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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.

According to the Department of Health, maternal mortality report, updated

in June 2010, hypertension complicated by pregnancy comprises 29 percent of

the causes of maternal deaths, and partum hemorrhage 15 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.

According to the National Demographic Health Survey (NDHS) of 2008,

only 44 percent of births in the Philippines occur in health facilities; 56 percent of

children are still delivered at home.

Under Philippine law, licensed midwives are authorized to carry out the

supervision and care of women during pregnancy, labor and management of

normal deliveries, including the administration of an oxytocin drug to prevent and

treat hemorrhage after the delivery of the placenta.

At present, Department of Health made a memorandum that there will no

more pregnant mother to deliver children at home due to unsafe and risk

delivery. Thus, as licensed midwives and proponents of this feasibility study

aims to establish a birthing center, to be named as “Mother Choice Birthing

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Center” to 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 at the same time, hospital addresses

different cases of health problems while birthing center only focus on parturient

cases at the same time cheaper.

Objectives of the Study

Generally, this study will be of great help to achieve the vision of the

Mother’s Choice Birthing Center, which is to be an effective partner in sustaining

and maintaining quality of care to our clients through excellent birthing center

service with full client’s satisfaction.

Significance of the Study

To the Researchers

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.

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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 School

The school administration will be proud of the brilliant researched studies

added to the College Library and Research Department for the useful reference

for future researchers.

To the Government

The government will surely support the study because of the situation of

health in our country today. If the study will be materialized it will be a big help to

the community in general.

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THE FEASIBILITY STUDY

This chapter presents the four (4) components of a project feasibility

study, namely: management, marketing, technical and financial. This project

feasibility study is prepared to ascertain if the project, as initially designed, will

have a chance in the niche market when implemented.

Management Feasibility

This aspect includes a study of the basic organization, form of business,

organizational chart and project operation schedules. This aspect helps to

determine the effectiveness of the organization and the qualification of the

individuals which will make-up the organization of the business.

Form of Business

The business will be registered and recognized under the name: Mother’s

Choice Birthing Center as universal-limited partnership and will be registered with

the Securities and Exchange Commission (SEC). A partnership duly formed

under the law is a juridical person separate and distinct from each of the partner.

The proponents are Registered Midwife (RM), to wit: Marites C. Bahian, Mary

Jane Beleno, Aubrey D. Nuñez, Roselie A. Rodicol and Susan L. Suralta.

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

agreement among the owners or partners. It is agreed that partners have

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specified duties and responsibilities to the business activities (as presented in the

organizational chart). Other positions left require hiring of workers to work for the

company.

All partners finished from the two-year Diploma in Midwifery, passed the

Board of Midwifery Licensure Examination and will finish their degree in Bachelor

of Science in Midwifery. Thus, they have enough knowledge and skills to run the

business.

Organizational Structure

The proponents agreed that they will join force in managing their business

considering that the company has limited resources. However, once the birthing

center will expand, they will hire additional staff to assist the business operation.

Next page is the designed organizational structure outlining the position

involves.

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Mother’s Choice Birthing Center

Note: Additional staff will be hired once the business is already established.

Business Experiences and Qualifications of Proponents

The experiences, trainings and seminar attended by the proponents are

considered excellent factor’s in business success. The course taken by the

proponents are in line with birthing management which will be a big factor in the

AUBREY D. NUÑEZMIDWIFE

MARITES C. BAHIANMIDWIFE

MARY JANE C. BELENOMIDWIFE

ROSELIE C. RODICOLPRINCIPAL-MIDWIFE

SUSAN L. SURALTAMIDWIFE

MIDWIFE

OBSTETRICIANON-CALL

PEDIATRICIANON-CALL

SONOLOGISTON-CALL

WACTHMAN STUDENTINTERN

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success of business. Through their experience, the proponents believe that

these can give them that much needed self-confidence to enable them to carry

their individual task.

Table 1. Unit Management PersonnelUnit Management

PersonnelTime to be

devoted to the project and duties

Qualification Compensation

Principal Midwife -12 hours-Manages and oversees the operation of the business

- Master’s Degree holder, BSM, RM-Competent Personality

P 10,000.00plus fringe benefits

Pediatrician on-call-24 hour cover of the clinic-Manage the immediate newborn care

-License Pediatric Medicine Physician-Competent Personality

Php 500 per new born

OB-Gyne Consultant

On-call-24 hour cover of the clinic-Manage the maternal care

-License OB-Gyne Medicine Physician-Competent Personality

Php 3,500 per mother or 500 per consultation

Ultrasound Sonologist

Part-time- 8 hours duty- Ultrasound In-charge

-License Sonologist

Php 200 per ultrasound

Skilled Midwife -12 hours- responsible for maternal and immediate new born care

Licensed Midwife Php8,000 per month plus fringe benefit

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Table 2. Labor Skills RequirementLabor Skills

RequiredNumber of

Required Skilled Labor

Qualification Compensation

Watchman 1 High School GraduateBasic Police Training

P 4,000.00 per month plus fringe benefit

Student Intern: Second year Midwifery SAIT studentProtocol:

*Observe*Assist*Research*Experience

Support groups:

Women’s League

SAIT -school

Shift rotations:

Staff are divided according to schedule (12 hours per duty) Eight hours only for security and housekeeper

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 undertaking. Hiring

scheme will be post in the internet and applicants will submit their application,

bio-data and requirements via e-mail at

motherschoicebirthingcenter@yahoo.com. The applicants will undergo a written

and practical examination to gauge their mental capacity and know if they had

the skills to carry out the work. Once they will pass, the principal midwife will

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conduct character reference of the person. Lastly, 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

skills, attitude and capacities to maximize the individual’s job performance.

Virtually, every employee in the company will undergo some degree of training

programs, either formal or informal. MDG trainings include: Partograph, IV

insertion, neonatal resuscitation, breastfeeding, basic life support, post partum

hemorrhage and immediate newborn care.

Fringe Benefits

Below are the fringe benefits offered by the company will be as follows:

- Full coverage on SSS, Philhealth and Pag-IBIG

- Annual vacation leave and sick leave for 15 days with pay

- 13th month bonus

- Retirement Package

- Commission

Facilities

The facilities of the birthing clinic based on Department of Health (DOH)

requirement will be the following:

Toilet and bathing facilities for mother and baby

24 hour supply of clean and hot water

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Electricity supply (including emergency lighting)

24 hour refrigerator for storing medicines

Equipment in satisfactory condition

One patient bed per room for private type

Seven pt. in ward with curtain and dividers to provide patient privacy for

each room

Each room must have bright lighting

Oxygen tank and supply available in the delivery room, must be secured

to solid object

Adequate prevention from occupational hazards

No animals in the clinic

All windows and doors should be covered with a minimum in a net

covering

Sufficient ventilation

Absolutely no smoking on the premises with an obvious sign at front desk

Table 3. Pre-Operating Activities

Activities Number of WeeksPreparation of the Project Feasibility Study 4Registration of the Business (SEC, DTI, Philhealth) 4Business Permit 2Construction of the Building 24Purchase of the Equipment 4Setting-up of the Equipment 4Purchases of facilities and office supplies 4Hiring of workers 2

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Note: It is expected by the proponents that at the end of one year preparation,

the birthing center will fully operate after the completion of pre-operating

activities.

Table 4. Pre-operating Expenses

Activities Initial Amount NeededPreparation of the Project Feasibility Study P 5,000.00Registration of the Business (SEC, DTI, Philhealth) 2,500.00Business Permit 5,000.00Renovation of the Building 480,000.00Purchase of the Equipment 21,620.00Setting-up of the Equipment 4,000.00Purchases of facilities and office supplies 3,000.00Purchases of Medicine 1,690.00Hiring of workers 1,000.00Initial Total Amount Needed P 523,810.00

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MARKETING FEASIBILITY

This aspect is considered as the lifeblood of virtually projected feasibility

study for the extent of the data and information gathering because the

succeeding aspects depend largely on it. This serves as the basis of the

financial section through projected demand. It includes the following information:

demand and supply gap analysis, marketing program and the projected number

of clients. The objective of this study is to determine the quantity of clients

needed to maintain the operation of the mother’s choice birthing center.

Below is the presentation of Bukidnon map highlighting Maramag,

Bukidnon where proponents would like to serve South Poblacion where Camp 1

is located. The said area has no available birthing center and far from the

hospitals and clinic in Poblacion, Maramag, Bukidnon. In addition, Camp 1,

Maramag, Bukidnon is a cross section between Quezon and Don Carlos,

Bukidnon with a bigger population.

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Table 5. Supply and Demand Gap Analysis

Area Population(2010)

Pregnant Woman

Potential Clients

Potential Clients Share

Maramag 90,901 7,635 3,054 275Quezon 94,584 7,945 3,178 286Don Carlos 64,334 5,404 2,161 194Source: NSO January 2013 Quickstat

Assumptions:

It is expected that 8.4% of the total female population gave birth in a year

It is expected that there will be 40% potential clients, since it is already

prohibited by DOH to deliver the baby at home.

With 40% potential clients to be served by birthing clinic, the proponents

will serve 9% only during the first year of its operation.

Major Clients

Catchment Area: Camp 1, Maramag Bukidnon and the nearby community

living 20 km in diameter, approximately. These will include the nearby barangays

of Don Carlos and Quezon, Bukidnon. 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 Admission to Birthing Center (Based on Phil health Mandate)

Low risk pregnancies only

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Age 19-45

Gestation 37-41 weeks

No significant co-morbidities

No previous caesarean sections

No current pregnancy complications

Have pre-natal during 1st trimester, 2nd trimester and twice in 3rd trimester

Has had all the necessary blood tests and investigations e.g. full blood

count, urea and electrolytes, and infection screening

With or without Phil health

Criteria for disqualification for admission in Birthing Center (Based on Phil health Mandate)

*With high blood pressure*With diabetes*Malformation*Multi-pregnancy*With previous caesarean section*With previous complication (below is the detailed list)

Table 6. Enumeration of Previous ComplicationsPrevious complications

Unexplained stillbirth/neonatal death or previous death related to intrapartum difficulty

Previous baby with neonatal encephalopathy Pre-eclampsia requiring preterm birth Placental abruption with adverse outcome Eclampsia Uterine rupture Primary postpartum hemorrhage requiring

additional treatment or blood transfusion Retained placenta requiring manual removal in

theatre Shoulder dystocia History of previous baby more than 4.5 kg Extensive vaginal, cervical, or third- or fourth-

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degree perineal trauma Placenta previa Abruptio placenta Still birth

Quality of Service

The proponents will ensure that the proposed birthing center will provide

the best quality service. Price offered is affordable compared to hospitals. (note:

specific services are put into detail in the technical feasibility study section)

Terms of Payment

For Phil health patient, the client’s full payment will be charged from their

Phil health Insurance.

For Non-Phil health patient, the clients may pay partial down payment

during admittance or full payment will be made before patient will be discharged.

Location of the Birthing Center

Mother’s Choice Birthing Center will be located in Camp 1, Maramag,

Bukidnon.

Emergency Vehicle

24 hour availability of vehicle to allow prompt transfer to hospital in case of

complications or complex care. Thus, collaboration is deemed necessary.

Collaboration for transfer, partner with nearby hospitals: BPH Maramag.

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Moreover, the proponents will provide a 24/7 transportation facilities for

immediate response for those patient who would like to be picked-up.

Promotional or Advertising Scheme to be adopted

The promotional or advertising schemes to be adopted by the proponents

are the following: leafleting in the nearby Barangay for the information about the

mother’s choice birthing center, referral fee of Php 500.00 per referral and radio

advertisement for the first month of operation.

Table 7. Promotional or Advertising Scheme to be adopted

Particulars AmountLeafleting P 1,000.00Radio Advertisement 4,000.00Referral Fee per month 2,000.00Total Amount P 7,000.00

Contribution to the Philippine Economy

The opening of the Mother’s Choice Birthing Center in Camp 1, Maramag

Bukidnon will provide birthing facility in the South of Poblacion, Maramag,

Bukidnon 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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Government will be facilitated by lowering the percentage of pregnant

woman and new born child from mortality rate and additional tax 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.

TECHNICAL FEASIBILITY

This aspect determines to what extent the project meets the technical

soundness criteria. The technical requirements of the project will be analyzed.

Description of the Project

The project will be named as Mother’s Choice Birthing Center under the

management of licensed and experienced midwives with the assistance of

licensed and experienced pediatrician and ob-gyne physicians.

Description of the Area

Minimum of 300 x 15 square feet (building and facility requirements is under the Department of Health prescription)

Toilet and adequate bathing facilities for mother and baby

24 hour supply of clean and hot water and electricity supply (including

emergency lighting)

24 hour refrigerator for storing medicines

Equipment in satisfactory condition

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One patient bed per room for private type

Seven pt. in ward with curtain and dividers to provide patient privacy for

each room

Each room must have bright lighting

Oxygen tank and supply to the delivery room, must be secured to solid

object

Adequate prevention from occupational hazards

No animals in the clinic

All windows and doors should be covered with a minimum of a net

covering

Sufficient ventilation

Absolutely no smoking on the premises with an obvious sign at front desk

Cleaning and Sanitation:

Daily thorough cleaning of facilities with the use of a regimented checklist

Cleaning of individual patient areas after every use e.g. wiping down beds

and cleaning up any spillage of body fluids

Individual disposal bins for sharp equipment, clinical waste and household

general waste with ideally a safe and environmentally friendly method of

discard

Sufficient plumbing and drainage facilities

Hand washing sinks and alcohol gel to be located near clinical workstation

A dirty utility room for dirty linen and sanitary waste

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A clean linen closet and laundry bag

A sterile laundry facility

Adequate method of sterilization of reusable instruments e.g. autoclave

Thorough hand washing with water and soap before and after each and

every patient contact including before and after each patient intervention

or procedure. Alcohol gel to be applied on entering and leaving the

birthing center

Mother’s Choice Birthing Center Confidentiality Statement

At Mother’s Choice Birthing Center, our goal is to provide the best

possible security and privacy measures for each patient.  All patient reports,

documents, lab values, and information will be kept confidential by the staff of

Mother’s Choice Birthing Center.  Prior to the release of any information, the

patient will first be asked for permission to disclose sensitive material to external

parties.  Staff members not associated with the patient’s care are not allowed to

review records. All records will be kept for the duration of the patient’s life, after

which time the records will be destroyed to protect confidentiality.  All records will

be kept in a locked, secure area of the clinic with no public access.

Antenatal Care

Patients should be given a choice at outset of care to have their birth at

Mother Choice Birthing Center or in the hospital. They should be educated that if

something goes wrong during their labor, outcomes for the woman and baby may

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be better in an obstetrics unit at hospital.  Obstetric units may be able to provide

direct access to obstetricians, anesthetists, neonatologists and other specialized

care, including epidural analgesia.  At any point during pregnancy or delivery,

they may need to be transferred to a hospital for emergency treatment.

Antenatal Guidelines

First Visit: When the mother first realizes she is pregnant

Patient Screening Questionnaire

Education for the Mother:

–      How the baby develops during pregnancy – government poster

–      General Advice About What to Expect During a Healthy Pregnancy

–      Keeping Healthy While Pregnant

–      Danger Signs during Pregnancy

_ Birth plan

Laboratory Test Requirements:

–      Hemoglobin

–      Hepatitis B

–      Blood glucose

Vitamin Supplementation and Medications

–      Folic Acid 400 mcg per day until the 12th week of pregnancy: this helps

prevent neural tube defects

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–      Iron supplements should not be offered routinely: give only if anemic or

hemoglobin <11g/100mL

–      Multivitamins

Second Visit: Between 18-20 Weeks

Follow up with first visit and make sure patient has completed required

tests.

Continue to record observations, VS, weight, fundal height, and any

problems or concerns the expecting mother may have.

Labs: Blood Glucose.

Make plan for next visit.

Third Visit: Between 24-28 weeks

Follow-up with second visit

Continue Antenatal Flow Chart and record observations, vital signs,

weight, fundal height, and any problems or concern the expecting mother

may have.

Laboratory Test Requirement:

–      Hemoglobin

–      Urine: proteinurea

–      Blood glucose

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–      Oral Glucose Tolerance Test (OGTT)

_ Ultrasound

Fourth Visit: Between 32-36 Weeks

Follow up with third visit

Continue record observations, vital signs, weight, fundal height, and fetal

presentation.

–      If fetus is found to be malpositioned through palpation, a confirmation must

be done by ultrasound.

–      If it is confirmed by ultrasound, give the woman a choice to follow up in one

to two weeks for a repeat ultrasound to check 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 clinic; however all post natal care from the

6 week baby check on are still available to her.

Laboratory Test Requirement:

–      Hemoglobin:

Normal: >10.

If hemoglobin <10, the woman should be referred to hospital for her birth, as low

Hb signifies a greater probability of bleeding during birth and the possible need

for blood products which the clinic cannot provide

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Discuss upcoming delivery with the woman and go over any concerns or

questions she may have.

Encourage financial planning and discuss costs.

Encourage prompt mobilization towards the birthing centre as soon as

they feel the beginning stages of labor.

Discuss the possibility that they may not be able to give birth at the clinic,

should there any complications with their labor.

Other Visits:

Reasons for extra visits include, but are not limited to: high blood

pressure, pain in abdomen, and extra blood sugar checks

Other visits should be at the discretion of the patient and the SBA

providing antenatal care

Intrapartum Care

Admission only if in established labor

Sign consent form for admission.

First Stage of Labor

Definitions:

Latent first stage of labor: A period of time, not necessarily continuous,

when: there are painful contractions and some cervical change, including

cervical effacement and dilatation up to 4 cm.

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Established first stage of labor: When there are regular painful

contractions and progressive cervical dilatation from 4 cm.

Duration of the first stage labor:

Nulliparous: 8-18 hours Multiparous: 5-12 hours

Assessment

Initial Assessment of a woman in labor should include:

Listening to her story and review clinical records

Physical observation: temperature, pulse, blood pressure, urinalysis

Length, strength and frequency of contractions

Abdominal palpation: fundal height, lie, presentation, position and station

Vaginal loss: show, liquor, blood

Assessment of pain

FHR auscultated for a minimum of 1 minute immediately after a

contraction

Vaginal examination should be offered if woman is in established labor

IV Fluid access

2 large cannula (at least 18G/Green) to be inserted into a patient’s veins

on admission

Assessment

A pictorial record of labor (partograph) should be used once labor is

established

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World Health Organization recommends 4-hour action line on partograph,

should one be used

Observations or Labor watch

Temperature and blood pressure every four hours

Pulse every hour

Documentation of frequency of contractions every thirty minutes

Frequency of emptying the bladder

Vaginal examination 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 FHR

abnormality is detected to differentiate the two heart rates. Intermittent

auscultation can be undertaken by Doppler ultrasound.

Second Stage of Labor

Definitions:

Passive second stage of labor: The finding of full dilatation of the cervix

prior to or in the absence of involuntary expulsive contractions.

Onset of the active second stage of labor:  The baby is visible with

expulsive contractions and a finding of full dilatation of the cervix or other

signs of full dilatation of the cervix.  As well as active maternal effort

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following confirmation of full dilatation of the cervix in the absence of

expulsive contractions.

Duration of the second stage labor

Nulliparous: Birth would be expected to take place within 3 hours of the

start of the active second stage in most women.

A diagnosis of delay in the active second stage should be made when it

has lasted 2 hours and women should be referred to a healthcare

professional trained to undertake an operative vaginal birth if birth is not

imminent.

Multiparous:  Birth would be expected to take place within 2 hours of the

start of the active second stage in most women.

A diagnosis of delay in the active second stage should be made when it

has lasted 1 hour and women should be referred to a healthcare

professional trained to undertake an operative vaginal birth if birth is not

imminent.

Observations

Blood pressure and pulse every hour

Temperature every four hours

Vaginal examination 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 frequency of contractions every hour

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Frequency of emptying the bladder

Ongoing consideration of the woman’s emotional and psychological

needs.

Assessment of progress should include maternal behavior, effectiveness

of pushing and fetal wellbeing, taking into account fetal position and

station at the onset of the second stage. These factors will assist in

deciding the timing of further vaginal examination and the need for

obstetric review.

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

FHR 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.

Women’s Position and Pushing in the Second Stage

Women 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.

Women should be informed that in the second stage they should be

guided by their own urge to push.

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If pushing is ineffective or if requested by the woman, strategies to assist

birth can be used, such as support, change of position, emptying of the

bladder and encouragement.

Reducing Perineal Trauma

Perineal massage should not be performed by healthcare professionals in

the second stage of labor.

Either the ‘hands on’ (guarding the perineum and flexing the baby’s head)

or the ‘hands poised’ (with hands off the perineum and baby’s head but in

readiness) technique can be used to facilitate spontaneous birth.

Lidocaine spray should not be used to reduce pain in the second stage of

labor.

A routine episiotomy should not be carried out during spontaneous vaginal

birth.

Women with a history of severe perineal trauma should be informed that

their risk of repeat severe perineal trauma is not increased in a

subsequent birth, compared with women having their first baby.

Third Stage of Labor

Definitions:

Third stage of labor: the time from the birth of the baby to the expulsion of

the placenta and membranes.

Prolonged third stage: over 30 minutes

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Observations

Blood pressure and pulse

Woman’s general physical condition, as shown by her color, respiration

and her own report of how she feels

Vaginal blood loss

Recommendation

Active management of the third stage is recommended, which includes the

use of oxytocin (10 international units [IU] by intramuscular injection),

followed by early clamping and cutting of the cord and controlled cord

traction.

Women should be informed that active management of the third stage

reduces the risk of maternal hemorrhage and shortens the third stage.

Pulling the cord or palpating the uterus should only be carried out after

administration of oxytocin as part of active management.

Start completing Postnatal Notes

Immediate Cord Care after Birth

When 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 blanket.

After a while, feel the cord if the pulsation stops then cut.

Change gloves for the n next procedure.

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Indications for Transfer to More Advanced Healthcare Facility via Ambulance

Need for continuous electronic fetal monitoring or EFM, indicated by:

Significant meconium-stained liquor, and this change should also be

considered for light meconium-stained liquor

Abnormal FHR detected by intermittent auscultation: less than 110 beats

per minute, greater than 160 bpm, any decelerations after a contraction; or

uncertainty of presence of fetal heartbeat

Maternal pyrexia: 38.0C once or 37.5C on two occasions 2 hours apart

Fresh bleeding starting in labor

The woman’s request to be transferred

Delay in the first or second stages of labor, diagnosed by:

Cervical dilatation of less than 2 cm in 4 hours for first labor

Cervical dilatation of less than 2 cm in 4 hours or a slowing in the progress

of labor for second or subsequent labors

Changes in the strength, duration and frequency of uterine contractions.

Request for epidural pain relief

Obstetric emergency – antepartum hemorrhage, cord

presentation/prolapsed, postpartum hemorrhage, maternal collapse or a

need for advanced neonatal resuscitation

Retained placenta that cannot be extracted by manual intervention

Malpresentation or breech presentation diagnosed for the first time at the

onset of labor, taking into account imminence of birth

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Either raised diastolic blood pressure: over 90 mmHg; or raised systolic

blood pressure: over 140 mmHg; on two consecutive readings taken 30

minutes apart

Third- or fourth-degree tear or other complicated perineal trauma requiring

suturing

If premature rupture of membranes occurred over 24 hours before onset

of labor

Care of Mother and Baby Immediately After Birth

Care of baby

APGAR scores at 1 and 5 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 Vital Signs

Skin-skin contact as soon as possible after birth

Baby dried and covered in warm dry blanket

Initial breastfeeding should be as soon as possible

Measurement of head circumference, body temperature and birth weight

should be measured soon after the 1st hour

An examination of the baby should be carried out to ensure no physical

abnormality

Apply Erythromycin ointment 0.5-1% or Tetracycline ointment 1% to both

eyes within 1 hour of birth

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Administer Vitamin K 0.5 mg IM, within 1 hour of birth

Complete Postnatal Notes

Administer BCG immunization prior to discharge.

Needs hemoglobin check before discharge

Care of Woman

Measure temperature, pulse, blood pressure, uterine contractions, lochia

Examine placenta and membranes: assessment of their condition,

structure, cord vessels and completeness

Early assessment of maternal emotional/psychological condition

Record successful voiding of the woman’s bladder within 6 hours post

delivery

Perineum Assessment and Repair

Complete Postnatal Notes

Mothers who arrive in the immediate postnatal phase

Ensure patient has been known the antenatal period, has attended all the

required antenatal appointments and has had all the necessary

investigations

If not, then immediately send mother and baby to nearest hospital via

emergency transportation

If vital signs and observations within normal limits, mother and baby may

stay at clinic for further management

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If any of the following occur, mother and baby should be transferred to

nearest hospital

Maternal systolic blood pressure greater than 140, less than 90, or

diastolic blood pressure greater than 90

Postpartum hemorrhage, with blood loss greater than 500 ml.  See

Management of Postpartum Hemorrhage

Maternal collapse

Maternal Pyrexia, defined by a temperature of 38C or greater

Retained placenta

Third or fourth degree perineal tear

Abnormality of baby

Neonatal resuscitation required at any point

Please ensure patient and baby stabilized before transferring to hospital

e.g. IV cannula inserted, fluid resuscitation

Postnatal Care

Postnatal Care of the Mother

Please complete Initial Mother Assessment form in Postnatal Notes

Give oral and demonstrational teaching on breastfeeding within 24 hours

of birth, prior to discharge from birthing centre

Breastfeeding:

Mother should educate about the important of breastfeeding

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Perineal Care

Assess mother for perineal pain, discomfort or stinging, offensive perineal

odor or dyspareunia.

If the mother is experiencing discomfort, she should be taught that topical

cold therapy provides effective perineal pain relief.

Encourage perineal hygiene, such as frequent sanitary pad changes,

frequent hand washing, and daily bathing to keep the perineum clean.

General Advice

See to it of keeping healthy after giving birth

Postnatal Care of the Baby

Complete Initial Baby Assessment form in Postnatal Notes

Complete full body assessment of baby, if any gross abnormalities,

especially jaundice, within first 24 hours, baby may need to be referred to

hospital of choice

Prior to Discharge

Provide mother with chance to ask any questions she may have before

leaving the clinic.

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 Follow Up

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Appointment at First Week

Follow Up for the Mother

Ask about any issues experienced and problems encounter like:

–      Signs of mastitis: flu-like symptoms, red, tender and painful breasts, if

present, encourage gentle massage of breast, continued feeding, paracetamol

for discomfort and increased fluid intake

–      Constipation and hemorrhoids: if no bowel movement three days after birth,

give patient a gentle laxative, encourage increased dietary fiber and fluid

consumption in both cases, and encourage cold packs and paracetamol for pain

management

–      Urinary incontinence: if this is an issue, give teaching on Keagel exercises

–      Fatigue: if experiencing excessive fatigue, review birthing events and

antepartum history, if any signs indicate hemorrhage, check mother’s

hemoglobin.

–      Emotional wellbeing: 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 sexual intercourse for six weeks postpartum

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Follow Up for the Baby

Babies should be assessed for: temperature, heart rate, respiratory rate,

color, regular urination and stooling, general appetite and breast milk

intake, body tone, and irritability.

Assess for jaundice, pale stools and dark urine. If present assess severity,

if acute jaundice present, refer to hospital.

Appointment at Sixth Week -for immunization

Perform a complete physical assessment of the baby, as outlined in the

Complete Physical Assessment of the Baby and assess social smiling and

visual fixing at this time as well.

Ask about any concerns the mother has had about her child since the last

appointment

Administer OPV 1, Pentavalent 1 and Rotarex 1

Appointment at Tenth Week

Follow Up for the Mother

Ask about any concerns the mother has had since the previous

appointment

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Continue to manage concerns that have arisen previously

Follow Up for the Baby

Ask about any concerns the mother has had about the child since the last

appointment

Continue to manage concerns that have arisen previously

Measure and plot height and weight on growth chart

Administer OPV 2 , Pentavalent 2 and Rotarex 2

Appointment at Fourteenth Week

Administer OPV 3and Pentavalent 3

Appointment at Sixth Month

Measure and plot baby’s height and weight in growth chart

Appointment at Ninth Month

Administer Measles immunization to baby and vitamin A

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Actual Building of the Mother’s Choice Birthing Center

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Proposed Floor Plan 12-Bed Ward

Table 7. Expected Attainable Clients

Area Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May TotalM 11 11 11 11 11 11 11 11 11 11 11 11 132Q 12 12 12 12 12 12 12 12 12 12 12 12 144

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D 8 8 8 8 8 8 8 8 8 8 8 8 96Total 31 31 31 31 31 31 31 31 31 31 31 31 372

Assumptions:

An increase of 16% of clients per year or an equivalent of additional 4

clients in a year will be realized on the second year.

Effect of Layout on Work Flow

The effect of layout on work flow will be smooth, convenient, thus resulting

for efficient and effective care for mother and baby.

Provision for Expansion

During the five years initial operations, partners agreed to focus more on

area penetration and long-term profit maximization and established good

relationship toward the clients to address and respond immediately to their need

and demand. Provision for expansion will be planned as business will grow and

become stable.

Structure

The structure will be fully concreted and will be build according to

government requirement to prevent hazard.

Waste Disposal

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There will be a separate trash can for biodegradable, non-biodegradable

and infectious items. Biodegradable waste will be disposed in a compose pit.

Non-biodegradable waste will be sold in junk shops. For Infectious Items

(Sharps and Biohazard Disposal) will be disposed as follows: All sharps including

needles, finger sticks, glass, ampules, IV supplies, and specimen containers will

be disposed of in a puncture proof plastic container provided by the clinic.  Each

container when full will be disposed of in a 3 meter deep hole, at least 20 meters

from the nearest water supply and building, as recommended by DOH. 

Biohazardous material including blood and birthing by-products should be

disposed of via incineration, or disposed of by the same method as detailed

above.

FINANCIAL FEASIBILITY

This chapter shows the financial performance and resources of the

proposed project. This includes: financial statements and financial ratios that

enable the proponents to determine the liquidity, profitability, stability of the

project and the proponents ability to pay its financial obligations. It will give

substantial information as basic for the establishment of the proposed project.

Table 8. Monthly Projected Cost

Particulars Amount (in Php)Ultrasound Rental 2,000.00Building Amortization (Finance) 1,600.00Lot Rental 2,000.00Water and Electricity Bill 5,500.00Midwife Salary (5) 40,000.00

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Principal Midwife 10,000.00Ob-Gyne (Consultation) 15,500.00Pediatrician (consultation) 15,500.00Supplies 1,900.00Watchman 4,000.00Total 98,000.00

Unit Cost per Patient

Unit Cost = Total Cost / Total no. of clients

= 98,000/31

= 3,161.29

Mark-up = 253%

Unit Price per Patient = 8,000.00

Table 8. Equipment

Particulars Qty Monthly YearlyNSVD set 4 P 4000.00 P 4000.00Stethoscope 1 500.00 500.00Weighing scale 1 1000.00 1000.00Blood pressure apparatus

1 500.00 500.00

Thermometer 3 300.00 300.00Doppler 1 15,000.00 15,000.00Measuring tape 1 20.00 20.00Kelly pad 1 200.00 200.00Goose neck lamp 1 300.00 300.00Tourniquet 1 50.00 50.00Total P 21,870.00 P 21,870.00

Table 9. Supply

Particulars Qty Monthly Yearly

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mask P 50.00 P 600.00soap 100.00 1,200.00bleach 70.00 840.00paper 150.00 1,800.00ball pen 50.00 600.00cotton 100.00 1,200.00gauze 100.00 1,200.00glove 100.00 1,200.00umbilical cord 50.00 600.00alcohol 100.00 1,200.00Ky jelly 100.00 600.00syringe 150.00 1,800.00Total P 1,120.00 P 13,440.00

Table 10. Medicine

Particulars Qty Monthly Yearly Paracetamol P 90.00 P 1,080.00 Anti-inflammatory 300.00 3,600.00Antiemetic 200.00 2,400.00Oxytocin 500.00 6,000.00Vit. k 200.00 2,400.00Erythromycin 300.00 3,600.00Albendazole 100.00 1,200.00Total P 1,690.00 P 20,280.00

Table 11. Rental Expense

Particulars Monthly YearlyUltrasound Rental P 2,000.00 P 24,000.00Land Rental 2,000.00 24,000.00Amortization (Building) 2,000.00 24,000.00Total P 6,000.00 P 72,000.00

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Note:

Ultrasound will be lend from GE company at Php 2,000.00/month payable for 20 years

Old Building will be renovated through Land Bank loan amounting to Php 480,000.00

Table 12. Ultrasound Income

Particulars Qty Monthly YearlyFirst Tri @ 600 31 P 18,600.00 P 223,200.00Second Tri @ 450 31 13,950.00 167,400.00Third Tri @ 450 31 13,950.00 167,400.00Total P 46,500.00 558,000.00Less:Sonologist Fee 31 18,600.00 P 223,200.00Net Income P 27,900.00 334,800.00Less: Rental 2,000.00 24,000.00

Net Income after Rental Fee P 25,900.00 310,800.00

Table 13.Schedule for Salaries and Wages

Particulars Qty Monthly YearlyPrincipal Midwife 1 P 10,000.00 P 120,000.00Midwives 5 40,000.00 480,000.00Watchman 2 8,000.00 96,000.00Pediatrician 1 15,500.00 186,000.00Ob-Gyne 1 15,500.00 186,000.00Sonologist 1 18,600.00 223,200.00

Total P 107,600.00 P 1,291,200.00

Mother’s Choice Birthing CenterProjected Income Statement

For 1 –year

Table 14. Projected Income Statement of Mother’s Choice Birthing CenterParticulars Year 1

Gross Profit 3,224,000.00

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Add: Ultrasound Income 558,000.00Total Gross Profit 3,782,000.00Less: ExpensesSalaries and Wages 1,291,200.00Advertising 7,000.00Rental Expense 48,000.00Amortization Expense 24,000.00Ultrasound Rental 24,000.00Equipment 21,870.00Supply 13,440.00Medicine 20,280.00Total Expenses 1,449,790.00Net Income 2,332,210.00Less: Income Tax (30%) 699,663.00Net Income after Tax 1,632,547.00

Mother’s Choice Birthing CenterProjected Cash Flow Statement

For 1 –year

Table 15. Projected Cash Flow Statement of Mother’s Choice Birthing CenterParticulars Pre-operating Period Year 1

Cash InflowOwner’s Capital 523,810.00Gross Profit 3,782,000.00Total Cash Inflow 4,305,810.00Less: Cash OutflowSalaries and Wages 1,291,200.00Advertising 7,000.00Rental Expense 48,000.00Amortization Expense 24,000.00Ultrasound Rental 24,000.00Equipment 21,870.00Supply 13,440.00Medicine 20,280.00Income Tax 699,663.00Total Cash Outflow 2,149,453.00

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Cash Balance Ending 2,156,357.00

Mother’s Choice Birthing CenterProjected Balance Sheet

For 1 –year

Table 15. Projected Balance Sheet of Mother’s Choice Birthing CenterParticulars Amount (Php)

Cash on Bank 2,000,000.00Cash on Hand 156,357.00Total Assets 2,156,357.00

Liabilities 480,000.00Add: Capital 43,810.00Add: Net Income 1,632,547.00Total Liabilities and Capital 2,156,357.00

Financial Analysis and Interpretation:

Profit Margin

= Net Income Sales

= 1,632,547.00 3,782,000.00

= 0.4317 or 43.17%

Analysis and Interpretation:

The profit margin shows that for every 1.00 sales, there is a net profit

margin of .43 centavo. This means that during the first year of operation the

birthing center will be able to earn 43% net profit considering also that various

expenses were incurred during the pre-operating period.

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Return on Investment

= Net Income Investment

= 1,632,547.00 523,810.00

= 3.11

Analysis and Interpretation

It is expected that for every 1.00 peso invested by the proponents, the

birthing center can return 3.11 pesos during the first year of operation.

Payback Period

= Investment Annual Cash Returns

= 523,810.00 3,782,000.00

= 0.138 or 13.8%

It reflects that the company can repay its invested capital during the first

year of its operation.

Conclusions:

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Based on the presentation of this study, the following conclusion was

made:

Birthing Center is feasible in Camp 1, Maramag, Bukidnon since there is

no available birthing center in the area including the nearby barangays.

Recommendation:

The following recommendations were drawn:

Birthing Center is commendable in the areas far from hospitals.