Community Health Nursing

1. COMMUNITY HEALTH
NURSING
CLASS PRESENTATION
ON
SAFE CHILD BIRTH CHECKLIST
PRESENTED TO:- MRS. KAMAL PRIYA MAM
(ASSISTANT PROFESSOR)
PRESENTED BY:- SHAISTA BASHEER
(B.Sc.(H) NURSING 4TH YEAR)

2. INTRODUCTION
The WHO safe childbirth checklist was
designed as a total to improve the quality of
care provided to the women giving birth.The
checklist is an organized list of evidence-
based essential birth practices, which targets
the major cause of maternal death,
intrapartum related still birth and neonatal
deaths that occur in health care facilities.The
majority of these deaths occur in low
resource setting. In response to these
unacceptable situation theWHO safe
childbirth checklist has been developed to
support safe delivery.

3. IMPORTANCE OF CHECKLIST
 Checklist helps to facilitate safety in high risk high
reliability.
 Checklists are tool that occur due to lapses in
concentration, distractions, fatigue or lack of
knowledge of evidence based practices.
 Provide confidence that no step will be forgotten.
 The goal of safe child birth checklist is to ensure
that heath care workers consistently follow a core of
set steps and promote safe delivery.

4. MATERNAL DEATH INCLUDE
 Hemorrhage.
 Hypertensive disorder.
 Infection.
 Intrapartum related still birth (inadequate
intrapartum care)

5. THE RIGHT MOMENTS TO PAUSE AND CHECK
Pause points are specific points in time when
verify or check that essential practices completed.
 PAUSE POINT 1:on admission.
 PAUSE POINT 2:just before pushing (or before
caesarean).
 PAUSE POINT 3:soon after birth.(with in one hour)
 PAUSE POINT 4:before discharge.

6. PAUSE POINT 1:ON ADMISSION
Check the mother at the time of admission is
important to detect and treat complication that she
may already have ,to confirm whether she needs to
be referred to another facility, to prepare her for labor
and delivery, and to educate her about the danger
signs for which she should call for help.

7. Does mother need referral?
• No
• Yes, organized
Check your facilities criteria
Partograph started?
• No,will start when >4cm
• Yes
Start plotting when cervix >1cm ,then cervix should dilate
1cm /hr
• Every 30 min :plot HR,contrtactions ,fetal HR.
• Every 2 hours :plot temperature.
• Every 4 hours :plot BP.
Does mother need to start
Antibiotics?
• No
• Yes, given
• Magnesium sulfate and
hyperttensive treatment?
• No
• Yes,Magnesium sulfate
given.
• Yes,Antihypertensive
medication given.
Ask for allergies before administration of any
medication.Give antibiotics to mother if any of:
• Mothers temperature >38⁰C..
• History of foul smelling vaginal discharge.
• Rupture of membranes >18 hours.
• Give Magnesium sulfate to mother if any of:
• Disystolic BP>110mmHG and 3+ proteinuria.
• Distolic BP >90 mmHG ,2+ proteinuria, and severe
headache,epigastric pain,visual disturbance.
• Give antihypertensive medication to mother if systolic
BP>160mmHG.
• Goal:keep BP<150/100mmHG.

8. CONT…..
• Confirm supplies are
clean hands and hands and
gloves for each vaginal exam.
• Encourage birth companion to
present at birth.
• Confirm that mother or
companion will call for help
during labor if needed.
Call for help if any of :
• Bleeding.
• Severe abdominal pain.
• Severe headache or visual
disturbance.
• Unable to urinate.
• Urge to push.

9. PAUSE POINT 2:JUST BEFORE PUSHING OR
BEFORE CAESAREAN
Checking the mother just before pushing or
caesarean is important to detect and complications
and to prepare for routine events and possible crisis
situations that may occur after birth.

10. JUST BEFORE PUSHING OR CAESAREAN
Does mother need to start :
Antibiotics?
• No
• Yes, given
Ask for allergies before administration of
any medication. Give antibiotics to mother
if any of :
• Mothers temperature >38⁰C.
• History of foul smelling vaginal discharge.
• Rupture of membrane >18 hrs.
• Caesarean section.
Magnesium sulfate and hypertensive
treatment?
• No
• Yes,manesium sulfate given.
• Yes, antihypertensive medication
given.
Give megnesium sulfate to mother if any of:
• Diastolic BP >110mmHG and 3+ proteinuria
.
Diastolic BP > 90 mmHG 2+ proteinuria .And
any servere headache ,visual disturbance,
epigastric pain.
Give antihyperteensive medicatiopn to mother
if systolic BP > 160mmHG.
• Goal:keep BP <150 /100 mmHG.

11. Confirm essential supplies arer
at bedside and prepare for
delivery :
For mothers
• Gloves
• Alcohol based handrub or
soap and clean water.
• Oxytocin 10 units in syringe.
• Prepare to care for mother immediately
after birth:Confirm single baby only (not
multiple birth).
• Give oxytocin with in 1 minute after birth.
• Deliver placenta 1-3 minutes after birth.
• Massage uterus after placenta is delivered.
• Confirm uterus is contracted.
For baby
• Clean towel.
• Tie or cor clamp .
• Sterile blade to cut cord.
• Suction device.
• Bag and mask.
Prepare to care for baby immediately after birth.
• Dry baby ,keep warm.
• If not breathing, stimulate and clean airway.
• If not breathing:
1)Clamp and cut cord.
2)Clean airway if necessary.
3)Ventilate with bag and mask.
4)Shout for help.

12. SOON AFTER BIRTH (WITH IN HOUR)
Is mother bleeding abnormally?
• No.
• Yes ,shout for help.
If bleeding abnormally:
• Massage uterus.
• Consider more uterotonic.
• Star IV fluids keep mother
warm.
Treat cause:uterine
atony,retained placenta
/fragments,vaginal tear,uterine
rupture.

13. Does mother need to start
antibiotic?
• No.
• Yes, given
Ask for allergies before administration of
any medication.
• Give antibiotics to mother if placenta
manually removed or if mothers
temperature >38C and any of:
• Chills .
• Foul smelling vaginal discharge.
• If the mother has a third or fourth degree
of perineal tear give antibiotics to
prevent infection.
Magnesium sulfate and
antihypertensive treatment?
• No.
• Yes,magnesium sulfate given .
• Yes, antihypertensive medication
given.
• Give magnesium sulfate to mother if any of.
• Diasystolic BP>110mmHG and 3+
proteinuria.
• Diasystolic BP> 90 mmHG ,2+
proteinuria,.and any severe headache,visual
disturbance, epigastric pain.
• Give antihypertensive medication to mother
if systolic BP >160 mmHG.
• Goal: keep BP<150/100.

14. Does baby need referral?
• No.
• Yes, organized.
Check your facility criteria .
Antibiotics.
• No.
• Yes, given.
Give baby antibiotics if antibiotics given to
mother for treatment for maternal infection during
childbirth or if baby has any of :
• Respiratory rate > 60 b/min or <30 b/min.
• Chest in drawing, grunting, or convulsions .
• Poor movement on stimulation.
• Babys temperature <35C or > 38C.
Special care and monitoring ?
• No.
• Yes, organized
Arrange special care/ monitoring for baby if
any:
• More than 1 month early.
• Birth weight <2500 grams.
• Needs antibiotics.
• Required resuscitation.

15. PAUSE POINT 4:BEFORE DISCHARGE
 Checking the mother and newborn before discharge is important to
be sure that the mother and newbornare healthy before
discharge,that follow up has been arranged, that family planning
options have been discussed and offered to the mother and that
education on danger signs to look out for, both in the mother and her
baby,has been given in case immediate care is needed.

16. Confirm stay at facility for 24
hours after delivery.
1)Does mother need to start
antibiotics?
• No.
• Yes, given and delay
discharge.
Ask for allergies before administration of any
medication.Give antibiotics to mother if any of:
• Mothers temperature >38C.
• Foul smelling vaginal discharge.
Is mothers blood pressure
normal ?
• No,treat and delay
discharge.
• Yes.
• Give magnesium sulfate to mother if any of :
• Diasystolic BP >110mmHG and 3+proteinuria.
• Diasystolic BP>90, 2+ proteinuria ,and any
severe headache,visual disturbance,epigastric
pain .
• Give antihyperytensive medication to mother if
systolic BP >160mmHG .
• Goal: keep BP <150/100mmHG.
Is mother bleeding
abnormally?
• No.
• Yes,give antibiotics, delay
discharge,give special
care.
If pulse >110 beats per minute and blood
pressure<90mmHG.
• Start IV and keep mother warm.
• Trteat cause(hypovolumic shock)

17. Does baby need to stat antibiotics?
• No.
• Yes, treat and delay discharge,give
special care.
Give antibiotics to baby if any of:
• Respiratory rate> 60b/m or <30b/m.
• Chest indrawing , grunting, or
convulsions.
• Babys temperature <35C or
temperature >38C.
• Stopped breastfeeding .
• Umbilicus redness extending to
skin or draining pus.
Is baby feeding well?
• No, establish good breastfeeding
practices and delay discharge.
• Yes.
Discuss and offer family planning options to
mother.
Arrange followup and confirm mother/
companion will seek help if danger
signs appear after discharge.

18. DANGER SIGNS
Mother has any of:
• Bleeding.
• Severe abdominal pain.
• Severe headache or visual
disturbance.
• Breathing difficulty.
• Fever or chills.
• Difficulty emptying bladder.
• Epigastric pain.
Baby has any of:
• Fast /difficult breathing.
• Fever.
• Unusual cold.
• Stops feeding.
• Less activity than normal .
• Whole body becomes normal.

19. SUMMARY
 On admission using the checklist extremely
exposes the absence of facility guidelines and
criteria to whom refer, thus effectively using the
checklist strengthens the facility to provide
guidelines and facility criteria for referral.Atthe
same time,risk factors for poor maternl /parental
such as prolonged drainage of liquor,fever, high BP
and proteinuria are easily detected because
healthcare worker must check these in order to
check the checklist.

20. CONCLUSION
 Using the safe child birth checklist ensures delivery of
essential maternal and perinatal midwifery care practices. The
safe child birth checklist addresses the major cause of
maternal deaths, neonatal deaths and complications.it also
enable the caregive to anticipate and avert complications. It
has the potential to facilitate compliance with best practices
for the delivery of evidenced based better birth.

21. BIBLOGRAPHY
 http:/www.int/patient
safety/Implementation/checklist[cited :July 26,
2018]
 World health Organization partograph in
Management of labor.
 http:/dot.org.