DEBREBIREHAN UNIVERSITY

INSTITUTE OF MEDICINE AND HEALTH SCIENCE COLLEGES

DEPARTMENT OF NURSING

CHECKLIST FOR ASSISTING NORMAL BIRTH (INCLUDING IMMEDIATE

NEWBORN CARE AND ACTIVE MANAGEMENT OF THE THIRD STAGE OF
LABOR)
Note How to Fill the Cells Corresponding to Each Task for Each Testee:
 1= If “Competently Performed” (but participant/student may not progress from step to step efficiently),
 1/2= If “Needs Improvement” (Step or task not performed correctly or out of sequence), and
 0= If “Not Observed” (Step, task or skill not performed by participant during evaluation by examiner)
SN STEP/TASK TESTEES NAME

A1. GETTING READY

1 Washes hands and prepares the necessary equipment.

2 Encourages the woman to adopt the position of choice and
continue spontaneous bearing down efforts.
3 Tells the woman what is going to be done, listens to her, and
responds
4 Provides continual emotional support and reassurance
5 Puts on personal protective barriers.
ASSISTING THE BIRTH
6 Washes hands thoroughly, and puts on 2 pairs of sterile
surgical gloves
7 Cleans the woman’s perineum and places one drape under the
woman’s buttocks and one over her abdomen - ask woman to
pant or give only small pushes with contractions.
8 Controls the birth of the head with the fingers of one hand to
maintain flexion, allow natural stretching of the perineal tissue,
and prevents tears, and use the other hand to support the
perineum.
9 Wipes mucous or membranes with gauze if needed from
baby’s eyes and mouth
10 Feels around the baby’s neck for the cord and respond
appropriately if the cord is present
11 Allows the baby’s head to turn spontaneously and, with the
hands on either side of the baby’s head, delivers the anterior
shoulder
12 When the arm fold is seen, guides the head upward as the
posterior shoulder is born over the perineum and lifts the
baby’s head anteriorly to deliver the posterior shoulder
13 Supports the rest of the baby’s body with both hand as it slides
out and places the baby on the mother’s abdomen
14 Clamps the cord at about 3 cm from the umbilicus and applies
second clamp 2cm apart, ties securely between clamps and cuts
with sterile scissors or blade
15 Notes the time and sex of the baby and tells the mother
16 Thoroughly dries the baby and assess breathing. If baby does
not breathe immediately, begins resuscitative measures
17 Removes wet towel and ensures that the baby is kept warm,
using skin-to-skin contact on the mother’s chest. Covers the
baby with a cloth or blanket, including the head (with hat if
possible)
18 Palpates the mother’s abdomen to rule out the presence of
additional baby (ies) and proceeds with active management of
the third stage
Total ---/18 ---/18 ---/18 ---/18
Examiner Sign.
 Examinee Sign.
A2. ACTIVE MANAGEMENT OF THIRD STAGE OF LABOR
1 If no additional baby, gives oxytocin 10 units IM within one
minute of birth
2 Changes gloves or removes top pair.
3 Clamps the cord close to the perineum using sponge forceps
and waits for a uterine contraction.
4 Applies counter traction in an upward direction to stabilize the
uterus
5 At the same time with the other hand, pulls with a firm, steady
tension on the cord in a downward direction
6 Delivers placenta with both hands, gently turning the entire
placenta and lifting it up and down
7 Immediately after placenta delivers, massages uterus until firm
8 Examines the placenta, membranes, and cord and disposes into
bucket lined with plastic bag or as culturally appropriate
9 Examines the vulva, perineum and vagina for lacerations/tears
and carries out appropriate repair as needed
10 Cleanses perineum and area beneath the woman and applies a
pad or cloth to vulva
11 Assists the mother to a comfortable position for continued
breastfeeding and bonding with her newborn
Total ---/11 ---/11 ---/11 ---/11
Examiner Sign.
Examinee Sign.
A3. POST-PROCEDURE TASKS

1 Disposes of contaminated items in a plastic bag or leakproof,

covered waste container
2 Decontaminates instruments by placing in a container filled
with 0.5% chlorine solution for 10 minutes
3 Decontaminates needle and syringe, hold the needle under the
surface of a 0.5% chlorine solution, fills the syringe, and
pushes out (flush) three times; then places in a puncture-
resistant sharps container
4 Immerses both gloves in 0.5% chlorine solution and removes
gloves by turning them inside out
5 Washes hands
6 Records all information on record including estimated blood
loss
7 Newborn danger signs
Total ----/7 ----/7 ----/7 ----/7
Examiner Sign.
Examinee Sign.
B. IMMEDIATE POST PARTUM AND NEWBORN CARE
1 Step 1. Deliver newborn onto mother’s abdomen or a dry
warm surface close to the mother.
2 Step 2. Dry newborn’s body with dry towel. Wrap with another
dry warm cloth and cover head.
3 Step 3. Assess breathing and color; if not breathing, gasping or
< 30 breaths/minute then resuscitate.
4 Step 4. Tie the cord two fingers from abdomen and another tie
two fingers from the first one. Cut the cord between the first
and second tie.
5 Step 5. Place the newborn in skin-to-skin contact and on the
breast to initiate breastfeeding
6 Step 6. Give eye care (while the newborn is held by his
mother)
7 Step 7. Give Vitamin K, 1mg IM on anterior lateral thigh
(while newborn held by his mother)
8 Step 8. Weigh newborn (if <1,500 gm refer urgently) - Weigh
the newborn after an hour of birth or after the first breastfeed
9 Newborn danger signs
Total ----/9 ----/9 ----/9 ----/9
Examiner Sign.
 Examinee Sign.
C. NEWBORN RESUSCITATION (HBB)
GETTING READY
1 Dries the baby, remove the wet cloth, and wraps
the baby in a dry, warm cloth
2 Places the baby on his/her back on a clean,
warms surface and keeps covered except for the
face and chest.
RESUSCITATION USING BAG AND MASK
3 Positions the head in a slightly extended position
to open the airway
4 Clears the airway by suctioning the mouth first
and then the nose:
 Introduces catheter into the baby’s mouth
for approximately 3cm and suctions while
withdrawing catheter;
 Introduces catheter into each nostril and
suctions while withdrawing catheter
5 Places the mask on the baby’s face so that it
covers the chin, mouth and nose.
6 Squeezes the bag with two fingers only or with
the whole hand, depending on the size of the bag
7 Checks the seal by ventilating two or three times
and observing the rise of the chest
8 If the baby’s chest is rising, ventilates at a rate of
40 breaths per minute, and observes the chest for
an easy rise and fall.
9 If the baby’s chest is not rising, determines why,
rectify problem and continue to ventilate.
10 Ventilates for 1 minute and then stops and quickly
assesses the baby for spontaneous breathing and
color; if breathing is normal, stop ventilating, and
provide routine newborn care
11 If the baby’s heart rate is normal but breathing is
less than 30 breaths per minute or irregular,
continues to ventilate for 3-5 minutes until the
baby is breathing well; stops ventilating and
monitors baby with mother
12 If breathing is not normal, and the heart rate is
normal or slow
manages accordingly (calls for help and improves
ventilation;
continues ventilation with oxygen if available)
Total ---/12 ---/12 ---/12 ---/12
Examiner Sign.
Examinee Sign.
1 If the baby is not breathing regularly after 20
minutes of ventilation, continues ventilation with
oxygen, organizes transfer and refers baby to a
tertiary care centre, if possible.
2 If there is no gasping or breathing at all after 20
minutes of ventilation stops ventilating, provides
emotional support to mother and family
CARE AFTER SUCCESSFUL RESUSCITATION
3 Keeps the baby skin-to-skin with the mother until
the baby’s
condition is stable
4 Monitors the baby’s respiratory rate and observes
for other signs of illness
5 Provides reassurance to the mother
POST-RESUSCITATION TASKS
6 Soaks suction catheters and mask in 0.5%
chlorine solution for 10 minutes for
decontamination
7 Wipes exposed surfaces of the bag with a gauze
 pad soaked in 0.5% chlorine solution or 60-90%
alcohol and rinses immediately
8 Washes hands thoroughly with soap and water
and dries with a clean, dry cloth (or air dry)
9 Completes records with details of resuscitation
and condition of newborn
Total ---/9 ---/9 ---/9 ---/9
D. BREAST FEEDING TECHNIQUES
1 Maternal Positioning displayed
 Lying position for whom?
 Sitting positions
2 Neonatal positioning
 Cradle hold
 Cross cradle hold
 Laid-back position
 Underarm hold (on same and opposite
side of breast), i.e football, also called
clutch, hold
3 Good attachment signs explained
4 Effective Suckling signs explsined
Total ---/4 ---/4 ---/4 ---/4
Examiner Sign.
Examinee Sign.