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1

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 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
Mothers 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 clients 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.

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.

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: Mothers
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. Nuez, 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

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.

Mothers Choice Birthing Center


ROSELIE C.
RODICOL
PRINCIPAL-

PEDIATRICIAN
ON-CALL

OBSTETRICIAN
ON-CALL

SONOLOGIST
ON-CALL

MARITES C.
BAHIAN
MIDWIFE
MARY JANE C.
BELENO

MIDWIFE

AUBREY D.
NUEZ
SUSAN L.
SURALTA
MIDWIFE
MIDWIFE

WACTHMAN

STUDENT
INTERN

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 factors in business success.

The course taken by the

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

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 Personnel
Unit Management
Time to be
Personnel
devoted to the
project and duties
Principal Midwife
-12 hours
-Manages and
oversees the
operation of the
business
Pediatrician
on-call
-24 hour cover of
the clinic
-Manage the
immediate
newborn care
OB-Gyne
On-call
Consultant
-24 hour cover of
the clinic
-Manage the
maternal care
Ultrasound
Part-time
Sonologist
- 8 hours duty
- Ultrasound Incharge
Skilled Midwife
-12 hours
- responsible for
maternal and
immediate new
born care

Qualification

Compensation

- Masters Degree
holder, BSM, RM
-Competent
Personality

P 10,000.00
plus fringe
benefits

-License Pediatric
Medicine
Physician
-Competent
Personality

Php 500 per new


born

-License OB-Gyne
Medicine
Physician
-Competent
Personality
-License
Sonologist

Php 3,500 per


mother or 500 per
consultation

Licensed Midwife

Php8,000 per
month plus fringe
benefit

Php 200 per


ultrasound

Table 2. Labor Skills Requirement


Labor Skills
Number of
Required
Required Skilled
Labor
Watchman
1

Qualification
High School
Graduate
Basic Police
Training

Compensation
P 4,000.00 per
month plus fringe
benefit

Student Intern: Second year Midwifery SAIT student


Protocol:
*Observe
*Assist
*Research
*Experience
Support groups:

Womens 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

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 individuals 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

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Table 3. Pre-Operating Activities


Activities
Number of Weeks
Preparation of the Project Feasibility Study
4
Registration of the Business (SEC, DTI, Philhealth)
4
Business Permit
2
Construction of the Building
24
Purchase of the Equipment
4
Setting-up of the Equipment
4
Purchases of facilities and office supplies
4
Hiring of workers
2
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
Preparation of the Project Feasibility Study
Registration of the Business (SEC, DTI, Philhealth)
Business Permit
Renovation of the Building
Purchase of the Equipment
Setting-up of the Equipment
Purchases of facilities and office supplies
Purchases of Medicine
Hiring of workers
Initial Total Amount Needed

Initial Amount Needed


P
5,000.00
2,500.00
5,000.00
480,000.00
21,620.00
4,000.00
3,000.00
1,690.00
1,000.00
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 mothers 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,

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


Bukidnon with a bigger population.

Table 5. Supply and Demand Gap Analysis


Area

Population
Pregnant
(2010)
Woman
Maramag
90,901
7,635
Quezon
94,584
7,945
Don Carlos
64,334
5,404
Source: NSO January 2013 Quickstat

Potential
Clients
3,054
3,178
2,161

Potential Clients
Share
275
286
194

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

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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

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

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(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 Complications
Previous
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 fourthdegree perineal trauma

Placenta previa

Abruptio placenta

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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 clients 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
Mothers 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
mothers 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
Leafleting
Radio Advertisement
Referral Fee per month
Total Amount

Amount
P 1,000.00
4,000.00
2,000.00
P 7,000.00

Contribution to the Philippine Economy


The opening of the Mothers 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 Mothers 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

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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 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

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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

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
Mothers Choice Birthing Center Confidentiality Statement

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At Mothers 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 Mothers
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 patients care are not allowed to review
records. All records will be kept for the duration of the patients 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
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

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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

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.

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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

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.

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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

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.

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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 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.

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

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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 patients veins


on admission

Assessment

27

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


established

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 womans 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

28

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
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

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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 womans wishes (after abdominal palpation and
assessment of vaginal loss)

Documentation of the frequency of contractions every hour

Frequency of emptying the bladder

Ongoing consideration of the womans 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.

30

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 womans position, hydration,


coping strategies and pain relief throughout the second stage.

Womens 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.

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.

31

Either the hands on (guarding the perineum and flexing the babys head)
or the hands poised (with hands off the perineum and babys 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

Observations

Blood pressure and pulse

32

Womans 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.

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Change gloves for the n next procedure.

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 womans 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.

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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

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

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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 babys 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

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

Complete Postnatal Notes

Administer BCG immunization prior to discharge.

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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 womans 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

37

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

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

38

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

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

39

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
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

40

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 mothers


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

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.

41

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

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

42

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 babys height and weight in growth chart

Appointment at Ninth Month

Administer Measles immunization to baby and vitamin A

Actual Building of the Mothers Choice Birthing Center

43

Proposed Floor Plan 12-Bed Ward

44

Table 7. Expected Attainable Clients


Area

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

Total

11

11

11

11

11

11

11

11

11

11

11

11

132

12

12

12

12

12

12

12

12

12

12

12

12

144

96

Total

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.

45

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
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

46

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
Ultrasound Rental
Building Amortization (Finance)
Lot Rental
Water and Electricity Bill
Midwife Salary (5)
Principal Midwife
Ob-Gyne (Consultation)
Pediatrician (consultation)
Supplies
Watchman
Total
Unit Cost per Patient
Unit Cost

= Total Cost / Total no. of clients


= 98,000/31
= 3,161.29

Mark-up

= 253%

Amount (in Php)


2,000.00
1,600.00
2,000.00
5,500.00
40,000.00
10,000.00
15,500.00
15,500.00
1,900.00
4,000.00
98,000.00

47

Unit Price per Patient = 8,000.00

Table 8. Equipment
Particulars

Qty

Monthly

NSVD set

Stethoscope

500.00

500.00

Weighing scale

1000.00

1000.00

Blood pressure
apparatus

500.00

500.00

Thermometer

300.00

300.00

Doppler

15,000.00

15,000.00

Measuring tape

20.00

20.00

Kelly pad

200.00

200.00

Goose neck lamp

300.00

300.00

Tourniquet

50.00

50.00

P 21,870.00

P 21,870.00

Total

4000.00

Yearly
P

4000.00

Table 9. Supply
Particulars
mask
soap

Qty

Monthly
P

50.00
100.00

Yearly
P

600.00
1,200.00

48

bleach

70.00

840.00

paper

150.00

1,800.00

50.00

600.00

cotton

100.00

1,200.00

gauze

100.00

1,200.00

glove

100.00

1,200.00

50.00

600.00

alcohol

100.00

1,200.00

Ky jelly

100.00

600.00

syringe

150.00

1,800.00

P 1,120.00

P 13,440.00

Monthly
90.00

Yearly

ball pen

umbilical cord

Total

Table 10. Medicine


Particulars
Paracetamol

Qty
P

P
Anti-inflammatory

1,080.00

300.00
3,600.00

Antiemetic

200.00
2,400.00

49

Oxytocin

500.00
6,000.00

Vit. k

200.00

Erythromycin

300.00

Albendazole

100.00

2,400.00
3,600.00
1,200.00
Total

P 1,690.00

20,280.00

Table 11. Rental Expense


Particulars
Ultrasound Rental

Monthly
2,000.00

Yearly
P

Land Rental

24,000.00

2,000.00
24,000.00

Amortization (Building)

2,000.00
24,000.00

Total

P 6,000.00

72,000.00

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
First Tri @ 600

Qty
31

Second Tri @ 450

31

13,950.00

Third Tri @ 450

31

13,950.00

Monthly
18,600.00

Yearly
P 223,200.00
167,400.00
167,400.00

Total

46,500.00
558,000.00

50

Less:
Sonologist Fee

31

18,600.00
P 223,200.00

Net Income

27,900.00
334,800.00

Less: Rental

2,000.00
24,000.00

Net Income after Rental Fee

25,900.00

310,800.00

Table 13.Schedule for Salaries and Wages


Particulars
Principal Midwife

Qty
1

Monthly
P 10,000.00

Yearly
P 120,000.00

Midwives

40,000.00
480,000.00

Watchman

8,000.00
96,000.00

Pediatrician

15,500.00
186,000.00

Ob-Gyne

15,500.00
186,000.00

Sonologist

18,600.00
223,200.00

Total

P 107,600.00

P 1,291,200.00

Mothers Choice Birthing Center


Projected Income Statement
For 1 year
Table 14. Projected Income Statement of Mothers Choice Birthing Center
Particulars
Year 1
Gross Profit
3,224,000.00
Add: Ultrasound Income
558,000.00

51

Total Gross Profit


Less: Expenses
Salaries and Wages
Advertising
Rental Expense
Amortization Expense
Ultrasound Rental
Equipment
Supply
Medicine
Total Expenses
Net Income
Less: Income Tax (30%)
Net Income after Tax

3,782,000.00
1,291,200.00
7,000.00
48,000.00
24,000.00
24,000.00
21,870.00
13,440.00
20,280.00
1,449,790.00
2,332,210.00
699,663.00
1,632,547.00

Mothers Choice Birthing Center


Projected Cash Flow Statement
For 1 year
Table 15. Projected Cash Flow Statement of Mothers Choice Birthing Center
Particulars
Pre-operating Period
Year 1
Cash Inflow
Owners Capital
523,810.00
Gross Profit
3,782,000.00
Total Cash Inflow
4,305,810.00
Less: Cash Outflow
Salaries and Wages
1,291,200.00
Advertising
7,000.00
Rental Expense
48,000.00
Amortization Expense
24,000.00
Ultrasound Rental
24,000.00
Equipment
21,870.00
Supply
13,440.00
Medicine
20,280.00
Income Tax
699,663.00
Total Cash Outflow
2,149,453.00
Cash Balance Ending
2,156,357.00

52

Mothers Choice Birthing Center


Projected Balance Sheet
For 1 year
Table 15. Projected Balance Sheet of Mothers Choice Birthing Center
Particulars
Amount (Php)
Cash on Bank
2,000,000.00
Cash on Hand
156,357.00
Total Assets
2,156,357.00
Liabilities
Add: Capital
Add: Net Income
Total Liabilities and Capital

480,000.00
43,810.00
1,632,547.00
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.

53

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:

54

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.