W.H.O. Safe Childbirth Checklist

• Conducted on

  Date

• Prepared by

• Location
  Address

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?

  YES, organized

  NO

• 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?

  YES

  NO, will start when ≥4cm

• 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?

  YES, given

  NO

• Does mother need to start Magnesium sulfate and antihypertensive treatment?

  Yes, magnesium sulfate given

  Yes, antihypertensive medication given

  NO

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

  YES

  NO

• Encourage birth companion to be present at birth.

  YES

  NO

• 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.

  YES

  NO

• 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

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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?

  YES, given

  NO

• Does mother need to start Magnesium sulfate and antihypertensive treatment?

  Yes, magnesium sulfate given

  Yes, antihypertensive medication given

  NO

• 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.

  YES

  NO

• 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

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AFTER BIRTH

3 -- Soon After Birth (Within 1 Hour)

• Is mother bleeding abnormally?<br>

  Yes, shout for help

  NO

• 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?

  YES, given

  NO

• Does mother need to start Magnesium sulfate and antihypertensive treatment?

  Yes, magnesium sulfate given

  Yes, antihypertensive medication given

  NO

• Check your facility’s criteria

• Does baby need Referral?

  YES, organized

  NO

• 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?

  YES, given

  NO

• 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?

  YES, organized

  NO

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

  YES

  NO

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

  YES

  NO

• 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

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4 -- Before Discharge

• Confirm stay at facility for 24 hours after delivery

  YES

  NO

• 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?

  YES, given and delay discharge

  NO

• 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?

  YES, treat and delay discharge

  NO

• 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?<br>

  YES, treat and delay discharge

  NO

• 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?

  NO

  YES, give antibiotics, delay discharge, give special care

• Is baby feeding well?

  YES

  NO, establish good breastfeeding practices and delay discharge

• Discuss and offer family planning options to mother.

  YES

  NO

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

  YES

  NO

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

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