PERFORMANCE CHECKLIST

NORMAL VAGINAL DELIVERY (EINC)

PROCEDURE

1. Prepare supplies completely (sterile scissors, cord

tie, clean blanket, sterile gloves).
Check the room temperature.
2. Explains the procedure to the patient., allow the
woman to adopt the most comfortable position.
3. Washes hand, forearm thoroughly with soap and

DONE

SCORE
2

2
2

water.
4. Puts on double gloves, gown.

5. Clean the perineum with antiseptic solution.

6. Applies clean drapes.

7. Encourage the woman to bear down as desired.

8. Supports the perineum at crowning with both

hands and allow the head to gradually extend.

9. Allows external rotation of the head to occur

spontaneously.
10. Assists in the completion of birth.
a. Feel if there is cord around the babys neck,
slide it through the shoulder, if tight, doubly
clamp the cord and cut.
b. Deliver the baby with guidance at the babys
back.
c. Slide one hand towards the babys ankles.
d. Record the time of birth.
e. Put the baby on the mothers abdomen head
facing down.
f. Dry the baby with clean towel and wipe the
babys eyes with clean cloth.
11. Assessing the baby.
a. Observe for the babys breathing.
b. Place the baby in skin to skin contract on the
mothers abdomen and cover with clean towel
c. Put on babys bonnet
d. Remove first pair of gloves
e. Feel for the cord pulsation, when it stops,
clamp the cord using sterile plastic cord clamp
2cm from the base. Apply sterile forceps/clamp
5cm from the base.

NOT
DONE

12. Give 10 units oxytocin deep IM with supervision

of the physician.
13. Deliver the placenta.
a. Controlled cord traction with counter traction
when the uterus is contracted.
b. Inspect completion of placenta upon delivery.
c. Massage the uterus.
14. Inspect the vagina and perineum for laceration

and suture if necessary.

15. Monitor the mothers vital sign every 15 minutes;
check the amount of bleeding. Massage the

uterus form time to time.

16. Monitor the babys vital sign, breathing, color,
signs of readiness for breast feeding at least 15

minutes. Make sure both of them are

comfortable.
17. Give prophylactic eye care to the baby and

vitamin K deem IM within 1 hour of birth.

18. Administer Hepatitis B birth dose 0.5cc IM,

antero-lateral thigh, within 24 hours after delivery.

19. Properly disinfects instrument and gloves. Proper

disposal of soaked linens and placenta.

TOTAL

50

Name: ____________________

Score: _______________

Section: ___________________

Date: _______________

Instructor:__________________