CENTRO ESCOLAR UNIVERSITY
Manila * Makati * Malolos
SCHOOL OF NURSING
PROCEDURE CHECKLIST WITH RATING FORM
Essential Intrapartum and Newborn Care (Adopted from EINC Team ADPCN)
Name of Student Score
Year/Section/Group/Number
Rate the student's performance by checking the appropriate box using the following criteria:
5 - Excellent (Carries out procedures efficiently, systematically and independently/Personality trait is observed at all times) 4 - Very
Satisfactory (Carries out procedures efficiently and systematically but requires minimal guidance and supervision/Personality trait is observed
at all times)
3 - Satisfactory (Carries out the procedures efficiently and systematically but requires moderate guidance and supervision/Personality trait is
observed at all times)
2 - Fair (Carries out the procedures efficiently and systematically but requires close guidance and supervision/Personality trait is observed at
all times)
1 - Poor (Carries out the procedures inefficiently, unsystematically even under close guidance and supervision/Personality trait is observed at
all times)
0 - Not done
Criteria 5 4 3 2 1 0
ASSESSMENT
1. Assess for the contractions that occur at regular intervals and the interval
between each contraction gradually becomes shorter.
2. Assess for the gradual increase in the duration of each contraction.
3. Check if the intensity of the contractions becomes stronger and stronger.
4. Assess if the cervix is progressively dilating.
5. Assess for the vaginal bleeding.
6. Assess for the continuous pain or discomfort at the back in the abdomen.
PLANNING
Prior to Woman's Transfer to the DR
7. Ensures that mother is in her position of choice while in labor.
8. Asks mother if she wishes to eat/drink or void.
9. Communicates with the mother - inform her of progress of labor, gave
reassurance and encouragement.
Woman Already in the DR (Preparing for Delivery)
10. Checks temperature in DR area to be 25-28 degrees Celsius; eliminates air
draft.
11. Asks woman if she is comfortable in the semi-upright position (the default
position of delivery table).
12. Prepares a clear, clean newborn resuscitation area. Checks the equipment if
clean, functional and within easy reach.
13. Ensures the woman's privacy.
14. Removes all jewelry then wash hands thoroughly observing the WHO 1-2-
3-4-5 procedure.
15. Arrange materials/supplies in a linear sequence:
15.1 Gloves, dry linen, bonnet, oxytocin injection, plastic clamp,
instrument clamp, scissors, 2 kidney basins.
15.2 In a separate sequence, to be used after the 1st breastfeed: Eye
ointment, stethoscope to symbolize PE, Vit.K, hepatitis B and BCG
vaccines, cotton balls.
16. Cleans the perineum with antiseptic solution.
17. Wash hands and put on 2 pairs of sterile gloves aseptically. (If same worker
handles perineum and cord).
Essential Intrapartum and Newborn Care (Adopted from EINC Team ADPCN)
Rev. September , 2018
Page 1 of 3
Criteria 5 4 3 2 1 0
IMPLEMENTATION
At the Time of Delivery
18. Encourages woman to push as desired.
19. Drapes the clean, dry linen over the mother's abdomen or arms in
preparation for drying the baby.
20. Applies perineal support and did controlled delivery of the head.
21. Calls out time of birth and sex of baby.
22. Informs the mother of outcome.
First 30 Seconds
23. Thoroughly dried baby for at least 30 seconds, starting from the face and
head, going down to the trunk and extremities while performing a quick
check for breathing.
1-3 MINUTES
24. Removes the wet cloth.
25. Places baby in skin-to-skin contact on the mother's abdomen or chest.
26. Covers baby with the dry cloth and the baby's head with a bonnet.
27. Excluded a 2nd baby by palpating the abdomen in preparation for giving
oxytocin.
28. Uses wet cloth to wipe the soiled gloves. Give IM oxytocin within one
minute of baby's birth. Disposes wet cloth properly.
29. Removes first set of gloves and decontaminates them properly (in 0.5%
chlorine solution for at least 10 minutes).
30. Palpates umbilical cord to check for pulsations.
31. After pulsation stops, clamp cord using the plastic clamp or cord tie 2 cm
from the base.
32. Places the instrument clamp 5 cm from the base.
33. Cuts near plastic clamp (not midway).
34. Performs the remaining steps of the AMTSL (Active Management of the
Third Stage of Labor:
34.1 Waits for strong uterine contractions then applies controlled cord
traction and counter traction on the uterus, continuing until placenta is
delivered.
34.2 Massages the uterus until firm.
35. Inspects the lower vagina and perineum for lacerations/ tears and repair
lacerations/tears, as necessary.
36. Examines the placenta for completeness and abnormalities.
37. Cleans the mother; flush perineum and applies perineal pad/napkin/cloth.
38. Checks baby color and breathing; checks that mother is comfortable and
uterus is contracted.
39. Disposes the placenta in a leak-proof container or plastic bag.
40. Decontaminates (soaked in 0.5% chlorine solution) instruments before
cleaning; decontaminates 2nd pair of gloves before disposal stating that
decontaminations lasts for at least 10 minutes.
41. Advises mother to maintain ski-to-skin contact. Baby should be prone on
mother's chest in between the breasts with head turns to one side 15-90
MINUTES
42. Advises mother to observe for feeding cues and cites example of feeding
cues.
43. Supports mother, instructs her on positioning and attachment.
44. Waits for FULL BREASTFEED to be completed.
45. After a complete breastfeed, administers eye ointment (first), did thorough
physical examination, then did Vit. K, hepatitis B and BCG injections
infections (simultaneously explains purpose of each intervention).
46. Advises DELAYS bathing of baby (after 24 hours of life).
Essential Intrapartum and Newborn Care (Adopted from EINC Team ADPCN)
Rev. September , 2018
Page 2 of 3
Criteria 5 4 3 2 1 0
47. Advises breastfeeding per demand and about Danger signs for referral.
EVALUATION
48. In the 1st hour: check baby's breathing and color, and check mother's vital
signs and massage uterus every 15 minutes.
49. In the 2nd hour: check mother-baby dyad every 30 minutes to 1 hour.
50. Complete all records.
Total Score:
Comments/Suggestions:
Computation: Total Score divided by 52 (number of items) x 20 (factor) = _________________
*Total points shall be transmuted using the table for 100 pts. Passing cut-off point is
65.
Equivalent Numeric Grade: _______________
Interpretation: __________________________
Evaluator: Conforme:
Clinical Instructor's Student’s Signature Date:
Printed Name & Signature
Essential Intrapartum and Newborn Care (Adopted from EINC Team ADPCN)
Rev. September , 2018
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