AREA: NORMAL LABOUR AND BIRTH
FACILITY: _____________________________________________________________________________________________________________________
ASSESSOR: _______________________________________________________________ DATE:
PERFORMANCE
STANDARDS
1. The RHC will have the
necessary equipment at
hand and in working
order for normal labour,
childbirth and the
immediate postpartum
period.
EOC Standards—March 2009
VERIFICATION CRITERIA
Determine whether the following criteria are present at the site of
intervention, in working order:
 Clean working area free of trash
 Curtains or doors for privacy
 Area next to woman’s labour bed for the family member to sit
 Clean bed frame and mattress (especially under the pad)
 Clean newborn exam area away from windows and doors and free of
draft
 Clean baby weighing scale with new, clean cloth for each baby
 Portable light source for suturing visibility
 Full oxygen tank with tubing and mask (or nasal prongs)
 Sterile delivery pack
o Sterile gauze (4 or more)
o Two large artery forceps
o Sterile or HLD gloves
o Umbilical clamps or sterile string
o Two scissors
o One sponge forceps
o Antiseptic solution
o 4 sterile drapes/cloths
o Bowl for holding placenta
o One small galli pot
 Ambu bags and masks for resuscitation (adult and infant)
 Stethoscope
 Fetoscope
 BP apparatus near bed (if labour area separate from birth room, then
have portable BP apparatus or one in each separate area)
 Thermometer
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Y, N
COMMENTS
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Normal Labour and Birth - 30
PERFORMANCE
STANDARDS
VERIFICATION CRITERIA
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2. Personnel conduct a rapid
initial assessment of the
pregnant woman at the first
contact (admission or shift
change).
EOC Standards—March 2009
Disposable gloves in all areas
Closed container for disposing needles/syringes
o Container is disposed of properly when ¾ full
o Empty container nearby and ready to replace full one
Medications available at site (not expired):
o Oxytocin,
o Ergometrine
o Lidocaine
IV tubing and IV solutions available at intervention site
Partograph and pen for recording vital signs and interventions
Clock
Functioning sink or bucket of water with faucet and soap
Bucket with 0.5% chlorine solution; bucket with soapy water
Plastic covered bucket for contaminated waste
Covered placenta bucket with 0.5% chlorine
Determine, on visits, whether the provider:
 Greets the woman
 Asks the woman if she is currently experiencing any of the
following:
o Vaginal bleeding
o Ruptured “bag of waters,” and if so, time and colour
o Respiratory difficulty
o Fever
o Severe headache/ blurred vision
o Severe abdominal pain
o Convulsions/loss of consciousness
 Assures immediate attention for any of the above signs
 Asks for the woman’s antenatal card or other information if available
about the history of this gestation
Y, N
COMMENTS
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Normal Labour and Birth - 31
PERFORMANCE
STANDARDS
VERIFICATION CRITERIA
Y, N
COMMENTS
Attending Normal Childbirth – First Stage
3. The provider assures a
supportive environment for
the labouring woman
EOC Standards—March 2009
Determine whether the provider completes each of the following:
 Explains all procedures, seeks permission, and discusses findings
with the woman and/or her female companion
 Respects the woman’s wishes to the best possible extent
 Asks her to wash her perineal area with soap and water
 Encourages the woman to empty her bladder
 Allows the woman to sit, stand and move around often in labour
 Assures privacy from the other patients
 Encourages a female companion to give support during labour (rub
the back, apply wet cloths, assist her to the toilet, etc.)
 Does not give an enema
 Encourages her to eat and drink juices or other nutritious drinks as
desired
 Helps her through her pain, gives encouragement and praise, and
informs the woman about the progress of her labour
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Normal Labour and Birth - 32
PERFORMANCE
STANDARDS
4. The provider correctly
conducts a physical exam.
EOC Standards—March 2009
VERIFICATION CRITERIA
Determine whether the provider completes each of the following during
the physical exam:
 Washes hands with soap and water and air dries or uses alcohol hand
rub
 Takes the woman’s vital signs (BP, pulse, resp, temp)
 With one hand lightly on the uterus, times the number and duration
of contractions in 10 minutes
 Determines the lie with Leopold’s manoeuvre
 Determines descent of foetal head by abdominal palpation
 Listens to the FHS for one full minute. If foetal distress suspected
(FHS < 120 or > 160), turns mother on her left side, applies oxygen
per nasal prong/mask at 6L per minute, and calls another provider to
confirm diagnosis
 Asks permission and does a vaginal exam with sterile gloves between
contractions
 Confirms absence or presence of membranes:
o Verifies intact amniotic membranes or, if ruptured, when and
what colour/odour
 Confirms cervical dilation quickly and efficiently:
o Confirms presenting part and position
 Rinses gloved hands in 0.5% chlorine; disposes of gloves
 Washes hands with soap and water and dries them or uses alcohol
hand rub
 Helps her to sit up or roll over off her back after the vaginal exam
 Informs the woman of the exam findings
 Advises the woman to take nutritious liquids and to empty her
bladder frequently
 Records all information on Partograph if in active labour (i.e. more
than 4cm dilated), or in progress notes if not in active labour
Y, N
COMMENTS
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Normal Labour and Birth - 33
PERFORMANCE
STANDARDS
5. A written record exists of
how the labour is
monitored (Partograph).
VERIFICATION CRITERIA
Verify whether the provider correctly uses the Partograph:
 Records name, date, time, gravida, para, hospital number, hour or
date of ruptured membranes and time/hour of beginning of 4cm (or
more), dilation for beginning of monitoring
 Records cervical dilation on alert line for first exam
 Records cervical dilation for each vaginal examination every four
hours unless indicated sooner
 Records descent of presenting part every four hours
 Records moulding and status of membranes every four hours
 Records contractions and their intensity every 30 minutes
 Monitors pulse every 30 minutes and records with a dot
 Monitors BP every 4 hours and records with arrows
 Monitors temperature every 4 hours
 Monitors FH every 30 minutes (for full minute each)
 Records any drugs given (route, dose and time)
Y, N
COMMENTS
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Attending normal childbirth – Second Stage
6. The provider prepares for
the birth and demonstrates
infection prevention
practices.
EOC Standards—March 2009
Determine whether the provider performs each of the following:
 Conducts a rapid initial assessment on any new patient who presents
to the DHQH in second stage of labour
 Assures a supportive environment for the labouring woman
 Conducts a quick and efficient physical exam if possible before the
pushing phase
 Encourages the woman to assume any position she wants to give
birth, maintaining safety and cleanliness
 Places clean plastic drape/cloth under her buttocks
 Puts on personal protective barriers (eye protection, closed shoes and
cover gown or apron)
 Washes hands with soap and water and air dries
 Opens the delivery set without contaminating the contents of the
pack
 Puts on Sterile gloves
 Explains to the woman all actions, comforting/encouraging her
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Normal Labour and Birth - 34
PERFORMANCE
STANDARDS
7. The provider avoids
harmful practices during
the birth.
VERIFICATION CRITERIA
EOC Standards—March 2009
COMMENTS
Observe whether the provider:
 Encourages the woman to assume any position she wants to
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8. The provider correctly
assists the birth of the
baby.
Y, N
give birth, maintaining safety and cleanliness
Avoids massage of the vagina and perineum
Avoids fundal pressure
Encourages mother to push ONLY when she feels the urge
Does not perform episiotomy unless:
o Frank breech or shoulder dystocia
o Foetal distress (FH below 100 per minute for more than 20
seconds)
Determine whether the provider performs each of the following:
 Monitors FH every 5 minutes except when pushing:
o Holds fetoscope with sterile gauze to prevent contamination of
gloves
 For birth of the head, the provider:
o Gently supports the perineum with one hand and maintains
flexion of the baby’s head with the other
o Allows the head to crown slowly, encouraging the mother to rest
between contractions
o Once the head is delivered, asks the mother not to push
o Checks for cord around the neck:
 If loose, slips it over the baby’s head or births the head
through the cord
 If tight, clamps/ties the cord in two places and cuts it
o Allows the baby’s head to rotate spontaneously (hands off)
 For birth of the body after internal rotation, the provider:
o Places one hand on top of head, one hand underneath, to support
the expulsion of the anterior shoulder first, then the posterior
o Supports the body with both hands as it slides out
o Places the baby on a sterile cloth over the mother’s abdomen and
dries the baby briskly to stimulate crying
 Clamps and cuts the umbilical cord
 Ensures baby is warm, in skin-to-skin contact with mother, and head
and back covered with another dry cloth
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Normal Labour and Birth - 35
PERFORMANCE
STANDARDS
VERIFICATION CRITERIA
Y, N
COMMENTS
Attending normal childbirth – Third Stage (Active Management)
9. The provider properly
delivers the placenta using
Active Management of the
Third Stage of Labour
(AMTSL).
EOC Standards—March 2009
Determine whether the provider performs each of the following:
 Asks the woman to assume a semi-reclining position
 Gently palpates the abdomen through sterile cloth to determine
presence or absence of another foetus (if twins, do not proceed with
AMTSL)
 Explains to the woman that she will give a dose of oxytocin and what
that is for
 Administers 10 units of oxytocin IM in the thigh within 1min after
birth
 Places needle in instrument tray by bedside until able to place needle
and syringe in puncture-proof container
 Re-clamps forceps higher up on the cord near the perineum
 Places one hand over the sterile towel just above the woman’s pubic
bone and stabilises the uterus by applying counter pressure (push)
during the controlled cord traction (CCT)
 Maintains traction on the cord and awaits a strong uterine contraction
(2-3 minutes)
 When the contraction is felt, gently pulls down and out on the cord
while maintaining counter-pressure on the uterus
 If the placenta does not descend during the 30-40 seconds of CCT,
does not continue to pull on the cord, but waits
 With the next contraction, repeats the CCT and delivers the placenta
 Holds the placenta in both hands and twists/turns it gently to tease
out the membranes
 Places the placenta in a bowl at the bedside for further examination
 Immediately tells the woman that she is going to massage her uterus,
and then massages the abdomen over the uterus (with hand over the
sterile cloth on the abdomen) to help uterus contract
 Carefully examines the placenta for completeness
 Assures the uterus is fully contracted before stopping massage
 Explains to the woman that she is going to examine her perineum and
vagina
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Normal Labour and Birth - 36
PERFORMANCE
STANDARDS
VERIFICATION CRITERIA
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10. The provider ensures a
safe, comfortable
environment for the
woman and the baby.
11. The provider demonstrates
correct infection
prevention practices
following the birth.
EOC Standards—March 2009
Gently, thoroughly examines the perineum and vagina for tears
Explains her findings to the woman’s companion
Explains the need to suture any tears, if necessary
Rinses gloved hands in 0.5% chlorine, removes gloves and puts them
into 0.5% chlorine
Washes and dries hands and puts on another pair of sterile gloves
Proceeds to suture tears, as needed, using sterile technique
Determine whether the provider performs each of the following:
 Assures the mother’s and baby’s vital signs are stable during the
cleanup and/or suturing
 Places clean, new pad over the perineum and asks the mother to tell
the provider how often she changes the pads from now onwards
 Assures safety and comfort of the mother and baby
 Assists the mother in putting baby to breast as soon as possible,
within the first hour of birth
Determine whether the provider performs each of the following:
 Removes all soiled linens and places them in appropriate containers
for blood-contaminated linens
 Places all disposable sharps in puncture-proof containers
 Places all instruments in a bucket of 0.5% chlorine solution for 10
minutes and then into soapy water for washing
 Cleans her eye protectors and apron with 0.5% chlorine solution
 Rinses gloves with 0.5% chlorine and then places them in 0.5%
chlorine solution for 10 minutes
 Washes hands with soap and water and dries them
 Records all interventions in the chart/register and the Partograph
Y, N
COMMENTS
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Normal Labour and Birth - 37
PERFORMANCE
STANDARDS
VERIFICATION CRITERIA
Y, N
COMMENTS
Immediate postpartum care (first two hours after childbirth)
12. The provider assures a
supportive environment for
the immediate postnatal
period (at first contact or at
shift change).
EOC Standards—March 2009
Determine whether the provider completed each of the following:
 Asks the woman how she feels and explains the need for a rapid
initial assessment (if this woman is unknown to her or has come into
the DHQH after childbirth)
 Explains all procedures and discusses findings with the woman
and/or her companion
 Encourages woman to bathe or wash when she can
 Advises the woman of the importance of an empty bladder and
checking to make sure uterus is firm (i.e. teach her to massage)
 Assures privacy from the other patients during examination
 Assures the presence of a family member, if the woman wants
 Encourages her to eat and drink nutritious drinks as soon as possible
 Assures her that postnatal contractions are normal and offer measures
to reduce the pain (Ponstan 500mg, Paracetamol (two tablets) PO
q6h or prn)
 Records the woman’s subjective information on her chart/register
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Normal Labour and Birth - 38
PERFORMANCE
STANDARDS
13. The provider conducts a
postpartum physical exam.
EOC Standards—March 2009
VERIFICATION CRITERIA
Determine whether the provider completes each of the following:
 Washes hands with soap and water and dries them or uses alcohol
hand rub
 Puts on clean examination gloves
 Monitors the woman’s vital signs every 15 minutes for the first 2
hours, then every 30 minutes for one hour (BP, pulse, resp and
fundal height and firmness, bleeding and number of pads used)
 Monitors the baby’s vital signs every 15 minutes for the first 2 hours,
then every 30 minutes for one hour (apex/heart rate and resp, stump
condition for bleeding and whether baby is latching on and suckling)
 Removes gloves and disposes in contaminated waste container
 Washes hands with soap and water or uses alcohol hand rub
 Explains all findings to the mother (including newborn exam)
 Assures baby is feeding well and emphasizes the importance of
exclusive breastfeeding for 6 months and weaning advice after 6
months
 Records all findings in the mother’s chart/register
Y, N
COMMENTS
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Normal Labour and Birth - 39
PERFORMANCE
STANDARDS
14. The provider assesses the
woman and newborn prior
to discharge.
VERIFICATION CRITERIA
Y, N
Determine whether the provider:
Counsels the mother and companion regarding danger signs and informs
her what to do if she has any of those danger signs:
 For mother:
o More than normal amount of vaginal bleeding
o Respiratory difficulty
o Fever
o Severe headache/blurred vision
o Severe abdominal pain
o Convulsions/loss of consciousness
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Total of standards
o Any bleeding in the baby, especially umbilical stump
o Any breathing problems with the baby
o Any unusual coloured skin (yellow or blue)
o Any suckling problems (problem with nipples or baby’s suck)
o Any high-pitched or unusual cry
Counsel on importance of exclusive breastfeeding for 6 months and
weaning advice after 6 months.
Counsels on importance of hygiene for her and baby
Counsels on the importance of eating well and resting
Counsels on options for family planning
Counsels on safest time to begin sexual relations again
Counsels about importance of immunizations for this baby and her
other children
Counsels mother to bring the baby for a newborn visit within one week
Assures LHW home visit within the first week PP (if possible)
COMMENTS
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Total observed
Total achieved
EOC Standards—March 2009
Normal Labour and Birth - 40