Republic of the Philippines

CAMARINES SUR POLYTECHNIC COLLEGES

Nabua, Camarines Sur

COLLEGE OF HEALTH SCIENCES

Name: ____________________________________ Rating: _______________________
Year and Section: __________________________ Group: _______ Date: ________

PROCEDURAL CHECKLIST
Assisting a Normal Spontaneous Delivery

Instruction: Below is the grading scale which will be used in rating your performance.
5 - Excellent - 95-100
4 - Very Satisfactory - 88-94
3 - Satisfactory - 82-87
2 - Fair - 76-81
1 - Needs Improvement - 70-75

A. EQUIPMENTS
 Primigravida Set (Disposable Syringe, Mayo Scissor, Needle Holder, Forceps, Chromic 2.0,
Cord Clamp, Kidney Basin, Thumb Forcep, Cherry Balls, Petridish, Lidocaine)
 Multigravida Set (Kidney Basin, Mayo Scissors, Forceps, Cord Clamp, Cherries)
 Mayo Stand with Sterile Cover
 Kelly Pad
 2 pails
 3 pieces of linen
 2 pairs of gloves

PROCEDURES 5 4 3 2 1 REMARKS
1. Prepare the necessary equipment and
ensure room warm (25- 28 degree Celsius)
and clean.
2. Position the client in recumbent position.
3. Perineal care done.
4. Provide emotional support.
5. Put on personal protective barriers.
ASSISTING THE BIRTH PROCESS
6. Wash hands and put on 2 pairs of surgical
gloves.
7. Stand in front of the woman in an upright
position.
a. Check for the condition of the
woman.
b. Be sure she has voided.
OBSERVE FOR THE MECHANISM OF
LABOR
8. When the fetal head fits into the large
diameter of maternal pelvis.
ENGAGEMEN 9. The head moves toward the pelvic brim in
T either left or right occipito transverse
(ROT).
10. Allows the widest part of the fetal head, fits
into a widest part of the maternal pelvis.
11. The baby’s descent through the pelvic inlet
DESCENT through the pelvic floor due to:
a. Uterine Contraction
b. Amniotic pressure
Effectivity Date: July 2021 Rev. 2

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 Republic of the Philippines
CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur

COLLEGE OF HEALTH SCIENCES

c. Abdominal muscle contraction
12. The fetal head comes into contact with the
pelvic floor, cervical flexion occurs.
13. Allows the presenting part of the fetus be
suboccipito- bregmatic, the fetal head gas
smaller diameter which assist the passage
through the pelvic.
FLEXION 14. Pelvic floor has a gutter shape with a
forward and down slowly.
15. This allows the head to rotate from the left
or right occipito- transverse position to an
occipito-anterior position.
16. The widest diameter of the fetal head is
successfully negotiated through the
narrowest part of the maternal pelvis.
17. The pelvic floor has a gutter shape with a
forward and down forward slope.
INTERNAL 18. This allows the head to rotate from a left or
ROTATION right occipito- transverse position to an
occipito- anterior position.
19. Occurs when the widest diameter of the
fetal head successfully negotiates through
the narrowest part of the maternal bony
CROWNING pelvis.
20. This is clinically evident even when the
head, visible at the vulva, no longer
retreats between contractions.
21. The occiput slip beneath the supra pubic
arch as the head extends and nape of the
EXTENSION neck is pivoting against the arch.
22. Extension of the head causing stretching
of the perineum.
23. Externally rotates to the face or the right or
left medial thigh of the mother.
EXTERNAL 24. At the same time, the shoulders are totally
ROTATION from a transverse position to an anterior-
posterior position.
25. This realignment of the shoulders with the
head is called restitution.
26. The delivery of the shoulder and the body
DELIVERY OF (downward traction).
THE 27. This assists in the delivery of the anterior
SHOULDER shoulder below the suprapubic arch.
AND THE 28. Upward traction.
BODY 29. Complete delivery of the baby.
30. Place on the mother’s abdomen in a prone
position.

Effectivity Date: July 2021 Rev. 2

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 Republic of the Philippines
CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur

COLLEGE OF HEALTH SCIENCES

REMARKS:
_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

___________________________
CLINICAL INSTRUCTOR/ SIGNATURE

DATE: ___________________________

Effectivity Date: July 2021 Rev. 2

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