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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 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.
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.
This project
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.
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.
proponents are in line with birthing management which will be a big factor in the
success of business.
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
-License OB-Gyne
Medicine
Physician
-Competent
Personality
-License
Sonologist
Licensed Midwife
Php8,000 per
month plus fringe
benefit
Qualification
High School
Graduate
Basic Police
Training
Compensation
P 4,000.00 per
month plus fringe
benefit
Womens League
SAIT -school
Shift rotations:
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
at
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.
Annual vacation leave and sick leave for 15 days with pay
Retirement Package
Commission
Facilities
The facilities of the birthing clinic based on Department of Health (DOH)
requirement will be the following:
10
Seven pt. in ward with curtain and dividers to provide patient privacy for
each room
Oxygen tank and supply available in the delivery room, must be secured
to solid object
Sufficient ventilation
11
12
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.
The said area has no available birthing center and far from the
In addition, Camp 1,
13
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
Major Clients
14
Age 19-45
No significant co-morbidities
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
15
Eclampsia
Uterine rupture
Shoulder dystocia
Placenta previa
Abruptio placenta
16
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.
17
Amount
P 1,000.00
4,000.00
2,000.00
P 7,000.00
18
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)
24 hour supply of clean and hot water and electricity supply (including
emergency lighting)
19
Seven pt. in ward with curtain and dividers to provide patient privacy for
each room
Oxygen tank and supply to the delivery room, must be secured to solid
object
Sufficient ventilation
20
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
Hand washing sinks and alcohol gel to be located near clinical workstation
Thorough hand washing with water and soap before and after each and
every patient contact including before and after each patient intervention
or procedure.
birthing center
Mothers Choice Birthing Center Confidentiality Statement
21
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
22
Birth plan
Hemoglobin
Hepatitis B
Blood glucose
Folic Acid 400 mcg per day until the 12th week of pregnancy: this helps
hemoglobin <11g/100mL
Multivitamins
Follow up with first visit and make sure patient has completed required
tests.
23
Hemoglobin
Urine: proteinurea
Blood glucose
Ultrasound
Continue record observations, vital signs, weight, fundal height, and fetal
presentation.
24
be done by ultrasound.
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.
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.
25
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
26
Assessment
Initial Assessment of a woman in labor should include:
Assessment of pain
IV Fluid access
Assessment
27
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.
29
30
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.
Third stage of labor: the time from the birth of the baby to the expulsion of
the placenta and membranes.
Observations
32
Recommendation
Pulling the cord or palpating the uterus should only be carried out after
administration of oxytocin as part of active management.
When the child the cord pulses and is fat and blue, do not cut at this time.
After a while, feel the cord if the pulsation stops then cut.
33
34
35
36
Care of Woman
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
Maternal systolic blood pressure greater than 140, less than 90, or
diastolic blood pressure greater than 90
See
Maternal collapse
Retained placenta
Abnormality of baby
38
Postnatal Care
Postnatal Care of the Mother
Breastfeeding:
Perineal Care
General Advice
39
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
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
Discuss plans for contraception following birth and encourage the mother
to abstain from sexual intercourse for six weeks postpartum
Assess for jaundice, pale stools and dark urine. If present assess severity,
if acute jaundice present, refer to hospital.
41
Ask about any concerns the mother has had about her child since the last
appointment
Ask about any concerns the mother has had since the previous
appointment
Ask about any concerns the mother has had about the child since the last
appointment
42
43
44
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
(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
Mark-up
= 253%
47
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
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
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
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:
Qty
31
31
13,950.00
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
25,900.00
310,800.00
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
51
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
52
480,000.00
43,810.00
1,632,547.00
2,156,357.00
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
Recommendation:
The following recommendations were drawn:
Birthing Center is commendable in the areas far from hospitals.