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INTRODUCTION
Our country today faces serious problem specifically on health sector and giving birth at home is one of the problems that should be given importance by the Philippine government since giving birth at home meets several complication and untoward problems that will cause mortality !ccording !ccording to the Department Department of "ealth# maternal mortality report# updated updated in $une %&'&# hypertension complicated by pregnancy comprises %( percent of the causes of maternal deaths# and partum hemorrhage ') percent * the second and third leading causes of maternal death Others are sepsis# obstructed labor and complications around unsafe abortion and giving births at home * most of which are preventable with proper diagnosis and intervention !ccording !ccording to the National Demographic "ealth +urvey ,ND"+- of %&&.# only // percent of births in the Philippines occur in health facilities0 )1 percent of children are still delivered at home Under Philippine law# licensed midwives are authori2ed to carry out the supervision and care of women during pregnancy# labor and management of normal deliveries# including including the administration administration of an o3ytocin drug to prevent and treat hemorrhage after the delivery of the placenta !t present# Department of "ealth made a memorandum memorandum that there will no more pregnant mother to deliver children at home due to unsafe and ris4 delivery Thus# Thus# as license licensed d midwives midwives and proponen proponents ts of this feasibility feasibility study aims to establish a birthing center# to be named as 56other Choice 7irthing Center8 to
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establish a safe and sustainable birth center and increase woman with access to healthcare provider and health care facility at lower cost and access to Philhealth is available In addition# proponents are encourage to open a birthing center since not all pregnant woman can access to hospital hospital at the same time# hospital hospital addresses different cases of health problems while birthing center only focus on parturient cases at the same time cheaper
Ob9ectives of the +tudy
:enerally# this study will be of great help to achieve the vision of the 6other;s Choice 7irthing Center# which which is to be an effective partner in sustaining sustaining and maintaining
+ignificance of the +tudy
To the Researchers Researche rs
The result of this study will be very significant to the researcher This is because it can give them better idea about starting a business about birthing center
2
establish a safe and sustainable birth center and increase woman with access to healthcare provider and health care facility at lower cost and access to Philhealth is available In addition# proponents are encourage to open a birthing center since not all pregnant woman can access to hospital hospital at the same time# hospital hospital addresses different cases of health problems while birthing center only focus on parturient cases at the same time cheaper
Ob9ectives of the +tudy
:enerally# this study will be of great help to achieve the vision of the 6other;s Choice 7irthing Center# which which is to be an effective partner in sustaining sustaining and maintaining
+ignificance of the +tudy
To the Researchers Researche rs
The result of this study will be very significant to the researcher This is because it can give them better idea about starting a business about birthing center
3
To the Client
The positive result of the study will provide them a birthing clinic with utmost consideration on the safety and security of pregnant woman and newborn babies
To the +chool
The school administration will be proud of the brilliant researched studies added to the College =ibrary and Research Department for the useful reference for future researchers
To the :overnment :o vernment
The government will surely support the study because of the situation of health in our country today If the study will be materiali2ed it will be a big help to the community in general
4
T"> ?>!+I7I=IT@ +TUD@
This chapter chapter present presents s the four ,/- compone components nts of a pro9ect pro9ect feasibil feasibility ity study# study# namelyA namelyA managem management# ent# mar4eting# mar4eting# technical technical and financia financial l
This This pro9ect pro9ect
feasibility study is prepared to ascertain if the pro9ect# as initially designed# will have a chance in the niche mar4et when implemented
6anagement ?easibility
This aspect includes a study of the basic organi2ation# form of business# organi2a organi2ation tional al chart and pro9ect pro9ect operation operation schedule schedules s
This This aspect aspect helps to
determin determine e the effecti effectiven veness ess of the organi2a organi2ation tion and the
?orm of 7usiness
The business will be registered and recogni2ed under the nameA 6other;s Choice 7irthing Center as universal*limited partnership and will be registered with the +ecuritie +ecurities s and >3change >3change Commission Commission ,+>C- ,+>C-
! partne partnershi rship p duly formed formed
under the law is a 9uridical person separate and distinct from each of the partner The proponents are Registered 6idwife ,R6-# to witA 6arites C 7ahian# 6ary $ane 7eleno# !ubrey D NuBe2# Roselie ! Rodicol and +usan = +uralta
The form of the business is an association of two or more persons to carry on as co*owners of a business for profit and as a result of a specific contractual agree agreemen mentt among among the the owner owners s or partne partners rs
It is agreed agreed that that partn partners ers have have
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specified duties and responsibilities to the business activities ,as presented in the organi2ational chart- Other positions left re
!ll partners finished from the two*year two*year Diploma in 6idwifery# 6idwifery# passed the 7oard of 6idwifery =icensure >3amination and will finish their degree in 7achelor of +cience in 6idwifery Thus# they have enough 4nowledge and s4ills to run the business
Organi2ational +tructure
The proponents agreed that they will 9oin force in managing their business considering that the company company has limited resources "owever# once the birthing center will e3pand# they will hire additional staff to assist the business operation
Ne3t page is the designed organi2ational structure outlining the position involves
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6other;s Choice 7irthing Center
ROSELIE C. RODICOL
PEDIATRICIAN ON-CALL
OBSTETRICIAN ON-CALL
SONOLOGIST ON-CALL
MARITES C. BAHIAN MARY JANE C. BELENO
AUBREY D. NUÑE SUSAN L. SURALTA MIDWIFE
WACTHMAN
STUDENT INTERN
NoteA !dditional staff will be hired once the business is already established
7usiness >3periences and ualifications of Proponents The e3periences# trainings and seminar attended by the proponents are considered e3cellent factor;s in business success
The course ta4en by the
proponents are in line with birthing management which will be a big factor in the
!
success of business
Through their e3perience# the proponents believe that
these can give them that much needed self*confidence to enable them to carry their individual tas4
Table ' Unit 6anagement Personnel Unit 6anagement Time to be Personnel devoted to the pro9ect and duties Principal 6idwife *'% hours *6anages and oversees the operation of the business Pediatrician on*call *%/ hour cover of the clinic *6anage the immediate newborn care O7*:yne On*call Consultant *%/ hour cover of the clinic *6anage the maternal care Ultrasound Part*time +onologist * . hours duty * Ultrasound In* charge +4illed 6idwife *'% hours * responsible for maternal and immediate new born care
ualification
Compensation
* 6aster;s Degree holder# 7+6# R6 *Competent Personality
P '&#&&&&& plus fringe benefits
*=icense Pediatric 6edicine Physician *Competent Personality
Php )&& per new born
*=icense O7*:yne 6edicine Physician *Competent Personality *=icense +onologist
Php #)&& per mother or )&& per consultation
=icensed 6idwife
Php.#&&& per month plus fringe benefit
Php %&& per ultrasound
"
Table % =abor +4ills Re
ualification
"igh +chool :raduate 7asic Police Training
Compensation
P /#&&&&& per month plus fringe benefit
+tudent InternA +econd year 6idwifery +!IT student ProtocolA FObserve F!ssist FResearch F>3perience +upport groupsA •
Eomen;s =eague
SAIT -#$%&&' +hift rotationsA •
+taff are divided according to schedule ,'% hours per duty-
•
>ight hours only for security and house4eeper
Recruitment Program The recruitment will be simple In case the clinic is under staff# the center will hire on*call midwife to facilitate under staff while hiring is underta4ing "iring scheme will be post in the internet and applicants will submit their application# bio*data
and
re
via
e*mail
at
motherschoicebirthingcenterGyahoocom The applicants will undergo a written and practical e3amination to gauge their mental capacity and 4now if they had the s4ills to carry out the wor4 Once they will pass# the principal midwife will
(
conduct character reference of the person =astly# there will be a final interview to choose the best applicant for the position Training Program
The goal of the training program in the company is to develop specific s4ills# attitude and capacities to ma3imi2e the individual;s 9ob performance Hirtually# every employee in the company will undergo some degree of training programs# either formal or informal
6D: trainings includeA Partograph# IH
insertion# neonatal resuscitation# breastfeeding# basic life support# post partum hemorrhage and immediate newborn care
?ringe 7enefits 7elow are the fringe benefits offered by the company will be as followsA *
?ull coverage on +++# Philhealth and Pag*I7I:
*
!nnual vacation leave and sic4 leave for ') days with pay
*
'th month bonus
*
Retirement Pac4age
*
Commission
?acilities The facilities of the birthing clinic based on Department of "ealth ,DO"re
•
Toilet and bathing facilities for mother and baby
•
%/ hour supply of clean and hot water
1)
•
>lectricity supply ,including emergency lighting-
•
%/ hour refrigerator for storing medicines
•
>
•
One patient bed per room for private type
•
+even pt in ward with curtain and dividers to provide patient privacy for each room
•
>ach room must have bright lighting
•
O3ygen tan4 and supply available in the delivery room# must be secured to solid ob9ect
•
•
•
!de
No animals in the clinic
!ll windows and doors should be covered with a minimum in a net covering
•
•
+ufficient ventilation
!bsolutely no smo4ing on the premises with an obvious sign at front des4
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Table Pre*Operating !ctivities !ctivities Number of Eee4s Preparation of the Pro9ect ?easibility +tudy / Registration of the 7usiness ,+>C# DTI# Philhealth/ 7usiness Permit % Construction of the 7uilding %/ Purchase of the >3penses !ctivities Preparation of the Pro9ect ?easibility +tudy Registration of the 7usiness ,+>C# DTI# Philhealth7usiness Permit Renovation of the 7uilding Purchase of the >
Initial !mount Needed P )#&&&&& %#)&&&& )#&&&&& /.&#&&&&& %'#1%&&& /#&&&&& #&&&&& '#1(&&& '#&&&&& P )%#.'&&&
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6!R>TIN: ?>!+I7I=IT@
This aspect is considered as the lifeblood of virtually pro9ected feasibility study for the e3tent of the data and information gathering because the succeeding aspects depend largely on it
This serves as the basis of the
financial section through pro9ected demand It includes the following informationA demand and supply gap analysis# mar4eting program and the pro9ected number of clients The ob9ective of this study is to determine the
The said area has no available birthing center and far from the
hospitals and clinic in Poblacion# 6aramag# 7u4idnon
In addition# Camp '#
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6aramag# 7u4idnon is a cross section between ue2on and Don Carlos# 7u4idnon with a bigger population
Table ) +upply and Demand :ap !nalysis !rea
Population Pregnant ,%&'&Eoman 6aramag (&#(&' J#1) ue2on (/#)./ J#(/) Don Carlos 1/#/ )#/&/ +ourceA N+O $anuary %&' uic4stat
Potential Clients #&)/ #'J. %#'1'
Potential Clients +hare %J) %.1 '(/
!ssumptionsA •
It is e3pected that ./K of the total female population gave birth in a year
•
It is e3pected that there will be /&K potential clients# since it is already prohibited by DO" to deliver the baby at home
•
Eith /&K potential clients to be served by birthing clinic# the proponents will serve (K only during the first year of its operation
6a9or Clients
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Catchment !reaA Camp '# 6aramag 7u4idnon and the nearby community living %& 4m in diameter# appro3imately These will include the nearby barangays of Don Carlos and ue2on# 7u4idnon In addition# clients served are those who cannot afford to give birth in the hospitals and can only afford the birthing center rates
Criteria for !dmission to 7irthing Center ,7ased on Phil health 6andate•
•
=ow ris4 pregnancies only
!ge '(*/)
•
:estation J*/' wee4s
•
No significant co*morbidities
•
No previous caesarean sections
•
No current pregnancy complications
•
"ave pre*natal during ' st trimester# % nd trimester and twice in rd trimester
•
"as had all the necessary blood tests and investigations eg full blood count# urea and electrolytes# and infection screening
•
Eith or without Phil health
Criteria for dis
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,7ased on Phil health 6andateFEith high blood pressure FEith diabetes F6alformation F6ulti*pregnancy FEith previous caesarean section FEith previous complication ,below is the detailed list-
Table 1 >numeration of Previous Complications Previous complications Une3plained stillbirthLneonatal death or previous death related to intrapartum difficulty •
•
Previous baby with neonatal encephalopathy
•
Pre*eclampsia re
•
Placental abruption with adverse outcome
•
>clampsia
•
Uterine rupture
•
•
Primary postpartum hemorrhage re
•
+houlder dystocia
•
"istory of previous baby more than /) 4g
•
•
•
>3tensive vaginal# cervical# or third* or fourth* degree perineal trauma Placenta previa !bruptio placenta
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•
+till birth
uality of +ervice The proponents will ensure that the proposed birthing center will provide the best
Terms of Payment
?or Phil health patient# the client;s full payment will be charged from their Phil health Insurance ?or Non*Phil health patient# the clients may pay partial down payment during admittance or full payment will be made before patient will be discharged
=ocation of the 7irthing Center
6other;s Choice 7irthing Center will be located in Camp '# 6aramag# 7u4idnon
>mergency Hehicle
%/ hour availability of vehicle to allow prompt transfer to hospital in case of complications or comple3 care
Thus# collaboration is deemed necessary
Collaboration for transfer# partner with nearby hospitalsA 7P" 6aramag
1!
6oreover# the proponents will provide a %/LJ transportation facilities for immediate response for those patient who would li4e to be pic4ed*up
Promotional or !dvertising +cheme to be adopted
The promotional or advertising schemes to be adopted by the proponents are the followingA leafleting in the nearby 7arangay for the information about the mother;s choice birthing center# referral fee of Php )&&&& per referral and radio advertisement for the first month of operation
Table J Promotional or !dvertising +cheme to be adopted Particulars =eafleting Radio !dvertisement Referral ?ee per month Total !mount
!mount P '#&&&&& /#&&&&& %#&&&&& P J#&&&&&
Contribution to the Philippine >conomy
The opening of the 6other;s Choice 7irthing Center in Camp '# 6aramag 7u4idnon will provide birthing facility in the +outh of Poblacion# 6aramag# 7u4idnon and will provide more convenience and basic health services needed by pregnant woman who needs more attentive care during the nine months of pregnancy as well as the immediate care for newborn babies
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:overnment will be facilitated by lowering the percentage of pregnant woman and new born child from mortality rate and additional ta3 for the operation of the said birthing center The immediate community will be given full health access for pregnant woman and new born babies at a very affordable price
T>C"NIC!= ?>!+I7I=IT@
This aspect determines to what e3tent the pro9ect meets the technical soundness criteria The technical re
Description of the Pro9ect
The pro9ect will be named as 6other;s Choice 7irthing Center under the management of licensed and e3perienced midwives with the assistance of licensed and e3perienced pediatrician and ob*gyne physicians
Description of the !rea 6inimum of && 3 ') s
Toilet and ade
•
%/ hour supply of clean and hot water and electricity supply ,including emergency lighting-
•
%/ hour refrigerator for storing medicines
1(
•
>
•
One patient bed per room for private type
•
+even pt in ward with curtain and dividers to provide patient privacy for each room
•
>ach room must have bright lighting
•
O3ygen tan4 and supply to the delivery room# must be secured to solid ob9ect
•
•
•
!de
No animals in the clinic
!ll windows and doors should be covered with a minimum of a net covering
•
•
+ufficient ventilation
!bsolutely no smo4ing on the premises with an obvious sign at front des4
Cleaning and +anitationA
•
Daily thorough cleaning of facilities with the use of a regimented chec4list
2)
•
Cleaning of individual patient areas after every use eg wiping down beds and cleaning up any spillage of body fluids
•
Individual disposal bins for sharp e
•
+ufficient plumbing and drainage facilities
•
"and washing sin4s and alcohol gel to be located near clinical wor4station
•
! dirty utility room for dirty linen and sanitary waste
•
! clean linen closet and laundry bag
•
! sterile laundry facility
•
!de
•
Thorough hand washing with water and soap before and after each and every patient contact including before and after each patient intervention or procedure
!lcohol gel to be applied on entering and leaving the
birthing center
6other;s Choice 7irthing Center Confidentiality +tatement
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!t 6other;s Choice 7irthing Center# our goal is to provide the best possible security and privacy measures for each patient !ll patient reports# documents# lab values# and information will be 4ept confidential by the staff of 6other;s Choice 7irthing Center Prior to the release of any information# the patient will first be as4ed for permission to disclose sensitive material to e3ternal parties +taff members not associated with the patient;s care are not allowed to review records !ll records will be 4ept for the duration of the patient;s life# after which time the records will be destroyed to protect confidentiality !ll records will be 4ept in a loc4ed# secure area of the clinic with no public access
!ntenatal Care
Patients should be given a choice at outset of care to have their birth at 6other Choice 7irthing Center or in the hospital They should be educated that if something goes wrong during their labor# outcomes for the woman and baby may be better in an obstetrics unit at hospital Obstetric units may be able to provide direct access to obstetricians# anesthetists# neonatologists and other speciali2ed care# including epidural analgesia !t any point during pregnancy or delivery# they may need to be transferred to a hospital for emergency treatment
!ntenatal :uidelines ?irst HisitA Ehen the mother first reali2es she is pregnant Patient +creening uestionnaire
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>ducation for the 6otherA M
"ow the baby develops during pregnancy M government poster
M
:eneral !dvice !bout Ehat to >3pect During a "ealthy Pregnancy
M
eeping "ealthy Ehile Pregnant
M
Danger +igns during Pregnancy
7irth plan
•
=aboratory Test Re
M
"emoglobin
M
"epatitis 7
M
7lood glucose
Hitamin +upplementation and 6edications M
?olic !cid /&& mcg per day until the '%th wee4 of pregnancyA this helps
prevent neural tube defects M
Iron supplements should not be offered routinelyA give only if anemic or
hemoglobin ''gL'&&m= M
6ultivitamins
+econd HisitA 7etween '.*%& Eee4s •
?ollow up with first visit and ma4e sure patient has completed re
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•
Continue to record observations# H+# weight# fundal height# and any problems or concerns the e3pecting mother may have
•
=absA 7lood :lucose
•
6a4e plan for ne3t visit
Third HisitA 7etween %/*%. wee4s •
?ollow*up with second visit
•
Continue !ntenatal ?low Chart and record observations# vital signs# weight# fundal height# and any problems or concern the e3pecting mother may have
=aboratory Test Re
"emoglobin
M
UrineA proteinurea
M
7lood glucose
M
Oral :lucose Tolerance Test ,O:TT-
Ultrasound
?ourth HisitA 7etween %*1 Eee4s •
?ollow up with third visit
•
Continue record observations# vital signs# weight# fundal height# and fetal presentation
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M
If fetus is found to be malpositioned through palpation# a confirmation must
be done by ultrasound
M
If it is confirmed by ultrasound# give the woman a choice to follow up in one
to two wee4s for a repeat ultrasound to chec4 fetal position If at that time the fetus is still malpositioned the woman should be referred to the nearest hospital and told she may not give birth at the clinic0 however all post natal care from the 1 wee4 baby chec4 on are still available to her
•
M
=aboratory Test Re
NormalA '& If hemoglobin '&# the woman should be referred to hospital for her birth# as low "b signifies a greater probability of bleeding during birth and the possible need for blood products which the clinic cannot provide
•
Discuss upcoming delivery with the woman and go over any concerns or
•
>ncourage financial planning and discuss costs
•
>ncourage prompt mobili2ation towards the birthing centre as soon as they feel the beginning stages of labor
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•
Discuss the possibility that they may not be able to give birth at the clinic# should there any complications with their labor
Other HisitsA Reasons for e3tra visits include# but are not limited toA high blood pressure# pain in abdomen# and e3tra blood sugar chec4s
•
Other visits should be at the discretion of the patient and the +7! providing antenatal care
Intrapartum Care •
•
!dmission only if in established labor
+ign consent form for admission
?irst +tage of =abor DefinitionsA •
=atent first stage of laborA ! period of time# not necessarily continuous# whenA there are painful contractions and some cervical change# including cervical effacement and dilatation up to / cm
•
>stablished first stage of laborA Ehen there are regular painful contractions and progressive cervical dilatation from / cm
Duration of the first stage laborA •
NulliparousA .*'. hours
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•
6ultiparousA )*'% hours
!ssessment Initial !ssessment of a woman in labor should includeA •
=istening to her story and review clinical records
•
Physical observationA temperature# pulse# blood pressure# urinalysis
•
=ength# strength and fre
•
•
•
•
!bdominal palpationA fundal height# lie# presentation# position and station
Haginal lossA show# li
!ssessment of pain
?"R auscultated for a minimum of ' minute immediately after a contraction
•
Haginal e3amination should be offered if woman is in established labor
IH ?luid access •
% large cannula ,at least '.:L:reen- to be inserted into a patient;s veins on admission
!ssessment
2!
•
! pictorial record of labor ,partograph- should be used once labor is established
•
Eorld "ealth Organi2ation recommends /*hour action line on partograph# should one be used
Observations or =abor watch •
Temperature and blood pressure every four hours
•
Pulse every hour
•
Documentation of fre
•
?re
•
Haginal e3amination offered every four hours or where there is concern about progress or in response to the woman;s wishes ,after abdominal palpation and assessment of vaginal loss-
•
Intermittent auscultation of the fetal heart after a contraction should occur for at least one minute# every fifteen minutes# and the rate should be recorded as an average The maternal pulse should be palpated if a ?"R abnormality is detected to differentiate the two heart rates Intermittent auscultation can be underta4en by Doppler ultrasound
+econd +tage of =abor
2"
DefinitionsA •
Passive second stage of laborA The finding of full dilatation of the cervi3 prior to or in the absence of involuntary e3pulsive contractions
•
Onset of the active second stage of laborA The baby is visible with e3pulsive contractions and a finding of full dilatation of the cervi3 or other signs of full dilatation of the cervi3 !s well as active maternal effort following confirmation of full dilatation of the cervi3 in the absence of e3pulsive contractions
Duration of the second stage labor •
NulliparousA 7irth would be e3pected to ta4e place within hours of the start of the active second stage in most women
•
! diagnosis of delay in the active second stage should be made when it has lasted % hours and women should be referred to a healthcare professional trained to underta4e an operative vaginal birth if birth is not imminent
•
6ultiparousA 7irth would be e3pected to ta4e place within % hours of the start of the active second stage in most women
•
! diagnosis of delay in the active second stage should be made when it has lasted ' hour and women should be referred to a healthcare
2(
professional trained to underta4e an operative vaginal birth if birth is not imminent
Observations •
7lood pressure and pulse every hour
•
Temperature every four hours
•
Haginal e3amination offered every hour in the active second stage or in response to the woman;s wishes ,after abdominal palpation and assessment of vaginal loss-
•
Documentation of the fre
•
?re
•
Ongoing consideration of the woman;s emotional and psychological needs
•
!ssessment of progress should include maternal behavior# effectiveness of pushing and fetal wellbeing# ta4ing into account fetal position and station at the onset of the second stage These factors will assist in deciding the timing of further vaginal e3amination and the need for obstetric review
3)
•
Intermittent auscultation of the fetal heart should occur after a contraction for at least one minute# at least every five minutes The maternal pulse should be palpated if there is suspected fetal bradycardia or any other ?"R anomaly to differentiate the two heart rates
•
Ongoing consideration should be given to the woman;s position# hydration# coping strategies and pain relief throughout the second stage
Eomen;s Position and Pushing in the +econd +tage •
Eomen should be discouraged from lying supine or semi*supine in the second stage of labor and should be encouraged to adopt any other position that they find most comfortable
•
Eomen should be informed that in the second stage they should be guided by their own urge to push
•
If pushing is ineffective or if re
Reducing Perineal Trauma
•
Perineal massage should not be performed by healthcare professionals in the second stage of labor
31
•
>ither the Qhands on; ,guarding the perineum and fle3ing the baby;s heador the Qhands poised; ,with hands off the perineum and baby;s head but in readiness- techni
•
=idocaine spray should not be used to reduce pain in the second stage of labor
•
! routine episiotomy should not be carried out during spontaneous vaginal birth
•
Eomen with a history of severe perineal trauma should be informed that their ris4 of repeat severe perineal trauma is not increased in a subse
Third +tage of =abor
DefinitionsA •
Third stage of laborA the time from the birth of the baby to the e3pulsion of the placenta and membranes
•
Prolonged third stageA over & minutes
Observations
•
7lood pressure and pulse
32
•
Eoman;s general physical condition# as shown by her color# respiration and her own report of how she feels
•
Haginal blood loss
Recommendation
•
!ctive management of the third stage is recommended# which includes the use of o3ytocin ,'& international units IUS by intramuscular in9ection-# followed by early clamping and cutting of the cord and controlled cord traction
•
Eomen should be informed that active management of the third stage reduces the ris4 of maternal hemorrhage and shortens the third stage
•
Pulling the cord or palpating the uterus should only be carried out after administration of o3ytocin as part of active management
•
+tart completing Postnatal Notes
Immediate Cord Care after 7irth
•
Ehen the child the cord pulses and is fat and blue# do not cut at this time
•
Place the bay on the mothers chest wrapped in a warm blan4et
•
!fter a while# feel the cord if the pulsation stops then cut
33
•
Change gloves for the n ne3t procedure
Indications for Transfer to 6ore !dvanced "ealthcare ?acility via !mbulance •
Need for continuous electronic fetal monitoring or >?6# indicated byA
•
+ignificant meconium*stained li
•
!bnormal ?"R detected by intermittent auscultationA less than ''& beats per minute# greater than '1& bpm# any decelerations after a contraction0 or uncertainty of presence of fetal heartbeat
•
6aternal pyre3iaA .&C once or J)C on two occasions % hours apart
•
?resh bleeding starting in labor
•
The woman;s re
•
Delay in the first or second stages of labor# diagnosed byA
•
Cervical dilatation of less than % cm in / hours for first labor
•
Cervical dilatation of less than % cm in / hours or a slowing in the progress of labor for second or subse
•
Changes in the strength# duration and fre
34
•
Re
•
Obstetric emergency M antepartum hemorrhage# cord presentationLprolapsed# postpartum hemorrhage# maternal collapse or a need for advanced neonatal resuscitation
•
Retained placenta that cannot be e3tracted by manual intervention
•
6alpresentation or breech presentation diagnosed for the first time at the onset of labor# ta4ing into account imminence of birth
•
>ither raised diastolic blood pressureA over (& mm"g0 or raised systolic blood pressureA over '/& mm"g0 on two consecutive readings ta4en & minutes apart
•
Third* or fourth*degree tear or other complicated perineal trauma re
•
If premature rupture of membranes occurred over %/ hours before onset of labor
Care of 6other and 7aby Immediately !fter 7irth
Care of baby
35
•
!P:!R scores at ' and ) minutes should be recorded for all births If no respirations# stimulate baby# if stimulation ineffective# begin neonatal resuscitation
•
Obtain baby;s vital signs# see Newborn Hital +igns
•
+4in*s4in contact as soon as possible after birth
•
7aby dried and covered in warm dry blan4et
•
Initial breastfeeding should be as soon as possible
•
6easurement of head circumference# body temperature and birth weight should be measured soon after the 'st hour
•
!n e3amination of the baby should be carried out to ensure no physical abnormality
•
!pply >rythromycin ointment &)*'K or Tetracycline ointment 'K to both eyes within ' hour of birth
•
•
•
!dminister Hitamin &) mg I6# within ' hour of birth
Complete Postnatal Notes
!dminister 7C: immuni2ation prior to discharge
36
•
Needs hemoglobin chec4 before discharge
Care of Eoman
•
6easure temperature# pulse# blood pressure# uterine contractions# lochia
•
>3amine placenta and membranesA assessment of their condition# structure# cord vessels and completeness
•
>arly assessment of maternal emotionalLpsychological condition
•
Record successful voiding of the woman;s bladder within 1 hours post delivery
•
Perineum !ssessment and Repair
•
Complete Postnatal Notes
6others who arrive in the immediate postnatal phase
•
>nsure patient has been 4nown the antenatal period# has attended all the re
•
If not# then immediately send mother and baby to nearest hospital via emergency transportation
3!
•
If vital signs and observations within normal limits# mother and baby may stay at clinic for further management
•
If any of the following occur# mother and baby should be transferred to nearest hospital
•
6aternal systolic blood pressure greater than '/&# less than (&# or diastolic blood pressure greater than (&
•
Postpartum hemorrhage# with blood loss greater than )&& ml
+ee
6anagement of Postpartum "emorrhage
•
6aternal collapse
•
6aternal Pyre3ia# defined by a temperature of .C or greater
•
Retained placenta
•
Third or fourth degree perineal tear
•
!bnormality of baby
•
Neonatal resuscitation re
•
Please ensure patient and baby stabili2ed before transferring to hospital eg IH cannula inserted# fluid resuscitation
3"
Postnatal Care
Postnatal Care of the 6other •
Please complete Initial 6other !ssessment form in Postnatal Notes
•
:ive oral and demonstrational teaching on breastfeeding within %/ hours of birth# prior to discharge from birthing centre
7reastfeedingA
•
6other should educate about the important of breastfeeding
Perineal Care •
!ssess mother for perineal pain# discomfort or stinging# offensive perineal odor or dyspareunia
•
If the mother is e3periencing discomfort# she should be taught that topical cold therapy provides effective perineal pain relief
•
>ncourage perineal hygiene# such as fre
:eneral !dvice •
+ee to it of 4eeping healthy after giving birth
Postnatal Care of the 7aby •
Complete Initial 7aby !ssessment form in Postnatal Notes
3(
•
Complete full body assessment of baby# if any gross abnormalities# especially 9aundice# within first %/ hours# baby may need to be referred to hospital of choice
Prior to Discharge
•
Provide mother with chance to as4 any
•
Provide mother with documentation and help if necessary to fill out the appropriate government forms to be reimbursed for the delivery of her baby
Postnatal ?ollow Up
!ppointment at ?irst Eee4
?ollow Up for the 6other
•
M
!s4 about any issues e3perienced and problems encounter li4eA
+igns of mastitisA flu*li4e symptoms# red# tender and painful breasts# if
present# encourage gentle massage of breast# continued feeding# paracetamol for discomfort and increased fluid inta4e
M
Constipation and hemorrhoidsA if no bowel movement three days after birth#
give patient a gentle la3ative# encourage increased dietary fiber and fluid
4)
consumption in both cases# and encourage cold pac4s and paracetamol for pain management
M
Urinary incontinenceA if this is an issue# give teaching on eagel e3ercises
M
?atigueA if e3periencing e3cessive fatigue# review birthing events and
antepartum history# if any signs
indicate hemorrhage#
chec4
mother;s
hemoglobin
M
>motional wellbeingA encourage the mother to communicate any changes in
mood# emotional state or behavior that seem abnormal to her
•
Discuss plans for contraception following birth and encourage the mother to abstain from se3ual intercourse for si3 wee4s postpartum
?ollow Up for the 7aby
•
7abies should be assessed forA temperature# heart rate# respiratory rate# color# regular urination and stooling# general appetite and breast mil4 inta4e# body tone# and irritability
•
!ssess for 9aundice# pale stools and dar4 urine If present assess severity# if acute 9aundice present# refer to hospital
41
!ppointment at +i3th Eee4 *for immuni2ation
•
Perform a complete physical assessment of the baby# as outlined in the Complete Physical !ssessment of the 7aby and assess social smiling and visual fi3ing at this time as well
•
!s4 about any concerns the mother has had about her child since the last appointment
•
!dminister OPH '# Pentavalent ' and Rotare3 '
!ppointment at Tenth Eee4
?ollow Up for the 6other
•
!s4 about any concerns the mother has had since the previous appointment
•
Continue to manage concerns that have arisen previously
?ollow Up for the 7aby
•
!s4 about any concerns the mother has had about the child since the last appointment
•
Continue to manage concerns that have arisen previously
42
•
•
6easure and plot height and weight on growth chart
!dminister OPH % # Pentavalent % and Rotare3 %
!ppointment at ?ourteenth Eee4
•
!dminister OPH and Pentavalent
!ppointment at +i3th 6onth
•
6easure and plot baby;s height and weight in growth chart
!ppointment at Ninth 6onth
•
!dminister 6easles immuni2ation to baby and vitamin !
!ctual 7uilding of the 6other;s Choice 7irthing Center
43
Proposed ?loor Plan '%*7ed Eard
44
Table J >3pected !ttainable Clients
!rea
$un
$ul
!ug
+ep
Oct
Nov
Dec
$an
?eb
6ar
!pr
6ay
Total
6
''
''
''
''
''
''
''
''
''
''
''
''
'%
'%
'%
'%
'%
'%
'%
'%
'%
'%
'%
'%
'%
'//
D
.
.
.
.
.
.
.
.
.
.
.
.
(1
Total
'
'
'
'
'
'
'
'
'
'
'
'
J%
!ssumptionsA !n increase of '1K of clients per year or an e
>ffect of =ayout on Eor4 ?low The effect of layout on wor4 flow will be smooth# convenient# thus resulting for efficient and effective care for mother and baby
45
Provision for >3pansion During the five years initial operations# partners agreed to focus more on area penetration and long*term profit ma3imi2ation and established good relationship toward the clients to address and respond immediately to their need and demand Provision for e3pansion will be planned as business will grow and become stable
+tructure The structure will be fully concreted and will be build according to government re
Easte Disposal
There will be a separate trash can for biodegradable# non*biodegradable and infectious items 7iodegradable waste will be disposed in a compose pit Non*biodegradable waste will be sold in 9un4 shops
?or Infectious Items
,+harps and 7ioha2ard Disposal- will be disposed as followsA !ll sharps including needles# finger stic4s# glass# ampules# IH supplies# and specimen containers will be disposed of in a puncture proof plastic container provided by the clinic >ach container when full will be disposed of in a meter deep hole# at least %& meters from the nearest water supply and building# as recommended by DO" 7ioha2ardous material including blood and birthing by*products should be
46
disposed of via incineration# or disposed of by the same method as detailed above ?IN!NCI!= ?>!+I7I=IT@
This chapter shows the financial performance and resources of the proposed pro9ect This includesA financial statements and financial ratios that enable the proponents to determine the li
It will give
substantial information as basic for the establishment of the proposed pro9ect
Table . 6onthly Pro9ected Cost Particulars Ultrasound Rental 7uilding !morti2ation ,?inance=ot Rental Eater and >lectricity 7ill 6idwife +alary ,)Principal 6idwife Ob*:yne ,ConsultationPediatrician ,consultation+upplies Eatchman Total
Unit Cost per Patient Unit Cost
Total Cost L Total no of clients (.#&&&L' #'1'%(
6ar4*up
%)K
!mount ,in Php%#&&&&& '#1&&&& %#&&&&& )#)&&&& /&#&&&&& '&#&&&&& ')#)&&&& ')#)&&&& '#(&&&& /#&&&&& (.#&&&&&
4!
Unit Price per Patient .#&&&&&
Table . >
Particulars
ty
6onthly
N+HD set
/
+tethoscope
'
)&&&&
)&&&&
Eeighing scale
'
'&&&&&
'&&&&&
7lood pressure apparatus
'
)&&&&
)&&&&
Thermometer
&&&&
&&&&
Doppler
'
')#&&&&&
')#&&&&&
6easuring tape
'
%&&&
%&&&
elly pad
'
%&&&&
%&&&&
:oose nec4 lamp
'
&&&&
&&&&
Tourni
'
)&&&
)&&&
P %'#.J&&&
P %'#.J&&&
Total
P
/&&&&&
@early P
/&&&&&
Table ( +upply
Particulars mas4 soap
ty
6onthly P
)&&& '&&&&
@early P
1&&&& '#%&&&&
4"
bleach
J&&&
./&&&
paper
')&&&
'#.&&&&
)&&&
1&&&&
cotton
'&&&&
'#%&&&&
gau2e
'&&&&
'#%&&&&
glove
'&&&&
'#%&&&&
)&&&
1&&&&
alcohol
'&&&&
'#%&&&&
y 9elly
'&&&&
1&&&&
syringe
')&&&
'#.&&&&
P '#'%&&&
P '#//&&&
6onthly (&&&
@early
ball pen
umbilical cord
Total
Table '& 6edicine
Particulars Paracetamol !nti*inflammatory !ntiemetic
ty P
P
'#&.&&&
#1&&&&
%#/&&&&
&&&& %&&&&
4(
O3ytocin
)&&&&
Hit 4
1#&&&&&
%#/&&&&
#1&&&&
'#%&&&&
P
%&#%.&&&
%&&&&
>rythromycin
&&&&
!lbenda2ole
'&&&&
Total
P '#1(&&&
Table '' Rental >3pense
Particulars Ultrasound Rental
P
=and Rental
6onthly %#&&&&&
@early P
%/#&&&&&
%/#&&&&&
%#&&&&&
!morti2ation ,7uilding-
%#&&&&& %/#&&&&&
Total
P 1#&&&&&
P
J%#&&&&&
NoteA •
•
Ultrasound will be lend from :> company at Php %#&&&&&Lmonth payable for %& years Old 7uilding will be renovated through =and 7an4 loan amounting to Php /.&#&&&&&
Table '% Ultrasound Income
Particulars ?irst Tri G 1&&
ty '
P
6onthly '.#1&&&&
@early P %%#%&&&&
+econd Tri G /)&
'
'#()&&& '1J#/&&&&
Third Tri G /)&
'
'#()&&& '1J#/&&&&
Total
P
/1#)&&&&
)).#&&&&&
5)
=essA +onologist ?ee
'
'.#1&&&& P %%#%&&&&
Net Income
P
%J#(&&&& /#.&&&&
=essA Rental
%#&&&&& %/#&&&&&
Net Income after Rental ?ee
P
%)#(&&&&
'&#.&&&&
Table '+chedule for +alaries and Eages
Particulars Principal 6idwife
ty '
6onthly P '&#&&&&&
@early P '%&#&&&&&
6idwives
)
/&#&&&&& /.&#&&&&&
Eatchman
%
.#&&&&&
Pediatrician
'
(1#&&&&&
')#)&&&& '.1#&&&&&
Ob*:yne +onologist
Total
' '
')#)&&&&
'.1#&&&&&
%%#%&&&&
'.#1&&&&
P '&J#1&&&&
P '#%('#%&&&&
6other;s Choice 7irthing Center Pro9ected Income +tatement ?or ' Myear Table '/ Pro9ected Income +tatement of 6other;s Choice 7irthing Center Particulars @ear ' :ross Profit #%%/#&&&&& !ddA Ultrasound Income )).#&&&&&
51
Total :ross Profit =essA >3penses +alaries and Eages !dvertising Rental >3pense !morti2ation >3pense Ultrasound Rental >3penses Net Income =essA Income Ta3 ,&KNet Income after Ta3
#J.%#&&&&& '#%('#%&&&& J#&&&&& /.#&&&&& %/#&&&&& %/#&&&&& %'#.J&&& '#//&&& %&#%.&&& '#//(#J(&&& %#%#%'&&& 1((#11&& '#1%#)/J&&
6other;s Choice 7irthing Center Pro9ected Cash ?low +tatement ?or ' Myear Table ') Pro9ected Cash ?low +tatement of 6other;s Choice 7irthing Center Particulars Pre*operating Period @ear ' Cash Inflow Owner;s Capital )%#.'&&& :ross Profit #J.%#&&&&& Total Cash Inflow /#&)#.'&&& =essA Cash Outflow +alaries and Eages '#%('#%&&&& !dvertising J#&&&&& Rental >3pense /.#&&&&& !morti2ation >3pense %/#&&&&& Ultrasound Rental %/#&&&&& >nding %#')1#)J&&
52
6other;s Choice 7irthing Center Pro9ected 7alance +heet ?or ' Myear Table ') Pro9ected 7alance +heet of 6other;s Choice 7irthing Center Particulars !mount ,PhpCash on 7an4 %#&&&#&&&&& Cash on "and ')1#)J&& Total !ssets %#')1#)J&& =iabilities !ddA Capital !ddA Net Income Total =iabilities and Capital
/.&#&&&&& /#.'&&& '#1%#)/J&& %#')1#)J&&
?inancial !nalysis and InterpretationA Profit 6argin Net Income +ales '#1%#)/J&& #J.%#&&&&& &/'J or /'JK !nalysis and InterpretationA The profit margin shows that for every '&& sales# there is a net profit margin of / centavo This means that during the first year of operation the birthing center will be able to earn /K net profit considering also that various e3penses were incurred during the pre*operating period
53
Return on Investment Net Income Investment '#1%#)/J&& )%#.'&&& '' !nalysis and Interpretation It is e3pected that for every '&& peso invested by the proponents# the birthing center can return '' pesos during the first year of operation
Paybac4 Period Investment !nnual Cash Returns )%#.'&&& #J.%#&&&&& &'. or '.K
It reflects that the company can repay its invested capital during the first year of its operation
ConclusionsA
