Republic of the Philippines

NORTHERN NEGROS STATE COLLEGE OF SCIENCE & TECHNOLOGY

College of Nursing and Allied Health Sciences
Brgy. Rizal, Sagay City, Negros Occidental
(034)722-4120, www.nonescost.edu.ph
ISO 9001:2015
Certfied

SKILLS FOR NORMAL VAGINAL DELIVERY (NSVD)

CLINICAL PERFORMANCE EVALUATION

Name of Student: _____________________ Year/Section__________ Date Performed: _____________

3 2 1
PROCEDURE:
1. Prepares supplies completely (sterile scissors, cord tie, clean blanket, sterile gloves, etc.)
2. Check the room temperature.
3. Explains the procedure to the patient, allows the woman to adopt the most comfortable position.
4. Washes hands, forearm thoroughly with soap and water.
5. Puts on double gloves, gown.
6. Cleans the perineum with antiseptic solution.
7. Applies clean drapes.
8. Encourages the woman to bear down as desired.
9. Supports the perineum at crowning with both hands and allow the head to gradually extend.
10. Allows external rotation of the head to occur spontaneously.
11. Assists in the completion of birth.
a. Feel if there is cord around the baby’s neck, slide it through the shoulder, if tight, doubly clamp
the cord and clamp
b. Slide one hand towards the baby’s ankles.
c. Record the time of birth.
d. Put the baby on the mother’s abdomen head facing down.
e. Dry the baby with clean towel and wipe the baby’s eyes with clean cloth.
12. Assessing the baby
a. Observe the baby’s breathing.
b. Place the baby in skin to skin contact on the mother’s abdomen and cover with clean towel
c. Put on the baby’s bonnet.
d. Remove first pair of gloves
e. Feel for the cord pulsation, when it stops, clamp the cord using sterile plastic cord clamp 2 cm.
from the base.
f. Apply sterile forceps/clamp 5 cm. from the base.
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. Check the blood pressure of the mother.
15. Inject 10 units ( 1 amp) oxytocin deep IM.
16. Inspect the vagina and perineum for laceration and suture if necessary.
17. Monitor the mother’s vital signs every 15 minutes, check amount of bleeding. Massage the uterus from
time to time.
18. Monitor the baby’s vital signs, breathing, color, signs of readiness for breastfeeding in at least 15
minutes. Make sure both of them are comfortable.
19. Give prophylactic eye care to the baby and Vitamin K (1mg/0.1) deep IM within 1 hour after birth.
20. Administer Hepatitis B birth dose 0.5 cc IM, antero-lateral thigh, within 24 hours after delivery.
21. Properly disinfects instruments and gloves. Proper disposal of soaked linens and placenta.
TOTAL SCORE
LEGEND: 3- SKILLFULLY DONE- Demonstrated correctly according to standard, has adequate knowledge and exhibited appropriate attitude.
2- NOT SKILLFULLY DONE- Demonstrated, but not according to standard, has minimal knowledge and exhibited appropriate attitude.
1- NOT DONE- Not demonstrated at any time.

Comments: ______________________________________________________________________________
________________________________________________________________________________________
Name and Signature of the Student: _________________________Date of Demonstration: _____________

Clinical Instructor Name and Signature: _______________________________ Date ___________________