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INTRODUCTION

Our country today faces serious problem specifically on health sector and

giving birth at home is one of the problems that should be given importance by

the Philippine government since giving birth at home meets several complication

and untoward problems that will cause mortality

 !ccording
 !ccording to the Department
Department of "ealth# maternal mortality report# updated
updated

in $une %&'&# hypertension complicated by pregnancy comprises %( percent of 

the causes of maternal deaths# and partum hemorrhage ') percent * the second

and third leading causes of maternal death Others are sepsis# obstructed labor 

and complications around unsafe abortion and giving births at home * most of 

which are preventable with proper diagnosis and intervention

 !ccording
 !ccording to the National Demographic "ealth +urvey   ,ND"+- of %&&.#

only // percent of births in the Philippines occur in health facilities0 )1 percent of 

children are still delivered at home

Under Philippine law# licensed midwives are authori2ed to carry out the

supervision and care of women during pregnancy# labor and management of 

normal deliveries# including

including the administration
administration of an o3ytocin drug to prevent and

treat hemorrhage after the delivery of the placenta

 !t present# Department of "ealth made a memorandum

memorandum that there will no

more pregnant mother to deliver children at home due to unsafe and ris4 delivery

Thus#
Thus# as license
licensed
d midwives
midwives and proponen
proponents
ts of this feasibility
feasibility study aims to

establish a birthing center# to be named as 56other Choice 7irthing Center8 to

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establish a safe and sustainable birth center and increase woman with access to

healthcare provider and health care facility at lower cost and access to Philhealth

is available

In addition# proponents are encourage to open a birthing center since not

all pregnant woman can access to hospital

hospital at the same time# hospital
hospital addresses

different cases of health problems while birthing center only focus on parturient

cases at the same time cheaper

Ob9ectives of the +tudy

:enerally# this study will be of great help to achieve the vision of the

6other;s Choice 7irthing Center# which

which is to be an effective partner in sustaining
sustaining

and maintaining <uality of care to our clients through e3cellent birthing center 

service with full client;s satisfaction

+ignificance of the +tudy

To the Researchers
Researche rs

The result of this study will be very significant to the researcher This is

because it can give them better idea about starting a business about birthing

center
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establish a safe and sustainable birth center and increase woman with access to

healthcare provider and health care facility at lower cost and access to Philhealth

is available

In addition# proponents are encourage to open a birthing center since not

all pregnant woman can access to hospital

hospital at the same time# hospital
hospital addresses

different cases of health problems while birthing center only focus on parturient

cases at the same time cheaper

Ob9ectives of the +tudy

:enerally# this study will be of great help to achieve the vision of the

6other;s Choice 7irthing Center# which

which is to be an effective partner in sustaining
sustaining

and maintaining <uality of care to our clients through e3cellent birthing center 

service with full client;s satisfaction

+ignificance of the +tudy

To the Researchers
Researche rs

The result of this study will be very significant to the researcher This is

because it can give them better idea about starting a business about birthing

center
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To the Client

The positive result of the study will provide them a birthing clinic with

utmost consideration on the safety and security of pregnant woman and newborn

babies

To the +chool

The school administration will be proud of the brilliant researched studies

added to the College =ibrary and Research Department for the useful reference

for future researchers

To the :overnment
:o vernment

The government will surely support the study because of the situation of 

health in our country today If the study will be materiali2ed it will be a big help to

the community in general

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T"> ?>!+I7I=IT@ +TUD@

This chapter
chapter present
presents
s the four ,/- compone
components
nts of a pro9ect
pro9ect feasibil
feasibility
ity

study#
study# namelyA
namelyA managem
management#
ent# mar4eting#
mar4eting# technical
technical and financia
financial
l This
This pro9ect
pro9ect

feasibility study is prepared to ascertain if the pro9ect# as initially designed# will

have a chance in the niche mar4et when implemented

6anagement ?easibility

This aspect includes a study of the basic organi2ation# form of business#

organi2a
organi2ation
tional
al chart and pro9ect
pro9ect operation
operation schedule
schedules
s This
This aspect
aspect helps to

determin
determine
e the effecti
effectiven
veness
ess of the organi2a
organi2ation
tion and the <ualific
<ualificatio
ation
n of the

individuals which will ma4e*up the organi2ation of the business

?orm of 7usiness

The business will be registered and recogni2ed under the nameA 6other;s

Choice 7irthing Center as universal*limited partnership and will be registered with

the +ecuritie
+ecurities
s and >3change
>3change Commission
Commission ,+>C-
,+>C- ! partne
partnershi
rship
p duly formed
formed

under the law is a 9uridical person separate and distinct from each of the partner

The proponents are Registered 6idwife ,R6-# to witA 6arites C 7ahian# 6ary

$ane 7eleno# !ubrey D NuBe2# Roselie ! Rodicol and +usan = +uralta

The form of the business is an association of two or more persons to carry

on as co*owners of a business for profit and as a result of a specific contractual

agree
agreemen
mentt among
among the
the owner
owners
s or partne
partners
rs It is agreed
agreed that
that partn
partners
ers have
have
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specified duties and responsibilities to the business activities ,as presented in the

organi2ational chart- Other positions left re<uire

re<uire hiring of wor4ers to wor4 for the

company

 !ll partners finished from the two*year

two*year Diploma in 6idwifery#
6idwifery# passed the

7oard of 6idwifery =icensure >3amination and will finish their degree in 7achelor 

of +cience in 6idwifery Thus# they have enough 4nowledge and s4ills to run the

business

Organi2ational +tructure

The proponents agreed that they will 9oin force in managing their business

considering that the company

company has limited resources "owever# once the birthing

center will e3pand# they will hire additional staff to assist the business operation

Ne3t page is the designed organi2ational structure outlining the position

involves
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6other;s Choice 7irthing Center 

ROSELIE C.
RODICOL

PEDIATRICIAN OBSTETRICIAN SONOLOGIST

ON-CALL ON-CALL ON-CALL

MARITES C.
BAHIAN

MARY JANE C.
BELENO

AUBREY D.
NUÑE

SUSAN L.
SURALTA

MIDWIFE

WACTHMAN STUDENT
INTERN

NoteA !dditional staff will be hired once the business is already established

7usiness >3periences and ualifications of Proponents

The e3periences# trainings and seminar attended by the proponents are

considered e3cellent factor;s in business success The course ta4en by the

proponents are in line with birthing management which will be a big factor in the
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success of business Through their e3perience# the proponents believe that

these can give them that much needed self*confidence to enable them to carry

their individual tas4

Table ' Unit 6anagement Personnel

Unit 6anagement Time to be ualification Compensation
Personnel devoted to the
pro9ect and duties
Principal 6idwife *'% hours * 6aster;s Degree P '&#&&&&&
*6anages and holder# 7+6# R6 plus fringe
oversees the *Competent benefits
operation of the Personality
business
Pediatrician on*call *=icense Pediatric Php )&& per new
*%/ hour cover of 6edicine born
the clinic Physician
*6anage the *Competent
immediate Personality
newborn care
O7*:yne On*call *=icense O7*:yne Php #)&& per
Consultant *%/ hour cover of 6edicine mother or )&& per
the clinic Physician consultation
*6anage the *Competent
maternal care Personality
Ultrasound Part*time *=icense Php %&& per
+onologist * . hours duty +onologist ultrasound
* Ultrasound In*
charge
+4illed 6idwife *'% hours =icensed 6idwife Php.#&&& per
* responsible for month plus fringe
maternal and benefit
immediate new
born care
 "

Table % =abor +4ills Re<uirement

=abor +4ills Number of  ualification Compensation
Re<uired Re<uired +4illed
=abor 
Eatchman ' "igh +chool P /#&&&&& per 
:raduate month plus fringe
7asic Police benefit
Training

+tudent InternA +econd year 6idwifery +!IT student

ProtocolA
FObserve
F!ssist
FResearch
F>3perience

+upport groupsA

• Eomen;s =eague

SAIT -#$%&&'

+hift rotationsA

• +taff are divided according to schedule ,'% hours per duty-

• >ight hours only for security and house4eeper 

Recruitment Program

The recruitment will be simple In case the clinic is under staff# the center 

will hire on*call midwife to facilitate under staff while hiring is underta4ing "iring

scheme will be post in the internet and applicants will submit their application#

bio*data and re<uirements via e*mail at

motherschoicebirthingcenterGyahoocom  The applicants will undergo a written

and practical e3amination to gauge their mental capacity and 4now if they had

the s4ills to carry out the wor4 Once they will pass# the principal midwife will
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conduct character reference of the person =astly# there will be a final interview

to choose the best applicant for the position

Training Program

The goal of the training program in the company is to develop specific

s4ills# attitude and capacities to ma3imi2e the individual;s 9ob performance

Hirtually# every employee in the company will undergo some degree of training

programs# either formal or informal 6D: trainings includeA Partograph# IH

insertion# neonatal resuscitation# breastfeeding# basic life support# post partum

hemorrhage and immediate newborn care

?ringe 7enefits

7elow are the fringe benefits offered by the company will be as followsA

* ?ull coverage on +++# Philhealth and Pag*I7I:

* !nnual vacation leave and sic4 leave for ') days with pay

* 'th month bonus

* Retirement Pac4age

* Commission

?acilities

The facilities of the birthing clinic based on Department of "ealth ,DO"-

re<uirement will be the followingA

• Toilet and bathing facilities for mother and baby

• %/ hour supply of clean and hot water

 1)

• >lectricity supply ,including emergency lighting-

• %/ hour refrigerator for storing medicines

• ><uipment in satisfactory condition

• One patient bed per room for private type

• +even pt in ward with curtain and dividers to provide patient privacy for

each room

• >ach room must have bright lighting

• O3ygen tan4 and supply available in the delivery room# must be secured

to solid ob9ect

•  !de<uate prevention from occupational ha2ards

• No animals in the clinic

•  !ll windows and doors should be covered with a minimum in a net

covering

• +ufficient ventilation

•  !bsolutely no smo4ing on the premises with an obvious sign at front des4

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Table  Pre*Operating !ctivities

 !ctivities Number of Eee4s

Preparation of the Pro9ect ?easibility +tudy /
Registration of the 7usiness ,+>C# DTI# Philhealth- /
7usiness Permit %
Construction of the 7uilding %/
Purchase of the ><uipment /
+etting*up of the ><uipment /
Purchases of facilities and office supplies /
"iring of wor4ers %
NoteA It is e3pected by the proponents that at the end of one year preparation#

the birthing center will fully operate after the completion of pre*operating

activities

Table / Pre*operating >3penses

 !ctivities Initial !mount Needed

Preparation of the Pro9ect ?easibility +tudy P )#&&&&&
Registration of the 7usiness ,+>C# DTI# Philhealth- %#)&&&&
7usiness Permit )#&&&&&
Renovation of the 7uilding /.&#&&&&&
Purchase of the ><uipment %'#1%&&&
+etting*up of the ><uipment /#&&&&&
Purchases of facilities and office supplies #&&&&&
Purchases of 6edicine '#1(&&&
"iring of wor4ers '#&&&&&
Initial Total !mount Needed P )%#.'&&&
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6!R>TIN: ?>!+I7I=IT@

This aspect is considered as the lifeblood of virtually pro9ected feasibility

study for the e3tent of the data and information gathering because the

succeeding aspects depend largely on it This serves as the basis of the

financial section through pro9ected demand It includes the following informationA

demand and supply gap analysis# mar4eting program and the pro9ected number 

of clients The ob9ective of this study is to determine the <uantity of clients

needed to maintain the operation of the mother;s choice birthing center

7elow is the presentation of 7u4idnon map highlighting 6aramag#

7u4idnon where proponents would li4e to serve +outh Poblacion where Camp '

is located The said area has no available birthing center and far from the

hospitals and clinic in Poblacion# 6aramag# 7u4idnon In addition# Camp '#

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6aramag# 7u4idnon is a cross section between ue2on and Don Carlos#

7u4idnon with a bigger population

Table ) +upply and Demand :ap !nalysis

 !rea Population Pregnant Potential Potential Clients

,%&'&- Eoman Clients +hare
6aramag (&#(&' J#1) #&)/ %J)
ue2on (/#)./ J#(/) #'J. %.1
Don Carlos 1/#/ )#/&/ %#'1' '(/
+ourceA N+O $anuary %&' uic4stat

 !ssumptionsA

• It is e3pected that ./K of the total female population gave birth in a year 

• It is e3pected that there will be /&K potential clients# since it is already

prohibited by DO" to deliver the baby at home

•  Eith /&K potential clients to be served by birthing clinic# the proponents

will serve (K only during the first year of its operation

6a9or Clients
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Catchment !reaA Camp '# 6aramag 7u4idnon and the nearby community

living %& 4m in diameter# appro3imately These will include the nearby barangays

of Don Carlos and ue2on# 7u4idnon In addition# clients served are those who

cannot afford to give birth in the hospitals and can only afford the birthing center 

rates

Criteria for !dmission to 7irthing Center ,7ased on Phil health 6andate-

• =ow ris4 pregnancies only

•  !ge '(*/)

• :estation J*/' wee4s

• No significant co*morbidities

• No previous caesarean sections

• No current pregnancy complications

• "ave pre*natal during ' st trimester# % nd trimester and twice in  rd trimester 

• "as had all the necessary blood tests and investigations eg full blood

count# urea and electrolytes# and infection screening

• Eith or without Phil health

Criteria for dis<ualification for admission in 7irthing Center

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,7ased on Phil health 6andate-

FEith high blood pressure

FEith diabetes
F6alformation
F6ulti*pregnancy
FEith previous caesarean section
FEith previous complication ,below is the detailed list-

Table 1 >numeration of Previous Complications

Previous
complications • Une3plained stillbirthLneonatal death or previous
death related to intrapartum difficulty

• Previous baby with neonatal encephalopathy

• Pre*eclampsia re<uiring preterm birth

• Placental abruption with adverse outcome

• >clampsia

• Uterine rupture

• Primary postpartum hemorrhage re<uiring

additional treatment or blood transfusion

• Retained placenta re<uiring manual removal in

theatre

• +houlder dystocia

• "istory of previous baby more than /) 4g

• >3tensive vaginal# cervical# or third* or fourth*

degree perineal trauma

• Placenta previa

•  !bruptio placenta
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• +till birth

uality of +ervice

The proponents will ensure that the proposed birthing center will provide

the best <uality service Price offered is affordable compared to hospitals ,noteA

specific services are put into detail in the technical feasibility study section-

Terms of Payment

?or Phil health patient# the client;s full payment will be charged from their 

Phil health Insurance

?or Non*Phil health patient# the clients may pay partial down payment

during admittance or full payment will be made before patient will be discharged

=ocation of the 7irthing Center 

6other;s Choice 7irthing Center will be located in Camp '# 6aramag#

7u4idnon

>mergency Hehicle

%/ hour availability of vehicle to allow prompt transfer to hospital in case of 

complications or comple3 care Thus# collaboration is deemed necessary

Collaboration for transfer# partner with nearby hospitalsA 7P" 6aramag

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6oreover# the proponents will provide a %/LJ transportation facilities for 

immediate response for those patient who would li4e to be pic4ed*up

Promotional or !dvertising +cheme to be adopted

The promotional or advertising schemes to be adopted by the proponents

are the followingA leafleting in the nearby 7arangay for the information about the

mother;s choice birthing center# referral fee of Php )&&&& per referral and radio

advertisement for the first month of operation

Table J Promotional or !dvertising +cheme to be adopted

Particulars !mount
=eafleting P '#&&&&&
Radio !dvertisement /#&&&&&
Referral ?ee per month %#&&&&&
Total !mount P J#&&&&&

Contribution to the Philippine >conomy

The opening of the 6other;s Choice 7irthing Center in Camp '# 6aramag

7u4idnon will provide birthing facility in the +outh of Poblacion# 6aramag#

7u4idnon and will provide more convenience and basic health services needed

by pregnant woman who needs more attentive care during the nine months of 

pregnancy as well as the immediate care for newborn babies

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:overnment will be facilitated by lowering the percentage of pregnant

woman and new born child from mortality rate and additional ta3 for the operation

of the said birthing center

The immediate community will be given full health access for pregnant

woman and new born babies at a very affordable price

T>C"NIC!= ?>!+I7I=IT@

This aspect determines to what e3tent the pro9ect meets the technical

soundness criteria The technical re<uirements of the pro9ect will be analy2ed

Description of the Pro9ect

The pro9ect will be named as 6other;s Choice 7irthing Center under the

management of licensed and e3perienced midwives with the assistance of 

licensed and e3perienced pediatrician and ob*gyne physicians

Description of the !rea

6inimum of && 3 ') s<uare feet

,building and facility re<uirements is under the Department of "ealth prescription-

• Toilet and ade<uate bathing facilities for mother and baby

• %/ hour supply of clean and hot water and electricity supply ,including

emergency lighting-

• %/ hour refrigerator for storing medicines

 1(

• ><uipment in satisfactory condition

• One patient bed per room for private type

• +even pt in ward with curtain and dividers to provide patient privacy for

each room

• >ach room must have bright lighting

• O3ygen tan4 and supply to the delivery room# must be secured to solid

ob9ect

•  !de<uate prevention from occupational ha2ards

• No animals in the clinic

•  !ll windows and doors should be covered with a minimum of a net

covering

• +ufficient ventilation

•  !bsolutely no smo4ing on the premises with an obvious sign at front des4

Cleaning and +anitationA

• Daily thorough cleaning of facilities with the use of a regimented chec4list

 2)

• Cleaning of individual patient areas after every use eg wiping down beds

and cleaning up any spillage of body fluids

• Individual disposal bins for sharp e<uipment# clinical waste and household

general waste with ideally a safe and environmentally friendly method of 

discard

• +ufficient plumbing and drainage facilities

• "and washing sin4s and alcohol gel to be located near clinical wor4station

•  ! dirty utility room for dirty linen and sanitary waste

•  ! clean linen closet and laundry bag

•  ! sterile laundry facility

•  !de<uate method of sterili2ation of reusable instruments eg autoclave

• Thorough hand washing with water and soap before and after each and

every patient contact including before and after each patient intervention

or procedure !lcohol gel to be applied on entering and leaving the

birthing center 

6other;s Choice 7irthing Center Confidentiality +tatement

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 !t 6other;s Choice 7irthing Center# our goal is to provide the best possible

security and privacy measures for each patient !ll patient reports# documents#

lab values# and information will be 4ept confidential by the staff of 6other;s

Choice 7irthing Center Prior to the release of any information# the patient will

first be as4ed for permission to disclose sensitive material to e3ternal parties

+taff members not associated with the patient;s care are not allowed to review

records !ll records will be 4ept for the duration of the patient;s life# after which

time the records will be destroyed to protect confidentiality !ll records will be

4ept in a loc4ed# secure area of the clinic with no public access

 !ntenatal Care

Patients should be given a choice at outset of care to have their birth at

6other Choice 7irthing Center or in the hospital They should be educated that if 

something goes wrong during their labor# outcomes for the woman and baby may

be better in an obstetrics unit at hospital Obstetric units may be able to provide

direct access to obstetricians# anesthetists# neonatologists and other speciali2ed

care# including epidural analgesia !t any point during pregnancy or delivery#

they may need to be transferred to a hospital for emergency treatment

 !ntenatal :uidelines

?irst HisitA Ehen the mother first reali2es she is pregnant

Patient +creening uestionnaire

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>ducation for the 6otherA

 M "ow the baby develops during pregnancy M government poster 

 M :eneral !dvice !bout Ehat to >3pect During a "ealthy Pregnancy

 M eeping "ealthy Ehile Pregnant

 M Danger +igns during Pregnancy

  7irth plan

• =aboratory Test Re<uirementsA

 M "emoglobin

 M "epatitis 7

 M 7lood glucose

Hitamin +upplementation and 6edications

 M ?olic !cid /&& mcg per day until the '%th wee4 of pregnancyA this helps

prevent neural tube defects

 M Iron supplements should not be offered routinelyA give only if anemic or 

hemoglobin ''gL'&&m=

 M 6ultivitamins

+econd HisitA 7etween '.*%& Eee4s

• ?ollow up with first visit and ma4e sure patient has completed re<uired

tests
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• Continue to record observations# H+# weight# fundal height# and any

problems or concerns the e3pecting mother may have

• =absA 7lood :lucose

• 6a4e plan for ne3t visit

Third HisitA 7etween %/*%. wee4s

• ?ollow*up with second visit

• Continue !ntenatal ?low Chart and record observations# vital signs#

weight# fundal height# and any problems or concern the e3pecting mother 

may have

=aboratory Test Re<uirementA

 M "emoglobin

 M UrineA proteinurea

 M 7lood glucose

 M Oral :lucose Tolerance Test ,O:TT-

  Ultrasound

?ourth HisitA 7etween %*1 Eee4s

• ?ollow up with third visit

• Continue record observations# vital signs# weight# fundal height# and fetal

presentation
 24

 M If fetus is found to be malpositioned through palpation# a confirmation must

be done by ultrasound

 M If it is confirmed by ultrasound# give the woman a choice to follow up in one

to two wee4s for a repeat ultrasound to chec4 fetal position If at that time the

fetus is still malpositioned the woman should be referred to the nearest hospital

and told she may not give birth at the clinic0 however all post natal care from the

1 wee4 baby chec4 on are still available to her

• =aboratory Test Re<uirementA

 M "emoglobinA

NormalA '&

If hemoglobin '&# the woman should be referred to hospital for her birth# as low

"b signifies a greater probability of bleeding during birth and the possible need

for blood products which the clinic cannot provide

• Discuss upcoming delivery with the woman and go over any concerns or 

<uestions she may have

• >ncourage financial planning and discuss costs

• >ncourage prompt mobili2ation towards the birthing centre as soon as

they feel the beginning stages of labor

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• Discuss the possibility that they may not be able to give birth at the clinic#

should there any complications with their labor

Other HisitsA

Reasons for e3tra visits include# but are not limited toA high blood

pressure# pain in abdomen# and e3tra blood sugar chec4s

• Other visits should be at the discretion of the patient and the +7!

providing antenatal care

Intrapartum Care

•  !dmission only if in established labor 

• +ign consent form for admission

?irst +tage of =abor 

DefinitionsA

• =atent first stage of laborA ! period of time# not necessarily continuous#

whenA there are painful contractions and some cervical change# including

cervical effacement and dilatation up to / cm

• >stablished first stage of laborA Ehen there are regular painful

contractions and progressive cervical dilatation from / cm

Duration of the first stage laborA

• NulliparousA .*'. hours

 26

• 6ultiparousA )*'% hours

 !ssessment

Initial !ssessment of a woman in labor should includeA

• =istening to her story and review clinical records

• Physical observationA temperature# pulse# blood pressure# urinalysis

• =ength# strength and fre<uency of contractions

•  !bdominal palpationA fundal height# lie# presentation# position and station

• Haginal lossA show# li<uor# blood

•  !ssessment of pain

• ?"R auscultated for a minimum of ' minute immediately after a

contraction

• Haginal e3amination should be offered if woman is in established labor 

IH ?luid access

• % large cannula ,at least '.:L:reen- to be inserted into a patient;s veins

on admission

 !ssessment
 2!

•  ! pictorial record of labor ,partograph- should be used once labor is

established

• Eorld "ealth Organi2ation recommends /*hour action line on partograph#

should one be used

Observations or =abor watch

• Temperature and blood pressure every four hours

• Pulse every hour 

• Documentation of fre<uency of contractions every thirty minutes

• ?re<uency of emptying the bladder 

• Haginal e3amination offered every four hours or where there is concern

about progress or in response to the woman;s wishes ,after abdominal

palpation and assessment of vaginal loss-

• Intermittent auscultation of the fetal heart after a contraction should occur 

for at least one minute# every fifteen minutes# and the rate should be

recorded as an average The maternal pulse should be palpated if a ?"R

abnormality is detected to differentiate the two heart rates Intermittent

auscultation can be underta4en by Doppler ultrasound

+econd +tage of =abor 

 2"

DefinitionsA

• Passive second stage of laborA The finding of full dilatation of the cervi3

prior to or in the absence of involuntary e3pulsive contractions

• Onset of the active second stage of laborA The baby is visible with

e3pulsive contractions and a finding of full dilatation of the cervi3 or other 

signs of full dilatation of the cervi3 !s well as active maternal effort

following confirmation of full dilatation of the cervi3 in the absence of 

e3pulsive contractions

Duration of the second stage labor 

• NulliparousA 7irth would be e3pected to ta4e place within  hours of the

start of the active second stage in most women

•  ! diagnosis of delay in the active second stage should be made when it

has lasted % hours and women should be referred to a healthcare

professional trained to underta4e an operative vaginal birth if birth is not

imminent

• 6ultiparousA 7irth would be e3pected to ta4e place within % hours of the

start of the active second stage in most women

•  ! diagnosis of delay in the active second stage should be made when it

has lasted ' hour and women should be referred to a healthcare

 2(

professional trained to underta4e an operative vaginal birth if birth is not

imminent

Observations

• 7lood pressure and pulse every hour 

• Temperature every four hours

• Haginal e3amination offered every hour in the active second stage or in

response to the woman;s wishes ,after abdominal palpation and

assessment of vaginal loss-

• Documentation of the fre<uency of contractions every hour 

• ?re<uency of emptying the bladder 

• Ongoing consideration of the woman;s emotional and psychological

needs

•  !ssessment of progress should include maternal behavior# effectiveness

of pushing and fetal wellbeing# ta4ing into account fetal position and

station at the onset of the second stage These factors will assist in

deciding the timing of further vaginal e3amination and the need for 

obstetric review
 3)

• Intermittent auscultation of the fetal heart should occur after a contraction

for at least one minute# at least every five minutes The maternal pulse

should be palpated if there is suspected fetal bradycardia or any other 

?"R anomaly to differentiate the two heart rates

• Ongoing consideration should be given to the woman;s position# hydration#

coping strategies and pain relief throughout the second stage

Eomen;s Position and Pushing in the +econd +tage

• Eomen should be discouraged from lying supine or semi*supine in the

second stage of labor and should be encouraged to adopt any other 

position that they find most comfortable

• Eomen should be informed that in the second stage they should be

guided by their own urge to push

• If pushing is ineffective or if re<uested by the woman# strategies to assist

birth can be used# such as support# change of position# emptying of the

bladder and encouragement

Reducing Perineal Trauma

• Perineal massage should not be performed by healthcare professionals in

the second stage of labor

 31

• >ither the Qhands on; ,guarding the perineum and fle3ing the baby;s head-

or the Qhands poised; ,with hands off the perineum and baby;s head but in

readiness- techni<ue can be used to facilitate spontaneous birth

• =idocaine spray should not be used to reduce pain in the second stage of

labor

•  ! routine episiotomy should not be carried out during spontaneous vaginal

birth

• Eomen with a history of severe perineal trauma should be informed that

their ris4 of repeat severe perineal trauma is not increased in a

subse<uent birth# compared with women having their first baby

Third +tage of =abor 

DefinitionsA

• Third stage of laborA the time from the birth of the baby to the e3pulsion of

the placenta and membranes

• Prolonged third stageA over & minutes

Observations

• 7lood pressure and pulse

 32

• Eoman;s general physical condition# as shown by her color# respiration

and her own report of how she feels

• Haginal blood loss

Recommendation

•  !ctive management of the third stage is recommended# which includes the

use of o3ytocin ,'& international units IUS by intramuscular in9ection-#

followed by early clamping and cutting of the cord and controlled cord

traction

• Eomen should be informed that active management of the third stage

reduces the ris4 of maternal hemorrhage and shortens the third stage

• Pulling the cord or palpating the uterus should only be carried out after 

administration of o3ytocin as part of active management

• +tart completing Postnatal Notes

Immediate Cord Care after 7irth

• Ehen the child the cord pulses and is fat and blue# do not cut at this time

•  Place the bay on the mothers chest wrapped in a warm blan4et

•  !fter a while# feel the cord if the pulsation stops then cut
 33

• Change gloves for the n ne3t procedure

Indications for Transfer to 6ore !dvanced "ealthcare ?acility via !mbulance

• Need for continuous electronic fetal monitoring or >?6# indicated byA

• +ignificant meconium*stained li<uor# and this change should also be

considered for light meconium*stained li<uor 

•  !bnormal ?"R detected by intermittent auscultationA less than ''& beats

per minute# greater than '1& bpm# any decelerations after a contraction0 or 

uncertainty of presence of fetal heartbeat

• 6aternal pyre3iaA .&C once or J)C on two occasions % hours apart

• ?resh bleeding starting in labor 

• The woman;s re<uest to be transferred

• Delay in the first or second stages of labor# diagnosed byA

• Cervical dilatation of less than % cm in / hours for first labor 

• Cervical dilatation of less than % cm in / hours or a slowing in the progress

of labor for second or subse<uent labors

• Changes in the strength# duration and fre<uency of uterine contractions

 34

• Re<uest for epidural pain relief 

• Obstetric emergency M antepartum hemorrhage# cord

presentationLprolapsed# postpartum hemorrhage# maternal collapse or a

need for advanced neonatal resuscitation

• Retained placenta that cannot be e3tracted by manual intervention

• 6alpresentation or breech presentation diagnosed for the first time at the

onset of labor# ta4ing into account imminence of birth

• >ither raised diastolic blood pressureA over (& mm"g0 or raised systolic

blood pressureA over '/& mm"g0 on two consecutive readings ta4en &

minutes apart

• Third* or fourth*degree tear or other complicated perineal trauma re<uiring

suturing

• If premature rupture of membranes occurred over %/ hours before onset

of labor 

Care of 6other and 7aby Immediately !fter 7irth

Care of baby
 35

•  !P:!R scores at ' and ) minutes should be recorded for all births If no

respirations# stimulate baby# if stimulation ineffective# begin neonatal

resuscitation

• Obtain baby;s vital signs# see Newborn Hital +igns

• +4in*s4in contact as soon as possible after birth

• 7aby dried and covered in warm dry blan4et

• Initial breastfeeding should be as soon as possible

• 6easurement of head circumference# body temperature and birth weight

should be measured soon after the 'st hour 

•  !n e3amination of the baby should be carried out to ensure no physical

abnormality

•  !pply >rythromycin ointment &)*'K or Tetracycline ointment 'K to both

eyes within ' hour of birth

•  !dminister Hitamin  &) mg I6# within ' hour of birth

• Complete Postnatal Notes

•  !dminister 7C: immuni2ation prior to discharge

 36

• Needs hemoglobin chec4 before discharge

Care of Eoman

• 6easure temperature# pulse# blood pressure# uterine contractions# lochia

• >3amine placenta and membranesA assessment of their condition#

structure# cord vessels and completeness

• >arly assessment of maternal emotionalLpsychological condition

• Record successful voiding of the woman;s bladder within 1 hours post

delivery

• Perineum !ssessment and Repair

• Complete Postnatal Notes

6others who arrive in the immediate postnatal phase

• >nsure patient has been 4nown the antenatal period# has attended all the

re<uired antenatal appointments and has had all the necessary

investigations

• If not# then immediately send mother and baby to nearest hospital via

emergency transportation
 3!

• If vital signs and observations within normal limits# mother and baby may

stay at clinic for further management

• If any of the following occur# mother and baby should be transferred to

nearest hospital

• 6aternal systolic blood pressure greater than '/&# less than (&# or 

diastolic blood pressure greater than (&

• Postpartum hemorrhage# with blood loss greater than )&& ml +ee

6anagement of Postpartum "emorrhage

• 6aternal collapse

• 6aternal Pyre3ia# defined by a temperature of .C or greater 

• Retained placenta

• Third or fourth degree perineal tear 

•  !bnormality of baby

• Neonatal resuscitation re<uired at any point

• Please ensure patient and baby stabili2ed before transferring to hospital

eg IH cannula inserted# fluid resuscitation

 3"

Postnatal Care

Postnatal Care of the 6other 

• Please complete Initial 6other !ssessment form in Postnatal Notes

• :ive oral and demonstrational teaching on breastfeeding within %/ hours

of birth# prior to discharge from birthing centre

7reastfeedingA

• 6other should educate about the important of breastfeeding

Perineal Care

•  !ssess mother for perineal pain# discomfort or stinging# offensive perineal

odor or dyspareunia

• If the mother is e3periencing discomfort# she should be taught that topical

cold therapy provides effective perineal pain relief

• >ncourage perineal hygiene# such as fre<uent sanitary pad changes#

fre<uent hand washing# and daily bathing to 4eep the perineum clean

:eneral !dvice

• +ee to it of 4eeping healthy after giving birth

Postnatal Care of the 7aby

• Complete Initial 7aby !ssessment form in Postnatal Notes

 3(

• Complete full body assessment of baby# if any gross abnormalities#

especially 9aundice# within first %/ hours# baby may need to be referred to

hospital of choice

Prior to Discharge

• Provide mother with chance to as4 any <uestions she may have before

leaving the clinic

• Provide mother with documentation and help if necessary to fill out the

appropriate government forms to be reimbursed for the delivery of her 

baby

Postnatal ?ollow Up

 !ppointment at ?irst Eee4

?ollow Up for the 6other 

•  !s4 about any issues e3perienced and problems encounter li4eA

 M +igns of mastitisA flu*li4e symptoms# red# tender and painful breasts# if 

present# encourage gentle massage of breast# continued feeding# paracetamol

for discomfort and increased fluid inta4e

 M Constipation and hemorrhoidsA if no bowel movement three days after birth#

give patient a gentle la3ative# encourage increased dietary fiber and fluid
 4)

consumption in both cases# and encourage cold pac4s and paracetamol for pain

management

 M Urinary incontinenceA if this is an issue# give teaching on eagel e3ercises

 M ?atigueA if e3periencing e3cessive fatigue# review birthing events and

antepartum history# if any signs indicate hemorrhage# chec4 mother;s

hemoglobin

 M >motional wellbeingA encourage the mother to communicate any changes in

mood# emotional state or behavior that seem abnormal to her 

• Discuss plans for contraception following birth and encourage the mother 

to abstain from se3ual intercourse for si3 wee4s postpartum

?ollow Up for the 7aby

• 7abies should be assessed forA temperature# heart rate# respiratory rate#

color# regular urination and stooling# general appetite and breast mil4

inta4e# body tone# and irritability

•  !ssess for 9aundice# pale stools and dar4 urine If present assess severity#

if acute 9aundice present# refer to hospital

 41

 !ppointment at +i3th Eee4 *for immuni2ation

• Perform a complete physical assessment of the baby# as outlined in the

Complete Physical !ssessment of the 7aby and assess social smiling and

visual fi3ing at this time as well

•  !s4 about any concerns the mother has had about her child since the last

appointment

•  !dminister OPH '# Pentavalent ' and Rotare3 '

 !ppointment at Tenth Eee4

?ollow Up for the 6other 

•  !s4 about any concerns the mother has had since the previous

appointment

• Continue to manage concerns that have arisen previously

?ollow Up for the 7aby

•  !s4 about any concerns the mother has had about the child since the last

appointment

• Continue to manage concerns that have arisen previously

 42

• 6easure and plot height and weight on growth chart

•  !dminister OPH % # Pentavalent % and Rotare3 %

 !ppointment at ?ourteenth Eee4

•  !dminister OPH and Pentavalent 

 !ppointment at +i3th 6onth

• 6easure and plot baby;s height and weight in growth chart

 !ppointment at Ninth 6onth

•  !dminister 6easles immuni2ation to baby and vitamin !

 !ctual 7uilding of the 6other;s Choice 7irthing Center 

 43

Proposed ?loor Plan '%*7ed Eard

 44

Table J >3pected !ttainable Clients

 !rea $un $ul !ug +ep Oct Nov Dec $an ?eb 6ar !pr 6ay Total

6 '' '' '' '' '' '' '' '' '' '' '' '' '%

 '% '% '% '% '% '% '% '% '% '% '% '% '//

D . . . . . . . . . . . . (1

Total ' ' ' ' ' ' ' ' ' ' ' ' J%

 !ssumptionsA

 !n increase of '1K of clients per year or an e<uivalent of additional /

clients in a year will be reali2ed on the second year

>ffect of =ayout on Eor4 ?low

The effect of layout on wor4 flow will be smooth# convenient# thus resulting

for efficient and effective care for mother and baby

 45

Provision for >3pansion

During the five years initial operations# partners agreed to focus more on

area penetration and long*term profit ma3imi2ation and established good

relationship toward the clients to address and respond immediately to their need

and demand Provision for e3pansion will be planned as business will grow and

become stable

+tructure

The structure will be fully concreted and will be build according to

government re<uirement to prevent ha2ard

Easte Disposal

There will be a separate trash can for biodegradable# non*biodegradable

and infectious items 7iodegradable waste will be disposed in a compose pit

Non*biodegradable waste will be sold in 9un4 shops ?or Infectious Items

,+harps and 7ioha2ard Disposal- will be disposed as followsA !ll sharps including

needles# finger stic4s# glass# ampules# IH supplies# and specimen containers will

be disposed of in a puncture proof plastic container provided by the clinic >ach

container when full will be disposed of in a  meter deep hole# at least %& meters

from the nearest water supply and building# as recommended by DO"

7ioha2ardous material including blood and birthing by*products should be

 46

disposed of via incineration# or disposed of by the same method as detailed

above

?IN!NCI!= ?>!+I7I=IT@

This chapter shows the financial performance and resources of the

proposed pro9ect This includesA financial statements and financial ratios that

enable the proponents to determine the li<uidity# profitability# stability of the

pro9ect and the proponents ability to pay its financial obligations It will give

substantial information as basic for the establishment of the proposed pro9ect

Table . 6onthly Pro9ected Cost

Particulars !mount ,in Php-

Ultrasound Rental %#&&&&&
7uilding !morti2ation ,?inance- '#1&&&&
=ot Rental %#&&&&&
Eater and >lectricity 7ill )#)&&&&
6idwife +alary ,)- /&#&&&&&
Principal 6idwife '&#&&&&&
Ob*:yne ,Consultation- ')#)&&&&
Pediatrician ,consultation- ')#)&&&&
+upplies '#(&&&&
Eatchman /#&&&&&
Total (.#&&&&&

Unit Cost per Patient

Unit Cost  Total Cost L Total no of clients

 (.#&&&L'

 #'1'%(

6ar4*up  %)K
 4!

Unit Price per Patient  .#&&&&&

Table . ><uipment

Particulars ty 6onthly @early

N+HD set / P /&&&&& P /&&&&&

+tethoscope ' )&&&& )&&&&

Eeighing scale ' '&&&&& '&&&&&

7lood pressure ' )&&&& )&&&&

apparatus

Thermometer  &&&& &&&&

Doppler ' ')#&&&&& ')#&&&&&

6easuring tape ' %&&& %&&&

elly pad ' %&&&& %&&&&

:oose nec4 lamp ' &&&& &&&&

Tourni<uet ' )&&& )&&&

Total P %'#.J&&& P %'#.J&&&

Table ( +upply

Particulars ty 6onthly @early

mas4 P )&&& P 1&&&&

soap '&&&& '#%&&&&

 4"

bleach J&&& ./&&&

paper ')&&& '#.&&&&

ball pen )&&& 1&&&&

cotton '&&&& '#%&&&&

gau2e '&&&& '#%&&&&

glove '&&&& '#%&&&&

umbilical cord )&&& 1&&&&

alcohol '&&&& '#%&&&&

y 9elly '&&&& 1&&&&

syringe ')&&& '#.&&&&

Total P '#'%&&& P '#//&&&

Table '& 6edicine

Particulars ty 6onthly @early

Paracetamol P (&&&
P '#&.&&&
!nti*inflammatory &&&&
  #1&&&&
 !ntiemetic %&&&&
  %#/&&&&
 4(

O3ytocin )&&&&
  1#&&&&&
Hit 4 %&&&&
  %#/&&&&
>rythromycin &&&&
  #1&&&&
 !lbenda2ole '&&&&
  '#%&&&&

Total P '#1(&&& P %&#%.&&&

Table '' Rental >3pense

Particulars 6onthly @early

Ultrasound Rental P %#&&&&&
P %/#&&&&&
=and Rental %#&&&&&
  %/#&&&&&
 !morti2ation ,7uilding- %#&&&&&
%/#&&&&&

Total P 1#&&&&& P J%#&&&&&

NoteA

• Ultrasound will be lend from :> company at Php %#&&&&&Lmonth payable

for %& years
• Old 7uilding will be renovated through =and 7an4 loan amounting to Php
/.&#&&&&&

Table '% Ultrasound Income

Particulars ty 6onthly @early

?irst Tri G 1&& ' P '.#1&&&&
P %%#%&&&&
+econd Tri G /)& ' '#()&&&
'1J#/&&&&
Third Tri G /)& ' '#()&&&
'1J#/&&&&
Total P /1#)&&&&
  )).#&&&&&
 5)

=essA

+onologist ?ee ' '.#1&&&&

P %%#%&&&&
Net Income P %J#(&&&&
/#.&&&&
=essA Rental %#&&&&&
%/#&&&&&

Net Income after Rental ?ee P %)#(&&&& '&#.&&&&

Table '+chedule for +alaries and Eages

Particulars ty 6onthly @early

Principal 6idwife ' P '&#&&&&&
P '%&#&&&&&
6idwives ) /&#&&&&&
/.&#&&&&&
Eatchman % .#&&&&&
  (1#&&&&&
Pediatrician ' ')#)&&&&
'.1#&&&&&
Ob*:yne ' ')#)&&&&
  '.1#&&&&&
+onologist ' '.#1&&&&
  %%#%&&&&

Total P '&J#1&&&& P '#%('#%&&&&

6other;s Choice 7irthing Center 

Pro9ected Income +tatement
?or ' Myear 

Table '/ Pro9ected Income +tatement of 6other;s Choice 7irthing Center 

Particulars @ear '
:ross Profit #%%/#&&&&&
 !ddA Ultrasound Income )).#&&&&&
 51

Total :ross Profit #J.%#&&&&&

=essA >3penses
+alaries and Eages '#%('#%&&&&
 !dvertising J#&&&&&
Rental >3pense /.#&&&&&
 !morti2ation >3pense %/#&&&&&
Ultrasound Rental %/#&&&&&
><uipment %'#.J&&&
+upply '#//&&&
6edicine %&#%.&&&
Total >3penses '#//(#J(&&&
Net Income %#%#%'&&&
=essA Income Ta3 ,&K- 1((#11&&
Net Income after Ta3 '#1%#)/J&&

6other;s Choice 7irthing Center 

Pro9ected Cash ?low +tatement
?or ' Myear 

Table ') Pro9ected Cash ?low +tatement of 6other;s Choice 7irthing Center 
Particulars Pre*operating Period @ear '
Cash Inflow
Owner;s Capital )%#.'&&&
:ross Profit #J.%#&&&&&
Total Cash Inflow /#&)#.'&&&
=essA Cash Outflow
+alaries and Eages '#%('#%&&&&
 !dvertising J#&&&&&
Rental >3pense /.#&&&&&
 !morti2ation >3pense %/#&&&&&
Ultrasound Rental %/#&&&&&
><uipment %'#.J&&&
+upply '#//&&&
6edicine %&#%.&&&
Income Ta3 1((#11&&
Total Cash Outflow %#'/(#/)&&
Cash 7alance >nding %#')1#)J&&
 52

6other;s Choice 7irthing Center 

Pro9ected 7alance +heet
?or ' Myear 

Table ') Pro9ected 7alance +heet of 6other;s Choice 7irthing Center 

Particulars !mount ,Php-
Cash on 7an4 %#&&&#&&&&&
Cash on "and ')1#)J&&
Total !ssets %#')1#)J&&

=iabilities /.&#&&&&&
 !ddA Capital /#.'&&&
 !ddA Net Income '#1%#)/J&&
Total =iabilities and Capital %#')1#)J&&

?inancial !nalysis and InterpretationA

Profit 6argin

 Net Income
  +ales

 '#1%#)/J&&
  #J.%#&&&&&

 &/'J or /'JK

 !nalysis and InterpretationA

The profit margin shows that for every '&& sales# there is a net profit

margin of / centavo This means that during the first year of operation the

birthing center will be able to earn /K net profit considering also that various

e3penses were incurred during the pre*operating period

 53

Return on Investment

 Net Income
  Investment

 '#1%#)/J&&
  )%#.'&&&

 ''

 !nalysis and Interpretation

It is e3pected that for every '&& peso invested by the proponents# the

birthing center can return '' pesos during the first year of operation

Paybac4 Period

 Investment
!nnual Cash Returns

 )%#.'&&&
  #J.%#&&&&&

 &'. or '.K

It reflects that the company can repay its invested capital during the first

year of its operation

ConclusionsA