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BEFORE BIRTH

BEFORE BIRTH

INSTRUCTIONS

1. Answer the questions below by selecting the most appropriate response.
2. Add photos and notes by clicking on the paperclip icon
3. To add a Corrective Measure click on the paperclip icon then "Add Action", provide a description, assign to a member, set priority, and due date
4. Complete audit by providing digital signature
5. Share your report by exporting as PDF, Word, Excel or Web Link

1 -- On Admission

Check your facility’s criteria

Does mother need referral?

Start plotting when cervix ≥4 cm, then cervix should dilate ≥1 cm/hr
• Every 30 min: plot HR, contractions, fetal HR
• Every 2 hrs: plot temperature
• Every 4 hrs: plot BP

Partograph started?

Ask for allergies before administration of any medication
Give antibiotics to mother if any of:
• Mother’s temperature ≥38°C
• History of foul-smelling vaginal discharge
• Rupture of membranes >18 hrs

Give magnesium sulfate to mother if any of:
• Diastolic BP ≥110 mmHg and 3+ proteinuria
• Diastolic 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 mmHg

Does mother need to start Antibiotics?

Does mother need to start Magnesium sulfate and antihypertensive treatment?

Confirm supplies are available to clean hands and wear gloves for each vaginal exam.

Encourage birth companion to be present at birth.

Call for help if any of:

• Bleeding
• Severe abdominal pain
• Severe headache or visual disturbance
• Unable to urinate
• Urge to push

Confirm that mother or companion will call for help during labour if needed.

This checklist is not intended to be comprehensive and should not replace the case notes or partograph. Additions and modifications to fit local practice are encouraged.

For more information on recommended use of the checklist, please refer to the “WHO Safe Childbirth Checklist Implementation Guide” at: www.who.int/patientsafety.

Completed By
2 -- Just Before Pushing (Or Before Caesarean)

Ask for allergies before administration of any medication

Give antibiotics to mother if any of:
• Mother’s temperature ≥38 °C
• History of foul-smelling vaginal discharge
• Rupture of membranes >18 hrs
• Caesarean section

Give magnesium sulfate to mother if any of:
• Diastolic BP ≥110 mmHg and 3+ proteinuria
• Diastolic 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 mmHg

Does mother need to start Antibiotics?

Does mother need to start Magnesium sulfate and antihypertensive treatment?

Confirm essential supplies are at bedside and prepare for delivery:

For mother

Prepare to care for mother immediately after birth:

Confirm single baby only (not multiple birth)
1. Give oxytocin within 1 minute after birth
2. Deliver placenta 1-3 minutes after birth
3. Massage uterus after placenta is delivered
4. Confirm uterus is contracted

Gloves

Alcohol-based handrub or soap and clean water

Oxytocin 10 units in syringe

For baby

Prepare to care for baby immediately after birth:

1. Dry baby, keep warm
2. If not breathing, stimulate and clear airway
3. If still not breathing:

• clamp and cut cord
• clean airway if necessary
• ventilate with bag-and-mask
• shout for help

Clean towel

Tie or cord clamp

Sterile blade to cut cord

Suction device

Bag-and-mask

Assistant identified and ready to help at birth if needed.

This checklist is not intended to be comprehensive and should not replace the case notes or partograph. Additions and modifications to fit local practice are encouraged.

For more information on recommended use of the checklist, please refer to the “WHO Safe Childbirth Checklist Implementation Guide” at: www.who.int/patientsafety.

Completed By

AFTER BIRTH

AFTER BIRTH
3 -- Soon After Birth (Within 1 Hour)

Is mother bleeding abnormally?

If bleeding abnormally:

• Massage uterus
• Consider more uterotonic
• Start IV fluids and keep mother warm
• Treat cause: uterine atony, retained placenta/fragments, vaginal tear,
uterine rupture

Ask for allergies before administration of any medication

Give antibiotics to mother if placenta manually removed or if
mother’s temperature ≥38 °C 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

Give magnesium sulfate to mother if any of:
• Diastolic BP ≥110 mmHg and 3+ proteinuria
• Diastolic 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 mmHg

Does mother need to start Antibiotics?

Does mother need to start Magnesium sulfate and antihypertensive treatment?

Check your facility’s criteria

Does baby need Referral?

Give baby antibiotics if antibiotics given to mother for treatment of maternal infection during childbirth or if baby has any of:

• Respiratory rate >60/min or <30/min
• Chest in-drawing, grunting, or convulsions
• Poor movement on stimulation
• Baby’s temperature <35 °C (and not rising after warming) or baby’s temperature ≥38 °C

Does baby need Antibiotics?

Arrange special care/monitoring for baby if any:

• More than 1 month early
• Birth weight <2500 grams
• Needs antibiotics
• Required resuscitation

Does baby need Special care and monitoring?

Started breastfeeding and skin-to-skin contact (if mother and baby are well).

Confirm mother / companion will call for help if danger signs present.

Responsibility for the interpretation and use of the material in this checklist lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. For more information visit www.who.int/patientsafety.

Completed By
4 -- Before Discharge

Confirm stay at facility for 24 hours after delivery

Ask for allergies before administration of any medication

Give antibiotics to mother if any of:
• Mother’s temperature ≥38 °C
• Foul-smelling vaginal discharge

Does mother need to start antibiotics?

Give magnesium sulfate to mother if any of:
• Diastolic BP ≥110 mmHg and 3+ proteinuria
• Diastolic 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 mmHg

Is mother’s blood pressure normal?

If pulse >110 beats per minute and blood pressure <90 mmHg
• Start IV and keep mother warm
• Treat cause (hypovolemic shock)

Is mother bleeding abnormally?

Give antibiotics to baby if any of:
• Respiratory rate >60/min or <30/min
• Chest in-drawing, grunting, or convulsions
• Poor movement on stimulation
• Baby’s temperature <35°C (and not rising after warming) or baby’s temperature ≥38°C
• Stopped breastfeeding well
• Umbilicus redness extending to skin or draining pus

Does baby need Antibiotics?

Is baby feeding well?

Discuss and offer family planning options to mother.

Arrange follow-up and confirm mother / companion will seek help if danger signs appear after discharge.

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
• Unusually cold
• Stops feeding well
• Less activity than normal
• Whole body becomes yellow

Responsibility for the interpretation and use of the material in this checklist lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. For more information visit www.who.int/patientsafety

Completed By

W.H.O. Safe Childbirth Checklist

Created by: SafetyCulture Staff | Industry: Health Services | Downloads: 14

The WHO Safe Childbirth Checklist is a tool intended to improve the quality of care for women and babies at the time of childbirth. The Checklist is an organized list of evidence-based essential birth practices targeting major causes of maternal deaths, intrapartum-related stillbirths and neonatal deaths that occur in facilities around the world. An implementation guide has been developed alongside this Checklist to help facilities successfully implement it.

Signup for a free iAuditor account to download and edit this checklist. It will be added to your free account and you will be able to conduct inspections from your mobile device.

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BEFORE BIRTH

BEFORE BIRTH

INSTRUCTIONS

1. Answer the questions below by selecting the most appropriate response.
2. Add photos and notes by clicking on the paperclip icon
3. To add a Corrective Measure click on the paperclip icon then "Add Action", provide a description, assign to a member, set priority, and due date
4. Complete audit by providing digital signature
5. Share your report by exporting as PDF, Word, Excel or Web Link

1 -- On Admission

Check your facility’s criteria

Does mother need referral?

Start plotting when cervix ≥4 cm, then cervix should dilate ≥1 cm/hr
• Every 30 min: plot HR, contractions, fetal HR
• Every 2 hrs: plot temperature
• Every 4 hrs: plot BP

Partograph started?

Ask for allergies before administration of any medication
Give antibiotics to mother if any of:
• Mother’s temperature ≥38°C
• History of foul-smelling vaginal discharge
• Rupture of membranes >18 hrs

Give magnesium sulfate to mother if any of:
• Diastolic BP ≥110 mmHg and 3+ proteinuria
• Diastolic 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 mmHg

Does mother need to start Antibiotics?

Does mother need to start Magnesium sulfate and antihypertensive treatment?

Confirm supplies are available to clean hands and wear gloves for each vaginal exam.

Encourage birth companion to be present at birth.

Call for help if any of:

• Bleeding
• Severe abdominal pain
• Severe headache or visual disturbance
• Unable to urinate
• Urge to push

Confirm that mother or companion will call for help during labour if needed.

This checklist is not intended to be comprehensive and should not replace the case notes or partograph. Additions and modifications to fit local practice are encouraged.

For more information on recommended use of the checklist, please refer to the “WHO Safe Childbirth Checklist Implementation Guide” at: www.who.int/patientsafety.

Completed By
2 -- Just Before Pushing (Or Before Caesarean)

Ask for allergies before administration of any medication

Give antibiotics to mother if any of:
• Mother’s temperature ≥38 °C
• History of foul-smelling vaginal discharge
• Rupture of membranes >18 hrs
• Caesarean section

Give magnesium sulfate to mother if any of:
• Diastolic BP ≥110 mmHg and 3+ proteinuria
• Diastolic 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 mmHg

Does mother need to start Antibiotics?

Does mother need to start Magnesium sulfate and antihypertensive treatment?

Confirm essential supplies are at bedside and prepare for delivery:

For mother

Prepare to care for mother immediately after birth:

Confirm single baby only (not multiple birth)
1. Give oxytocin within 1 minute after birth
2. Deliver placenta 1-3 minutes after birth
3. Massage uterus after placenta is delivered
4. Confirm uterus is contracted

Gloves

Alcohol-based handrub or soap and clean water

Oxytocin 10 units in syringe

For baby

Prepare to care for baby immediately after birth:

1. Dry baby, keep warm
2. If not breathing, stimulate and clear airway
3. If still not breathing:

• clamp and cut cord
• clean airway if necessary
• ventilate with bag-and-mask
• shout for help

Clean towel

Tie or cord clamp

Sterile blade to cut cord

Suction device

Bag-and-mask

Assistant identified and ready to help at birth if needed.

This checklist is not intended to be comprehensive and should not replace the case notes or partograph. Additions and modifications to fit local practice are encouraged.

For more information on recommended use of the checklist, please refer to the “WHO Safe Childbirth Checklist Implementation Guide” at: www.who.int/patientsafety.

Completed By

AFTER BIRTH

AFTER BIRTH
3 -- Soon After Birth (Within 1 Hour)

Is mother bleeding abnormally?

If bleeding abnormally:

• Massage uterus
• Consider more uterotonic
• Start IV fluids and keep mother warm
• Treat cause: uterine atony, retained placenta/fragments, vaginal tear,
uterine rupture

Ask for allergies before administration of any medication

Give antibiotics to mother if placenta manually removed or if
mother’s temperature ≥38 °C 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

Give magnesium sulfate to mother if any of:
• Diastolic BP ≥110 mmHg and 3+ proteinuria
• Diastolic 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 mmHg

Does mother need to start Antibiotics?

Does mother need to start Magnesium sulfate and antihypertensive treatment?

Check your facility’s criteria

Does baby need Referral?

Give baby antibiotics if antibiotics given to mother for treatment of maternal infection during childbirth or if baby has any of:

• Respiratory rate >60/min or <30/min
• Chest in-drawing, grunting, or convulsions
• Poor movement on stimulation
• Baby’s temperature <35 °C (and not rising after warming) or baby’s temperature ≥38 °C

Does baby need Antibiotics?

Arrange special care/monitoring for baby if any:

• More than 1 month early
• Birth weight <2500 grams
• Needs antibiotics
• Required resuscitation

Does baby need Special care and monitoring?

Started breastfeeding and skin-to-skin contact (if mother and baby are well).

Confirm mother / companion will call for help if danger signs present.

Responsibility for the interpretation and use of the material in this checklist lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. For more information visit www.who.int/patientsafety.

Completed By
4 -- Before Discharge

Confirm stay at facility for 24 hours after delivery

Ask for allergies before administration of any medication

Give antibiotics to mother if any of:
• Mother’s temperature ≥38 °C
• Foul-smelling vaginal discharge

Does mother need to start antibiotics?

Give magnesium sulfate to mother if any of:
• Diastolic BP ≥110 mmHg and 3+ proteinuria
• Diastolic 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 mmHg

Is mother’s blood pressure normal?

If pulse >110 beats per minute and blood pressure <90 mmHg
• Start IV and keep mother warm
• Treat cause (hypovolemic shock)

Is mother bleeding abnormally?

Give antibiotics to baby if any of:
• Respiratory rate >60/min or <30/min
• Chest in-drawing, grunting, or convulsions
• Poor movement on stimulation
• Baby’s temperature <35°C (and not rising after warming) or baby’s temperature ≥38°C
• Stopped breastfeeding well
• Umbilicus redness extending to skin or draining pus

Does baby need Antibiotics?

Is baby feeding well?

Discuss and offer family planning options to mother.

Arrange follow-up and confirm mother / companion will seek help if danger signs appear after discharge.

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
• Unusually cold
• Stops feeding well
• Less activity than normal
• Whole body becomes yellow

Responsibility for the interpretation and use of the material in this checklist lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. For more information visit www.who.int/patientsafety

Completed By