UNIVERSITY OF BOHOL

0186 Dr. Cecilio Putong Street, Tagbilaran City, Bohol 6300

www.universityofbohol.edu.ph
trunk line (038) 4 11-3101
COLLEGE OF NURSING

CHECKLIST FOR INTRAPARTAL CARE

Didactics

Name: ________________________ Group/Yr/Section: ________________ Date:

__________

Instruction: Please check () on the space provided to assure whether the participant
is able to perform the procedure correctly or incorrectly.

WEIGHT
DESCRIPTION MEANING
VALUE
2 Competent Students performs correctly the
procedure
1 Needs Improvement Performance is too slow to judge
satisfactorily
0 Not Performed Procedure/Step not done

PROCEDURE 2 1 0
At Labor Room
1. Receive patient safely while providing privacy via stretcher
or wheelchair and ushered to bed. Introduce yourself and
establish rapport.
2. Assist patient to assume comfortable position.
3. Monitor the progress of labour/uterine contractions as to:
a. Frequency
b. Duration
c. Intensity
d. Interval
Record data on the Labor Watch Flowsheet.
4. Observe for membrane/bag of water (BOW) status
whether intact or ruptured.
5. Coach mother on breathing techniques and effective
pushing.
6. Educate patient on the importance of breastfeeding.
At the Delivery Room
7. Receive patient safely while providing privacy via stretcher
or wheelchair, ushered to delivery table. Introduce yourself
and establish rapport.
8. Securely place the under pads on the delivery table.
9. Assist patient to assume semi-upright/lithotomy position.
Remove diaper if necessary.
10. Obtain baseline FHT.
11. Prepare the following:
a. room, instruments and equipment needed
b. sterile DR pack (identify primigravida and
multigravida pack)
c. Add accessories and instruments excluded in pack:
For primigravida
 2 scissors
 Plastic clamp
 OS
Note: Local anesthetics, sutures, 10 cc syringe –
optional for primigravida
For multigravida
 Scissors
 Plastic clamp
 OS
12. Observe proper usage of disinfectant to maintain sterility.
13. Performs perineal care using sterile technique.
14. Don two pairs of sterile gloves according to hospital policy.
15. Arrange instruments and accessories according to use.
Keep your table clean and orderly.
16. Drape aseptically a pair of leggings. Put it to the left leg
first, then to right leg and extend it to abdomen.
17. Place the first towel just above the abdomen. Observe for
crowning of the head.
18. Properly offer a pair of scissors to the physician for
episiotomy.
19. Support the perineum with supporting towel until the
delivery of the baby’s BODY.
20. Call out time of birth. (eg. Baby Boy out 10:10 am)
21. Discard/drop the support towel.
Delivery of baby and Placenta – EINC Protocol
22. Start time bound procedures routinely by placing the baby
on the mother’s abdomen.
23. Feel the cord pulsations (1 – 3 minutes) while maintaining
 skin to skin contact
24. Notify if pulsations STOP.
25. Offer the plastic cord clamp, Kelly forceps and scissors.
26. Identify signs of placental separation. These are:
a. Change in shape of the uterus (globular shape)
b. Appearance of placenta at the vaginal opening
c. Lengthening of umbilical cord
d. Firm uterine contractions
e. Sudden gush of vaginal blood
27. Check the characteristics/completeness of the placenta
(Schultz and Duncan) placed on the kidney basin.
Check blood pressure once expelled.
28. Prepare for the administration of drugs: 10 units oxytocin
IM and/or 10 units oxytocin incorporate to IV then regulate
to 20 drops per minute.
29. Assist in uterine exploration.
30. Place third towel/buttocks towel under the buttocks to
widen area of sterility.
31. Remove first set of gloves aseptically to prepare for
episiorrhaphy.
32. Assist physician in episiorrhaphy.
33. Remove the buttocks towel and perform perineal care with
betadine antiseptic.
34. Do after care.
35. Observe proper documentation of carried orders regarding
patient’s treatment.
36. Patient brought to the ward per stretcher in fair condition.
TOTAL
PERCENTAGE
EQUIVALENT

UNIVERSITY OF BOHOL
 0186 Dr. Cecilio Putong Street, Tagbilaran City, Bohol 6300
www.universityofbohol.edu.ph
trunk line (038) 4 11-3101
COLLEGE OF NURSING

CHECKLIST FOR IMMEDIATE CARE OF THE NEWBORN

Didactics

Name: ________________________ Group/Yr/Section: ________________ Date:

__________

Instruction: Please check () on the space provided to assure whether the participant
is able to perform the procedure correctly or incorrectly.

WEIGHT
DESCRIPTION MEANING
VALUE
2 Competent Students performs correctly the
procedure
1 Needs Improvement Performance is too low to judge
satisfactorily
0 Not Performed Procedure/Step not done

PROCEDURE 2 1 0
1. Do hand washing.
2. Prepare newborn’s clothing, bonnet and extra linen.
Maintain adequacy of supplies as newborn’s care is
rendered.
3. Maintain warmth. The temperature of the environment
must be 25-28oC.
4. Observe precautionary measures related to the use of
electrical equipment such as gooseneck lamp and
suction machine.
5. Prepare the following:
a. two pairs of sterile gloves
b. plastic cord clamp
c. newborn kit (inclusions: thermometer, cloth
diaper syringes, sterile gloves)
d. erythromycin
e. Vitamin K
f. Hepatitis B shots vaccine
6. Put on both set of gloves aseptically.
 7. Drape aseptically a pair of leggings to mother.
Delivery of Newborn
8. Apply immediate and thorough drying for at least 30
seconds.
9. Establish and maintain patent airways. Do a quick
check of breathing while drying.
10. Drop the first towel.
11. Put newborn on prone position on the mother’s
abdomen or chest. Initiate skin to skin contact.
12. Put on dry linen on back and bonnet.
13. Use the second linen to cover baby and maintain
warmth.
14. Remove first pair of gloves prior to handling of the
cord.
15. Wait for the cord pulsations to stop.
16. Clamp the cord using a cord clamp at about 2cm from
the base of umbilicus.
17. Apply the second clamp (using Kelly curve forcep) at 5
cm from the base of the umbilicus.
Note: Do not pull the cord too much
18. Cut the cord correctly just above the plastic cord
clamp.

19. Take anthropometric measurements including:

a. Head Circumference
b. Chest Circumference
c. Abdominal Circumference
d. Height (cm)
e. Weight (g)
20. Ensure safety while handling the newborn on the
weighing scale. Return the baby on prone position to
mother.
21. Ensure proper identification of newborn. Name tag
must include the following:
a. Gender, Surname
b. Date and time of delivery
c. Name of mother
d. Physician
22. Apply Crede’s prophylaxis on the both eyes (from inner
to outer canthus).
23. Administer Vitamin K (1mg IM) and hepatitis B vaccine
(0.1 ml IM) to the lateral anterior thigh or vastus
lateralis.
24. Put on newborn’s clothing.
25. Take vital signs (temperature per rectum to check
patency). Report any signs of abnormality to the
pediatrician.
26. Document the newborn’s record.
TOTAL
PERCENTAGE
EQUIVALENT