the first hour, the baby already has reflexes, it’s not really hunger but the interest to feed), the baby reaches satisfaction and falls asleep. And then he wakes up and cries. Imagine putting the baby in the nursery right away and separating him from his mother just when he needs her.”

Maybe we should do away with the nurseries, I tell Dr. Silvestre who nods as she flashes an infectious smile. “There should be an ICU for sick babies but no nurseries. Putting the baby in a nursery is counterproductive to the mother’s and the baby’s health.”

The First Embrace, a regional launch in 37 countries, says Dr. Silvestre, is taking off from the Philippine experience of changing the way we care for our babies, especially immediately after birth, as well as changing our practices for mothers. “Many other countries of the region have picked up on how simple but very timely the change in practices has been to address still existing problems of newborns dying or developing illnesses that are preventable. This is what we’re targeting: preventable deaths, like deaths from not breathing at birth because the mother was in difficult labor or deaths from infection, from hypothermia or cold. These are the preventable causes of deaths in newborns that we actually should be responsible for because we have not standardized the way our health care workers and our hospitals and facilities are addressing the needs of our mothers and babies.”

Dr. Sobel elaborates, “Skin-to-skin contact reduces the number of babies that don’t breathe by half and protects them against hypothermia. It gives babies warmth and gets them colonized with the right bacteria, the family bacteria, the same bacteria that the mother has in her body. The baby gets this coating of protection outside and inside the gut, protection against diarrhea, pneumonia, and neonatal infections.”

He stresses, “By waiting before cutting the cord, the babies get a free transfusion of blood that prevents them from getting anemia and a gut problem.”

The good doctor asks, “Do you smoke?” I vigorously shake my head. “Did you ever smoke?” Never, I quickly reply. “Do you have friends who smoke?” I lot, I reply as I heave a sigh.

Dr. Sobel points out, “Most people know smoking is dangerous, I think almost everybody. But if you quit smoking, your risk of dying goes down by half even if you do it late. You still have other risks, but your cardiovascular risk is reduced. If you give a newborn baby infant formula, that baby has a vastly increased risk, much bigger than the risk from smoking to an adult. A newborn baby who’s given infant formula over the first six months has between four and six times increased risk of death. So, exclusive breastfeeding, 0 to six months, is one of the most important things we can do. Skin-to-skin contact, combined with breastfeeding, is extremely protective to babies. We hope that mothers will be smart enough to understand that.”

Breast is best and breastfeeding is recommended for all babies. Dr. Sobel relates, “In Baguio General Hospital in the 1970s, we already knew that by promoting exclusive breastfeeding, getting rid of the formula in hospitals, and rooming in for the mother and baby, they were able to cut deaths from neonatal sepsis (bacterial blood stream infection) by 95 percent. We’re going back to basics: get the formula away from babies because it is very dangerous for babies, it increases their risk of death many times more.”

Dr. Sobel is happy to share, “In 2008, there was nothing. Now, in the most recent survey, about 60 percent of the facilities are practicing skin-to-skin contact. It’s being done to some degree in Cambodia while  Mongolia and Vietnam have done a great job.”

“The campaign is showing early signs of success,” says an optimistic Dr. Silvestre. “There have been stumbling blocks, like the policies of hospitals, but it’s getting easier and easier. We’ve trained many private hospitals, but there are still a lot more. There are 2.2 million births in the Philippines every year. We have not covered all of that. Instead of telling hospitals that they’re bad and we will punish them, we’re assisting them on how to apply this practice. We’re training midwives and nurses.  We also have to make families and communities, birthing stations, lying-in clinics aware that this is happening so they’re ready.”

So, to all the expectant mommies out there: Get ready for your baby’s first embrace.

Dr. Howard Sobel and Dr. Maria Asuncion Silvestre: The First Embrace campaign hopes to save 50,000 newborn lives a year and ensure a healthy start for the baby.