Monitoring of baby

  • Check every 15 minutes
    • Breathing, warmth,pulse, SpO2
    • Umbilical cord stump should be well ligatured

Care of baby

  • Ensure the room is warm
  • Wipe off blood or meconium with wet cloth
    • Do not remove vernix or bathe the baby within the first 24 hours
  • Apply an eye antimicrobial e.g. tetracycline eye ointment
    • Leave in place and do not wash it away
  • Apply chlorhexidine digluconate gel to the cord stump daily after every bath, until the cord falls
    off. Provide the gel to the mother and teach her how to use it while at home
  • Give vitamin K 1 mg IM
  • Keep baby warm with skin to skin contact

If feet are cold or mother and baby are separated

  • Cover baby with blanket; cover baby’s toes and fingers as well as the head with warm clothing
  • Reassess after 1 hour

If breathing difficulty

  • Examine the baby according to first newborn examination requirements, classify the condition,
    and treat accordingly


Ensure the mother starts breastfeeding as soon as possible (preferably within the first hour)

  • Offer mother help to position (attach) the baby correctly onto the breast to avoid cracked nipples
  • Counsel and reassure mother

If unable to start breastfeeding:

  • Plan for alternative feeding method
    • Ensure that alternative method is Affordable, Feasible, Acceptable, Sustainable and Safe
    • Do not give artificial feeds, sugar water or local feeds before baby has attempted to initiate natural breastfeeding
    • Consider referral to a higher level

Baby dead or stillborn

In case the baby dies or is stillborn

  • Give supportive care to the mother
  • Respect local customs; find out if the mother/family would like to look at or hold the stillborn baby
  • Check, identity and give wrapped body to family for disposal/burial according to local customs
  • Provide death certificate and complete required reporting formalities


  • Advise on postpartum care and hygiene
  • Advise mother on breast care; wear a firm bra, do not express the breasts
  • Give paracetamol if breasts are painful You may give lactation suppression drugs such as
    bromocriptine 2.5 mg once a day for 2 weeks
  • Counsel on appropriate family planning