University of Bohol

City of Tagbilaran
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 Delivery Table
7. Receive patient safely while providing privacy via stretcher or
wheelchair, ushered to delivery table. Introduce yourself and
establish rapport.
8. Securely place the underpads 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
  Plastic clamp
 OS
 Lidocaine (a local anesthetic)
 10 cc syringe

For multigravida
 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.
26. Clamp using the Kelly forceps.
27. Offer scissors.
28. 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
29. Check the characteristics/completeness of the placenta
(Schultz and Duncan) placed on the kidney basin.
Check blood pressure once expelled.
30. 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.
31. Assist in uterine exploration.
32. Place third towel/buttocks towel under the buttocks to widen
area of sterility.
33. Remove first set of gloves aseptically to prepare for
episiorrhaphy.
34. Assist the physician in episiorrhaphy.
35. Remove the buttocks towel and perform perineal care with
betadine antiseptic. Put on diapers.
36. Do after care.
37. Observe proper documentation of carried orders regarding
patient’s treatment.
38. Patient brought to the ward per stretcher in fair condition.
TOTAL
PERCENTAGE
EQUIVALENT

RLE PERFORMANCE SCALE

EQUIVALENT 75% PASSING MEANING
 1.0 95-100
1.1 94
1.2 93
COMPETENT
1.3 92
1.4 91
1.5 90
1.6 89
1.7 88
1.8 87
1.9 86 NEEDS IMPROVEMENT
2.0 85
2.1 84
2.2 83
2.3 82
2.4 81
2.5 80
2.6 79
NOT PERFORMED
2.7 78
2.8 77
2.9 76
3.0 75

Evaluated by:

_______________________________
DR-Clinical Instructor

________________________________
Name and Signature of Student