Central Mindanao University

University Town, Musuan, Maramag Bukidnon

College of Nursing

PERFORMANCE CHECKLIST

ESSENTIAL INTRAPARTUM and NEWBORN CARE

NAME: ________________________________ RATING: _____________

SEC/GRP: ________________ DATE:_______________

Definition:
ESSENTIAL INTRAPARTUM and NEWBORN CARE :
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Purpose:
ESSENTIAL INTRAPARTUM and NEWBORN CARE:
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Materials needed:
ESSENTIAL INTRAPARTUM and NEWBORN CARE:
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STEPS RATIONALE REMARKS

Preparatory Phase
STAGE 1 - ACTIVE PHASE (4CM-7CM)
Reassess client/mother’s previous medical
1 records if available.

Perform hand washing using soap and water.

2
Determine the scope of assessment needed.
3 Prepare necessary equipment.

Introduce yourself and verify the mother’s

4 identity.

Explain the procedure to the mother.

5
Position the mother comfortably and provide
6 privacy.

Instruct the mother to remove jewelries.

7
Ensure that the mother is in her position of
8
choice when in labor.
Communicate with the mother – inform her of
9 progress of labor, give reassurance and
encouragement.
Check temperature in the DR area and checks
10 for air draft.

Working Phase
STAGE 1 - TRANSITION PHASE (8CM-10CM)
Mother is in the Delivery Room Preparing for Delivery
Instruct the mother to assume Lithotomy
11 position, which is the default position for
delivery.
Perform hand hygiene using 70% alcohol.
12
Done by the Handle Nurse
13 Puts on 2 pairs of sterile gloves aseptically (if
 STEPS RATIONALE REMARKS
same nurse handles the delivery and cord
cutting).
14 Arrange things in the mayo table in a linear
fashion.
Done by the Assistant Nurse
15 Don clean gloving.

16 Cleanse the perineum with antiseptic solution.

STAGE 2 – EXPULSION (DELIVERY OF NEWBORN)

Done by the Handle Nurse
17 Drape the mother’s abdomen with sterile dry
linen in preparation for drying the baby.

18 Don sterile leg drape.

19 Encourage the mother to push as desired with

well contracted uterus.

20 Apply perineal support and do controlled

delivery of the head and body of the baby.

21 Firmly hold the head and neck with the

dominant hand. The other hand (non-
dominant) should support the buttocks of the
baby.
22 Call out time of birth and sex of the baby.

23 Place the baby on the sterile dry cloth in the

mother’s abdomen.

24 Inform the mother of the delivery outcome.

25 Thoroughly dry the baby for at least 30 seconds

starting from the face, head, back, going down
to the trunk and extremities. Simultaneously
assessing the Apgar’s score of the baby (refer
to APGAR Score).
Done by the Assistant Nurse
26 Palpate the mother’s abdomen. Make sure
there is NO second baby prior to giving IM
oxytocin
Give oxytocin IM within 1 minute after the
27 baby's birth.

First 30 Seconds (Immediate and Thorough Drying)

Done by the Newborn Care Nurse
28 Remove the wet cloth.

29 Place the baby on skin-to-skin contact in the

mother’s abdomen.
30 Cover the baby with a clean dry cloth/towel.
31 Covers the baby’s head with a bonnet.

32 Use the wet cloth to wipe the soiled gloves.

33 Disposes the wet cloth properly.

Properly Timed Cord Clamping (1-3mins)

Done by the Handle Nurse
34 Remove the first set of gloves.

35 Palpate umbilical cord to check for pulsations.

36 If pulsations diminished or decreases in

intensity, place the plastic clamp (forceps)
 STEPS RATIONALE REMARKS
2CM from the base of the umbilicus.

37 Apply 2nd clamp 5CM from the base of the

umbilicus. Then cut 1CM above the plastic
clamp.
STAGE 3 – PLACENTAL DELIVERY
38 Perform the remaining steps of the active
management of third stage of labor.
39 Wait for strong uterine contraction then apply
controlled cord traction and counter traction on
the uterus until the placenta is delivered.
40 Deliver the placenta. Call the time of
placental delivery.

Done by the Assistant Nurse

41 Check the BP of the mother after the placenta
was delivered. Record the time and BP.
Done by the Handle Nurse
42 Examine the placenta for completeness and
abnormalities. Dispose the placenta in a leak-
proof container or plastic bag.

43 Inspect the lower vagina and perineum for

lacerations or tears. Repair lacerations/tears
if necessary.

44 Check if the mother’s uterus is contracted.

Massage the uterus until it is firm.

45 Assist mother in changing maternity pad or

adult diaper.

46 Transfer the mother to a stretcher or bed.

Check if the mother is comfortable.

47 Advise the mother to maintain skin-to-skin

contact with the baby.

48 The baby should be in a prone position on the

mother's chest. The head of the baby is in-
between the mother’s breast with the head
turned to one side.
49 Soak and decontaminate instruments in 0.5%
chlorine solution before cleaning or brushing.
50 Rinse the instruments and arrange it properly.

Within 90 Minutes
Done by the Newborn Care Nurse
51 Advise mother to observe for feeding cues.
52 Support mother and instruct her on
positioning and attachment.
53 Look for signs of good attachment and
suckling:
a. Mouth open wide
b. Lower lip turned outwards
c. Baby’s chin touching the breast
d. Suckling is slow, deep with some pauses.
54 Continue skin-to-skin contact while on
breastfeeding.
55 Waits until full breastfeeding is completed.
After a Complete Breast Feeding
56 Weight the baby in kilograms then transfer the
baby to an infant radiant warmer or newborn
crib

57 Perform quick head to toe assessment.

 STEPS RATIONALE REMARKS
58 Take Vital Signs
a. Temperature per rectum
b. Pulse (Make sure to warm the stethoscope
first)
c. Respirations in full minute

59 Do anthropometric measurements
a. Head circumference in cm
b. Chest circumference in cm
c. Abdominal circumference in cm
d. Length in cm
60 Put on identification band.

61 Administer Crede’s prophylaxis to both eyes:

a. Gentamicin/Erythromycin eye drops
b. Tetracycline ointment
(Medication varies among different
institutions)
63 Administer Hepatitis B Vaccine 0.5mL IM via
right vastus lateralis.
64 Administer Vitamin K 1mg IM via left vastus
lateralis.
a. newborns 2.5kgs and above: 1mg
b. newborns below 2.5kgs: 0.5mg
65 Assist mother in doing Kangaroo Mother Care
or Skin-to-skin Contact.

66 Room in. Give health teachings on

breastfeeding per demand and about danger
signs.
67 In the first hour, check the baby’s breathing
and color; and check the mother's vital signs
every 15 minutes. Maintain uterine
contraction by massage.
68 In the second hour, check mother-baby-dyad
every 30 minutes to one hour.
69 Document all nursing interventions
implemented.
Termination Phase
70 Do after care. Fix the equipment used and
arrange it properly.
71 Remove soiled gloves.

72 Perform hand washing using soap and water.

73 Document the findings in the client’s record.

TOTAL

Reference:

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 SKILLS
PERFORMANCE Excellent Good Needs Improvement Unacceptable
SCORE
CRITERIA 5 4 3 0-2
Performed the The student is
Performed the Performed the procedure guidelines unprepared,
procedure procedure but showed little there is an
guidelines with guidelines with unpreparedness during inaccuracy,
PREPAREDNESS great accuracy, minimal the steps, with some incompleteness
completeness, and inaccuracy, inaccuracy of the
confidence incompleteness and incompleteness of performance
the performance
Performed Totally performed Performed the Performed the
entirely the the procedure procedure with some procedure with
COMPLETENESS procedure guidelines with inadequacy of steps lots of
guidelines minimal inadequacy and
correctly incompleteness incompleteness

The student is The student is The student is The student is

competent competent but partially competent, not yet
observant, less observant, not observant, competent and
CONSISTENCY accurate, and accurate, and accurate, and focus on is distracted in
focus in doing the focus in doing the doing the steps of the doing the steps
steps of the steps of the procedure of the procedure
procedure procedure
ABILITY TO ASK Ask questions Ask questions Some questions are not Questions
QUESTIONS TO comprehensively with mostly good connected to the topic included has
CLIENT points little connection
to the topic
Total Score
20

KNOWLEDGE
CRITERIA VERY SATISFACTORY GOOD POOR
SATISFACTORY
5 4 3 0-2
IDEAS AND Rationale and Rationale and Rationale and Rationale and
CONTENT information are information of most information are information are
accurate and correct for steps are accurate less accurate often inaccurate
all steps. and correct. and with some and with lacking
incorrect entries.
entries.
LANGUAGE Rationale and Rationale and Rationale and Rationale and
AND GRAMMAR information are clearly information are information are information
described using correct described well but not described described vaguely
and clear language. language or words well and words using incorrect
used are sometimes used is not words.
vague and inaccurate. correct or
inaccurate.
ORGANIZATION Rationale and Rationale and Organization Rationale and
information are well information are well exhibits some information lack
organized. It exhibits organized. It mostly commands of proper
focus and coherent exhibits focus and focus, organization. It
organization on the coherent organization relatedness of does not exhibit
steps and relatedness. on the steps and the steps and commands of focus
relatedness. organized. and relatedness of
the steps.
Total Score
20
Remarks/Comments:

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Signature over the printed name of Student

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Signature over the printed name of Clinical Instructor

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DATE