Republic of the Philippines

Tarlac State University

College of Science
Department of Nursing
Lucinda Campus, Brgy. Ungot, Tarlac City Philippines 2300
Accredited Level 3 Status by the Accrediting Agency of Chartered Colleges and Universities in the Philippines

PERFORMANCE EVALUATION CHECKLIST

ESSENTIAL INTRAPARTIUM AND NEWBORN CARE PRACTICE (EINC)

Name of Student: ___________________________

Year and Clinical Group: ______________________
School year: ________Term: __1st Sem ___2nd Sem _____Summer
Inclussive dates of Clinical Rotation: ________________
Instructor: _________________

SCORE
STEPS Remarks
2 1 0
PRIOR TO WOMAN’S TRANSFER TO THE LR / DR
 Ensure that the mother is in her position of choice while in labor.
 Ask mother if she wishes to eat/drink or void.
 Communicate with the mother –informed her of progress of labor, gave
reassurance and encouragement.
WOMAN ALREADY IN THE DR
1 PREPARING FOR DELIVERY
2 Check temperature in DR area to be 25-28 Celsius; eliminate air draft.
3 Ensure the woman’s privacy.
4 Prepare a clear, clean newborn resuscitations area. Checked the
equipment if clean, functional and within easy reach.
5 Arrange materials/supplies in a linear sequence.
(Gloves, dry linen, bonnet, oxytocin injection, plastic clamp, instrument
clamp, scissors, 2 kidney basins)
6 Clean the perineum with antiseptic solution.
7 Wash hands and put it on 2 pairs of sterile gloves aseptically. (if same
worker handles perineum and cord)
8 AT THE TIME OF DELIVERY
9 Encourage woman to push as desired.
10 Drape clean, dry linen over the mother’s abdomen or arms in preparation
for drying the baby.
11 Apply perineal support and do controlled delivery of the head. 7w

12 Call out time of birth and gender of the baby.

13 Inform the mother of outcome.
14 FIRST 30 SECONDS
15 Thoroughly dry the baby at least 30 seconds, starting from the face and
the head, going down to the trunk and extremities while performing a
quick check for breathing.
16 1-3 MINUTES
17 Place the baby in skin-to-skin contact on the mother’s abdomen or chest.
18 Cover baby with the dry cloth and the baby’s head with a bonnet.
19 Give IM oxytocin within one minute of baby’s birth
20 Palpate umbilical cord to check for pulsations.
21 After pulsations stopped, clamped cord using the plastic clamp /cord tie 2

1|Page
 cm from the base.
22 Place instrument clamp 5 cm from the base.
23 Cut near plastic clamp (not midway).
24 Perform the remaining steps of AMTSL (Active Management of the Third
Stage of the Labor)
25 Wait for the strong uterine contractions then controlled cord traction and
counter traction on the uterus, continuing until placenta was delivered.
26 Massage the uterus until its firm.
27 Inspect the lower vagina and perineum for lacerations/tears and report it
to the Physician for repair of lacerations/tears, as necessary.
28 Examine the placenta for completeness and abnormalities.
29 Clean the mother: flushed perineum and applied perineal
pad/napkin/cloth.
30 Check the baby’s color and breathing; check that mother is comfortable,
and the uterus is contracted.
31 Dispose the placenta in leak-proof container or plastic bag.
32 15-90 MINUTES
33 Advise mother to observe for feeding cues and cited examples of feeding
cues.
34 Support mother; instruct her on positioning and attachment.
35 Administered eye ointment (first).
36 Perform thorough physical examination.
37 Administer Vitamin K, Hepatitis B and BCG injections (simultaneously
explained purpose of each intervention)
38 Advise OPTIONAL/DELAYED bathing of baby (and able to explain the
rationale).
39 In the first hour: checked baby’s breathing and color, and checked
mother’s vital signs and massage uterus every 15 minutes.
In the second hour: checked mother-baby vital signs and condition every
30 minutes to 1 hour.
40 Document all findings and procedure performed
TOTAL

Shown to me
VANESSA V. LICYAYO, RN, MAN
Signature over Printed Name
Clinical Instructor

Shown to me:
________________________________
Signature over Printed Name
Student

2|Page