33

Training Manual for Facilitators

Evaluation Forms
EDD Weight and BP Measurement
Equipment: Weight scale, blood pressure machine, stethoscope, chair, role player, medical record
Scenario: A woman attends the antenatal clinic for the first time – you are the health
professional. She states that she is approximately 3 months pregnant. The first day of her last
menstrual period was 3rd January 2015. You will conduct her antenatal check.

Participant Name: Facilitator name:

Pre course date: Post course date:
Skills Lab Name: District, State:

Total Score
Remark
Mark Pre Post
Ask to calculate EDD (Answer: 10th October 2015) 2
Explain and demonstrate the use of the weighing scales
▪▪ Ensure scale is on flat and hard surface 1
▪▪ Ensure scale is calibrated to zero 2
▪▪ Read to nearest 100g 1
▪▪ Record on MCP card 1
Describe and demonstrate the measurement of BP
▪▪ Ensure patient is sitting or lying down on her left side 1
▪▪ Ensure sphygmomanometer is at level of heart. Note zero error. 1
▪▪ Position cuff (3cm above elbow) 1
▪▪ Increase cuff pressure until pulse disappears + 30mmHg 1
▪▪ Put stethoscope on brachial artery 1
▪▪ Slowly release pressure 1
▪▪ Note the BP when the sound is heard (systolic) 2
and when it disappears (diastolic)
▪▪ Record on MCP card 1
State normal weight gain
9-11 kg 1
How do you diagnose pre-eclampsia?
▪▪ Hypertension 2
▪▪ Albumin (+2) in urine
What diastolic blood pressure indicates severe pre-eclampsia?
110 mmHg 1
Total score: 20

Faculty Comments & Initials:

34
Daksh Skills Lab for RMNCH+A Services

Abdominal Examination
Equipment: Abdominal mannequin, fetal stethoscope, tape measure, watch with second hand.
Scenario: A woman attends your antenatal clinic at 36 weeks gestation for routine antenatal care.

Participant Name: Facilitator name:

Pre course date: Post course date:
Skills Lab Name: District, State:

Total Score
Remark
Mark Pre Post
Please elaborate the steps before you carry out an abdominal examination/palpation
▪▪ Ensure privacy of woman 1
▪▪ Obtain verbal consent from woman 1
▪▪ Check that she has emptied her bladder and 1
instruct her to keep her legs and thighs in a semi-
flexed position with thighs kept slightly open
▪▪ Examine from the right-hand side
1
▪▪ Centralize the uterus with one hand if it is tilted to one side
1
Please demonstrate how to do an abdominal examination/palpation
Here instructor would prompt: What do you look for on the
abdomen?
Visually assess:
▪▪ scars 1
▪▪ shape 1
▪▪ size 1
Measure fundal height:
▪▪ Using ulnar border of left hand, start palpating 1
gently from xiphisternum downwards till you meet
the first resistance (fundus of the uterus)
▪▪ Identify symphysis pubis
▪▪ Measure the distance between symphysis pubis 1
and fundus in cm with the tape face down 1
Here the facilitator would prompt: What is the importance of this?
▪▪ cm = approx. gestational age in weeks 1
To be continued....
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Training Manual for Facilitators

Palpation:
▪▪ Fundal grip: Keep both hands over the fundus and 1
try to palpate the part of the fetus at the upper
pole of the uterus to identify head or breech
▪▪ Lateral grip: Keep hand on one side of the abdomen
and palpate other side of the abdomen with other 1
hand and repeat the manoeuvre to identify which side
is the back of the fetus and determine the lie
Pelvic pole to confirm presenting part and determine engagement:
▪▪ First pelvic grip : With the fingers and thumb of the 1
right hand try to hold the part of the fetus at the lower
pole of the uterus just above the symphysis pubis and
identify it and move it to see if it is movable or fixed
▪▪ Second pelvic grip: Turn towards the feet of the woman, 1
slightly extend the woman’s legs. Keep both hands on either
side of the presenting part with fingers towards the pelvis
Auscultate FH on spino-umbilical line at the side identified as back
▪▪ For 60 seconds 1
▪▪ Record findings 1
▪▪ Explain to mother 1
What is the normal FH range?
120-160 beats/min regular 1
Total score: 20

Faculty Comments & Initials:

36
Daksh Skills Lab for RMNCH+A Services

Hemoglobin Estimation
Equipment: Sahli’s Haemoglobinometer, N/10 HCl, gloves, spirit swabs, lancet, distilled water
and dropper, puncture proof container, 0.5% chlorine solution.

Participant Name: Facilitator name:

Pre course date: Post course date:
Skills Lab Name: District, State:

Total Score
Remark
Mark Pre Post
Perform Haemoglobin estimation with Sahli’s Haemoglobinometer.
▪▪ Keep all the necessary items ready 1
▪▪ Wash hands and wear gloves 1
▪▪ Clean the Hb tube and pipette 1
▪▪ Fill the Hb tube with N/10 HCl up to 2g with the dropper 1
▪▪ Clean tip of the person’s ring finger with the spirit swab 2
▪▪ Prick the ring finger with the lancet and 2
discard the first drop of blood
▪▪ Allow a large blood drop to form on the fingertip 1
▪▪ Suctions it with the pipette up to 20 [Link] 2
mark. (Connect pipette to syringe and pull the
barrel instead of mouth sucking by pipette)
▪▪ Take care that air entry is prevented 1
while suctioning the blood.
▪▪ Wipe the tip of the pipette and transfer the 1
blood to the Hb tube containing N/10 HCl
▪▪ Rinse the pipette 2-3 times with N/10 HCl in the Hb Tube 1
▪▪ Leave the solution in test tube for 10 minutes 1
▪▪ After 10 minutes, dilute the acid by adding distilled 1
water drop-by-drop and mix it with stirrer
▪▪ Match with the colour of the comparator 1
▪▪ Note down the reading (lower meniscus) 1
▪▪ Dispose of the used lancet in a puncture proof container 1
▪▪ Immerse the used gloves in 0.5% chlorine solution 1
Total score: 20

Faculty Comments & Initials:

 37
Training Manual for Facilitators

Pregnancy Detection Test

Equipment: Pregnancy test kit with dropper, urine sample in container, watch or clock with
second hand.
Scenario: 27 year old woman with missed period attends your health centre. She is otherwise fit
and well.

Participant Name: Facilitator name:

Pre course date: Post course date:
Skills Lab Name: District, State:

Total Score
Remark
Mark Pre Post
How would you confirm her pregnancy?
▪▪ Explain what you are doing and why 1
▪▪ Ask woman to collect her urine sample in the container 1
▪▪ Check expiry date on test kit and read instructions 2
▪▪ Take out the test card from packaging and place on flat surface 2
▪▪ Use dropper to put 2–3 drops of urine in 1
the correct place on the test kit
How long should you wait?
▪▪ As per manufacturer’s instructions 1
How would you read the test?
▪▪ 1 band = not pregnant 2
▪▪ 2 bands = pregnant 2
▪▪ 0 bands = test kit failed, try again with new test kit 2
Test is positive – what would you do next?
▪▪ Explain to the patient that she is pregnant 2
▪▪ Encourage her to attend ANC 2
▪▪ Register on MCP card/MCTS system 2
Total score: 20

Faculty Comments & Initials:

38
Daksh Skills Lab for RMNCH+A Services

Urine Test
Equipment: Urine collection bottles, urine dipsticks, red disposal bin, and clock with second hand.
Scenario: 27 year old attending a routine antenatal check-up at 28 weeks of pregnancy.

Participant Name: Facilitator name:

Pre course date: Post course date:
Skills Lab Name: District, State:

Total Score
Remark
Mark Pre Post
Demonstrate how you would carry out a routine urine test for sugar and protein (albumin)
▪▪ Explain to the patient what the test is for 1
▪▪ Ask for a urine sample 1
▪▪ Check expiry date on dipsticks and read instructions carefully 2
▪▪ Remove one strip and close container tightly 2
▪▪ Dip indicator side of the strip in the urine sample, remove it 2
and tap at the edge of container to remove excess urine
▪▪ Follow manufacturer’s recommendations for 1
when it is time to read the results
▪▪ Compare the sugar reagent part with the
sugar chart on the container 1
▪▪ Compare the albumin reagent part with the
albumin results chart on side of bottle 1
▪▪ Discard used test stick in red bin (as per GoI protocol) 1
▪▪ Explain results to the patient and record on MCP card 2
Why is it important to test urine for the presence of protein?
To detect pre-eclampsia 2
Why do you test urine for glucose?
To screen for gestational diabetes 2
What will you do if test is positive for sugar?
Refer to higher facility for further blood tests 2
Total score: 20

Faculty Comments & Initials:

 39
Training Manual for Facilitators

Hand Washing
Equipment: Running water, soap, clean towel.
Scenario: You are going to carry out a routine neonatal examination.

Participant Name: Facilitator name:

Pre course date: Post course date:
Skills Lab Name: District, State:

Total Score
Remark
Mark Pre Post
Demonstrate how you would wash your hands
Remove rings, bracelets and watches 2
Wet hands with clean running water and apply soap 2
Rub hands vigorously on both sides in the following order:
▪▪ Palms, fingers and web spaces 1
▪▪ Back of hands 1
▪▪ Fingers and knuckles 1
▪▪ Thumbs 1
▪▪ Fingertips and creases 1
▪▪ Wrist 1
Rinse thoroughly under clean running water 2
Dry hands using clean towel or air-dry 2
What could you do if there was no running water available?
Use alcohol rub 2
How would you use this?
Rub both sides of hands for 30 seconds or until the solution is dry 2
When would this not be appropriate?
If hands are soiled or bloody 2
Total score: 20

Faculty Comments & Initials:

40
Daksh Skills Lab for RMNCH+A Services

Preparation of 0.5% Chlorine Solution

Equipment: Plastic bucket with cover, plastic mug, wooden stirrer, 1L clean water, utility gloves,
plastic apron, teaspoon, bleach powder in airtight container.
Scenario: You are working on the labour ward and have been asked to decontaminate
instruments used at a birth.

Participant Name: Facilitator name:

Pre course date: Post course date:
Skills Lab Name: District, State:

Total Score
Remark
Mark Pre Post
What would you use to carry out the primary decontamination of the gloves and instruments?
0.5% chlorine solution 3
Please demonstrate how to prepare 0.5% chlorine solution
▪▪ Put on plastic apron and utility gloves 2
▪▪ Pour 1 L of water into the plastic bucket 2
▪▪ Take some water in the mug from the bucket, 4
then add 3 level teaspoons of bleaching
powder to it to make a thick paste
▪▪ Add the paste to the 1 L of water in the 2
bucket and mix with the wooden stirrer
▪▪ Cover bucket 3
How would you store the bleaching powder?
Airtight container away from sunlight 2
When do you need to change the solution?
At least every 24 hours or if it becomes turbid due to multiple use 2
Total score: 20

Faculty Comments & Initials:

 41
Training Manual for Facilitators

Personal Protective Equipment

Equipment: Waterproof apron, gown, cap, mask, eye cover, shoe covers.
Scenario: You are going to deliver a baby on the labour ward.

Participant Name: Facilitator name:

Pre course date: Post course date:
Skills Lab Name: District, State:

Total Score
Remark
Mark Pre Post
Demonstrate how you would use personal protective equipment to protect yourself and the patient
▪ Shoe covers 1
▪ Waterproof apron 1
▪ Eye cover 1
▪ Cap 1
▪ Mask 1
▪ Gown 1
▪ Gloves 1
Put on the sterile gloves using the following procedure:
▪▪ Ask assistant to open the outer package of the gloves 1
▪▪ Open the inner wrapper exposing the cuffed 1
gloves with the palm facing upwards
▪▪ Pick up the first glove by the cuff, touching 1
only the inside portion of the cuff
▪▪ Hold the cuff in one hand and slip the other hand 1
into the glove ensuring that the fingers enter
the corresponding finger of the glove
▪▪ Pick up the second glove by sliding the fingers of the 1
gloved hand under the cuff of the second glove
▪▪ Put the second glove on the ungloved hand by maintaining 1
a steady pull through the cuff until the fingers reach
the end of the corresponding finger of the glove
▪▪ Adjust the cuff until the gloves fit comfortably 1
and cover both the wrists.
After the procedure, how would you remove the contaminated gloves?
▪▪ Grasp one of the gloves near the cuff and 1
pull downwards towards the fingers
▪▪ Grasp the second glove and pull downwards 1
▪▪ Pull off the two gloves at the same time, being careful to touch 1
only the inside surfaces of the gloves with your bare hands
▪▪ Place them in a container of 0.5% chlorine solution 1
What precautions should you take to avoid contaminating sterile gloved hands?
▪▪ Don’t touch unsterile items with gloved hands 1
▪▪ Keep gloved hands above waist level 1
Total score: 20

Faculty Comments & Initials:

42
Daksh Skills Lab for RMNCH+A Services

Cervical Dilatation
Equipment: Cervical Dilatation Model, Sterile, Gloves, bowl with cotton swabs, Antiseptic
solution, Sponge Holder, 0.5% Chlorine Solution, Colour Coded Waste Disposal Bins, PPE,
Kidney tray

Participant Name: Facilitator name:

Pre course date: Post course date:
Skills Lab Name: District, State:

Total Score
Remark
Mark Pre Post
Ask the Participant to demonstrate the steps to assess Cervical effacement and dilatation inform
that in woman has just urinated.
▪▪ Wash hands 2
▪▪ Wear HLD/sterilized gloves on both hands 2
▪▪ Take an antiseptic solution swab in a sponge holder 2
and clean both labia from above downwards.
▪▪ Repeat the step again using another swab 2
▪▪ Discard the swabs in the yellow bucket 1
▪▪ Separate the labia, clean with a swab 2
from above downwards
▪▪ Insert index and middle finger to perform 2
the vaginal examination
▪▪ Rotate the hand 90 degrees so that the palm faces 2
upwards and gently stretches the fingers till the rim
of cervix is felt (usually at 3–9 o’clock position)
▪▪ Assess cervical dilatation and informs in cms. 2
▪▪ Feel the rim of the cervix with the index and middle finger 1
▪▪ Assess the cervical effacement and informs ( in %) 1
▪▪ Remove the glove inside out and put 1
in 0.5% chlorine solution
Total score: 20

Faculty Comments & Initials:

 43
Training Manual for Facilitators

Normal Delivery
Equipment: Mannequin, baby, towels, gloves, antiseptic solution swabs, normal delivery set, and
disposal bins. Plastic sheet is placed under buttocks and a clean towel on abdomen.
Scenario: A 21 year old primigravida, accompanied by her husband, is in active labour. You have
ensured privacy and gained consent. You had prepared the room and she is about to deliver the
baby. Demonstrate how you would conduct a normal vaginal delivery.

Participant Name: Facilitator name:

Pre course date: Post course date:
Skills Lab Name: District, State:

Total Score
Remark
Mark Pre Post
How would you ensure the woman’s bladder is empty?
Palpate the suprapubic region 1
Which aseptic techniques are important?
▪▪ Wash hand and put on sterile gloves 1
▪▪ Clean the woman’s perineum 1
How do you control the birth of the head?
▪▪ Encourage the woman to make small pushes with contractions 1
▪▪ Control the birth of the head with fingers
of one hand to maintain flexion 1
▪▪ Support the perineum with other hand using a clean pad 1
What do you do after the head has delivered?
▪▪ Allow the baby’s head to turn spontaneously 1
▪▪ Place hands on either side of baby’s head 2
and deliver anterior shoulder
▪▪ Deliver posterior shoulder once axillary crease is 2
seen by guiding head in an upwards direction
▪▪ Once delivery complete, place the baby on the mother’s abdomen 1
▪▪ Inform mother of sex of baby 1
▪▪ Delay cord clamping for 1–3 minutes 1
▪▪ Note time of birth, sex of baby on partograph 1
How would you care for the newborn baby?
▪▪ Dry the baby and mother’s abdomen with pre-warmed towels 1
▪▪ Cover the baby loosely with second pre- 1
warmed towel from head to toe
▪▪ Simultaneously, check for crying/ breathing – if 1
crying/ breathing, then go ahead with ENBC
If the baby is not breathing, what do you do?
Cut the cord immediately and begin resuscitation 2
Total score: 20

Faculty Comments & Initials:

44
Daksh Skills Lab for RMNCH+A Services

Partograph Details
A woman having her first baby was admitted to the labour ward from home in labour. Please
plot the details below on the partograph.

Cervical Head descent Fetal heart rate Membranes/ Contractions

Time
dilatation (5ths) (beats/min) amniotic fluid (duration)
10:00 5 cm 2 140 Membranes 3 (50 secs)
intact
14:00 7 cm 2 130 Artificial rupture 2 (35 secs)
of membranes
16:00 9 cm 1 155 Clear 3 (45 secs)

WHO
Partograph
Name Gravida Para Hospital number

Date of admission Time of admission Ruptured membranes Hours

200
190
180
Foetal heart rate

170
160
150
140
130
120
110
100
90
80

Amniotic fluid
Moulding
10
9
8
Cervix (cm) 7 Alert
on
[Plot x] 6 Acti
5
Hours

4
Descent 3
of head 2
[Plot o] 1
0
Hours 1 2 3 4 5 6 7 8 9 10 11 12

Time

5
Contractions
per 10 mins

4
<20 Sec
20 - 40 Sec 3
>40 Sec
2

Oxytocin IU/Litre
drops/min

Drugs given
and IV fluids

180
170
160
150
Pulse 140
[Plot ] 130
120
110
100
BP 90
[Plot ] 80
70
60

Temp ºC

{
Protein
Urine Acetone
Volume
 45
Training Manual for Facilitators

Partograph
Equipment: Blank partograph and pen, question sheet.
Scenario: A primigravida woman was admitted to the labour ward from home in labour. Please
plot the details on the question sheet onto the partograph.

Participant Name: Facilitator name:

Pre course date: Post course date:
Skills Lab Name: District, State:

Total Score
Remark
Mark Pre Post
At 10:00
▪▪ Allocate a mark for correct allocation of:
°° Time 1
°° Cervical dilation 1
°° Head descent 1
°° Fetal heart rate 1
°° Contractions 1
▪▪ What is your assessment of the labour at this time? 1
Answer: Normal
At 14:00
▪▪ Allocate a mark for correct allocation of:
°° Time 1
°° Cervical dilation 1
°° Head descent 1
°° Fetal heart rate 1
°° Contractions 1
▪▪ What is your assessment of the labour at this time? 1
Answer: Slow progress
▪▪ What interventions would you make? 1
Answer: Artificial rupture of membranes and augment labour
▪▪ After how many hours would you reassess?
1
Answer: After 2 hours

At 16:00
▪▪ Allocate a mark for correct allocation of:
°° Time 1
°° Cervical dilation 1
°° Head descent 1
°° Fetal heart rate 1
°° Contractions 1
▪▪ What is your assessment of the labour at this time? 1
Answer: Satisfactory
Total score: 20

Faculty Comments & Initials:

46
Daksh Skills Lab for RMNCH+A Services

Active Management 3rd Stage Labour

Equipment: Model of placenta, kidney tray, forceps, syringe of ‘oxytocin’, gloves, abdominal
model (put placenta inside abdomen and hold until ready to deliver).
Scenario: The second stage of labour is over. The baby is well and breathing normally. Now
demonstrate active management of the third stage of labour.

Participant Name: Facilitator name:

Pre course date: Post course date:
Skills Lab Name: District, State:

Total Score
Remark
Mark Pre Post
Before attempting delivery of the placenta, what should you check for?
▪▪ Exclude additional baby (babies) by 1
palpating the mother’s abdomen
Describe and demonstrate how you should actively manage the third stage of labour
▪▪ Administer inj. oxytocin (10 IU IM on anterolateral 2
aspect of thigh) or misoprostol (600 mcg oral)
▪▪ Palpate the uterus for contractions 1
▪▪ Wait for the uterus to contract 1
▪▪ Apply CCT with countertraction 1
Following delivery of the placenta, what action should you take?
▪▪ Massage fundus 1
▪▪ Ensure uterus is well contracted 1
▪▪ Examine placenta and membranes to ensure completeness 1
▪▪ Put placenta in the yellow bag 1
▪▪ Estimate blood loss 1
▪▪ Complete records 1
Post-delivery, what would you check and how frequently?
Uterine contraction and vaginal bleeding every 15 minutes for 2 4
hours, maternal pulse, and BP
How long would you wait to deliver the placenta before referring to a higher facility?
30 minutes 2
When would you not perform CCT?
▪▪ When no contraction is present 1
▪▪ Without applying counter traction above symphysis pubis 1
Total score: 20

Faculty Comments & Initials:

 47
Training Manual for Facilitators

Postpartum Haemorrhage
Equipment: MamaNatalie, IV arm, drip stand, BP apparatus, stethoscope, tourniquet,
Catheterization model, iv set, inj. oxytocin, IV fluids, iodine solution, 0.5% chlorine solution,
PPE, adhesive tape, long gloves, IV cannula, drip set.
Scenario: Following a prolonged labour, normal delivery of a healthy baby and AMTSL, you note
there is profuse vaginal bleeding estimated at 1000ml. You have checked and found signs of shock.

Participant Name: Facilitator name:

Pre course date: Post course date:
Skills Lab Name: District, State:

Total Score
Remark
Mark Pre Post
Describe the steps you will take in this scenario
▪▪ Shout for help 1
▪▪ Reassure the woman 1
Demonstrate management
▪▪ Insert IV cannula (wide bore) 1
▪▪ Take blood for cross-matching 1
▪▪ Start IV fluids (1L RL) 1
▪▪ Check whether oxytocin has been given in 1
AMTSL. If not, give oxytocin 10 IU IM
▪▪ Start oxytocin 20 IU in 500 ml of RL at 40–60 drops per minute 1
▪▪ Wash hands 1
▪▪ Wear gloves 1
▪▪ Palpate and massage uterus to ensure well contracted 1
▪▪ If atonic, start uterine massage 1
▪▪ Check for soft-tissue trauma 1
▪▪ Catheterize the bladder 1
▪▪ Continue to massage the uterus if not contracted 1
▪▪ Check placenta and membranes complete 1
If bleeding has not stopped, what further management would you perform?
Bimanual compression 1
How do you reassess the woman once bleeding is under control?
▪▪ Take pulse every 30 minutes 1
▪▪ Take blood pressure every 4 hours 1
▪▪ Assess urine output every 4 hours until > 30 ml/hour 1
If bleeding does not settle what will you do?
Refer to higher facility with complete referral note 1
Total score: 20

Faculty Comments & Initials:

48
Daksh Skills Lab for RMNCH+A Services

Insertion of IV Line
Equipment: Arm model, swabs, IV cannula, spirit swabs, adhesive tape, 2 ml N/S gloves, syringe,
tourniquet.
Scenario: A pregnant woman in your care requires IV antibiotics.

Participant Name: Facilitator name:

Pre course date: Post course date:
Skills Lab Name: District, State:

Total Score
Remark
Mark Pre Post
Describe and demonstrate what steps you would take to prepare and insert an IV cannula
Assemble the necessary equipment:
▪▪ Sterile cotton wool swabs and iodine/betadine 1
▪▪ IV cannula 1
▪▪ Saline flush 1
▪▪ Gloves and splints/tourniquet 1
▪▪ Blood sample bottles 1
Identify the site of insertion 1
Apply tourniquet proximal to vein 1
Wash hands and put on gloves 1
▪▪ Clean the site with alcohol 1
▪▪ Wait for 30 seconds 1
▪▪ Apply povidone iodine solution 1
▪▪ Remove the povidone iodine using alcohol 1
▪▪ Allow to air-dry for 30 seconds 1
Insert cannula into vein (15-degree angle) 1
When blood is seen, advance cannula whilst withdrawing the stylet 1
Flush with 2 ml of NS to check for flow of the fluid 1
Connect to IV fluids or put in stopper 1
Secure cannula with adhesive tape 1
Safe disposal of:
▪▪ Stylet in puncture-proof container 1
▪▪ Plastic waste in red bin 1
Total score: 20

Faculty Comments & Initials:

 49
Training Manual for Facilitators

Catheterization
Equipment: Catheterization mannequin, Foleys catheter, 10CC syringe, 10ml distilled water,
Cotton swabs, antiseptic solution, sponge holder, kidney tray, uro bag.
In the below evaluation list, both procedures carry 10 marks each.
Participant Name: Facilitator name:
Pre course date: Post course date:
Skills Lab Name: District, State:

Total Score
Remark
Mark Pre Post
Steps for catheterization:
▪▪ Check the expiry date on the pack(16/18 F foley’s catheter) 1
▪▪ Open the pack and leave it partially 1
drawn out on the sterile tray
▪▪ Hand wash and put on sterile gloves 1
▪▪ Clean the vulva with wet cotton swabs 1
soaked in cetrimide solution
▪▪ Separate the labia majora and insert the tip of 1
Foley’s catheter in the urinary meatus
▪▪ Push the catheter and connect the other 2
end of the catheter to the urobag
▪▪ Check the flow of urine 1
▪▪ Inflate the bulb of catheter with 10ml normal saline 2
Steps for Removal of catheter
▪▪ Put on sterile pair of gloves 2
2
▪▪ Take 10 ml syringe and attach the barrel of
the syringe to short end of catheter 2
▪▪ Deflate the bulb by withdrawing normal
saline with the help of syringe 2
▪▪ Pull out the catheter and dispose catheter 2
and urobag as per the guidelines
Total score: 20

Faculty Comments & Initials:

50
Daksh Skills Lab for RMNCH+A Services

CAB Approach
Equipment: Sphygmomanometer, stethoscope, pulse-oximeter (if available), supplemental
oxygen, oxygen face mask and tubing.
Scenario: A 25-year-old woman, unconscious, delivered at home 5 hours ago. The family said
she lost a lot of blood at the time of delivery. The placenta has been delivered. She has been
brought to your health centre. Examination on arrival shows a blood pressure of 90/55 mmHg,
and pulse rate of 115 beats/min.

Participant Name: Facilitator name:

Pre course date: Post course date:
Skills Lab Name: District, State:

Total Score
Remark
Mark Pre Post
What would you do first?
▪▪ Shout for help 1
▪▪ Insert 2 IV lines 1
▪▪ Take blood and send it to lab 1
▪▪ Start fluids at a rapid rate (1 L in 20 mins) 1
What would you do next?
▪▪ Assess airway patency 1
(looking at chest movements, listening for
and / or feeling air through nostrils)
If the airway is not patent, what would you do?
▪▪ Perform head tilt, chin lift and jaw thrust 1
The woman is breathing. What would you do next?
▪▪ Provide immediate management of shock 1
What steps would you take to provide immediate management of shock?
▪▪ Turn patient to left lateral position 1
▪▪ Start oxygen @ 6–8 L/min 1
▪▪ Keep the woman warm 1
▪▪ Elevate her legs 1
▪▪ Catheterize the woman 1
▪▪ Monitor vital signs every 15 mins 1
The woman is not breathing. Demonstrate what you would do
▪▪ Suction only if vomit or blood present 1
▪▪ Positioning 1
▪▪ Insert airway 1
▪▪ Give 30 chest compressions followed by 2 1
breaths @ 100 compressions/min
▪▪ Press sternum vertically to depress it by 4–5 cm 1
▪▪ Each breath should be provided for 1 1
second and should raise the chest
You have successfully resuscitated the woman. What would you do next?
▪▪ Find out the cause and manage accordingly 1
Total score: 20

Faculty Comments & Initials:

 51
Training Manual for Facilitators

IUCD
Equipment: Sponge-holding forceps, uterine sound, Sims speculum, vulsellum, Cu-IUCD, bowl with
cotton balls, betadine solution, PPE, scissors, bucket with 0.5% chlorine solution, kidney tray.
Scenario: A woman comes to a clinic 6 weeks after the birth of her second baby, asking for
contraception advice. After counselling she decides that an IUCD will be her best choice.

Participant Name: Facilitator name:

Pre course date: Post course date:
Skills Lab Name: District, State:

Total Score
Remark
Mark Pre Post
Demonstrate how you will insert an IUCD
▪▪ Check the IUCD pack for expiry date and for tears in the pack 1
▪▪ Read the instructions 1
▪▪ Wear PPE. Wash the hands and wear 2 appropriate- 1
sized gloves one on top of the other on each hand
▪▪ Perform bimanual pelvic examination and 1
note the size and position of the uterus
▪▪ Remove the outer gloves and discard in the appropriate bin 1
▪▪ Perform speculum examination and check 1
cervix and vagina for signs of infection
▪▪ Clean cervix and vagina with antiseptic solution 1
▪▪ Hold the cervix by the anterior lip using vulsellum and 1
pass uterine sound to assess depth of uterine cavity
▪▪ Remove IUCD from the opened package and 1
load plunger rod into the insertion tube
▪▪ Set length-gauge at uterine length 1
▪▪ Align the length-gauge and folded arms 1
of the T to horizontal position
▪▪ Insert IUCD into the cervical canal 1
observing a non-touch technique
▪▪ Advance until blue length-gauge comes into contact 1
with the cervix, keeping it in a horizontal position
▪▪ While holding the plunger rod, withdraw the insertion tube 1
and gently push the insertion tube towards the fundus
▪▪ Withdraw the insertion tube from the 1
canal and locate the strings
▪▪ Cut strings at 3 to 4 cm from the cervical os 1
▪▪ Gently remove the speculum and the vulsellum 1
▪▪ Put all used instruments in 0.5% chlorine 1
solution for decontamination
Can you name two complications the mother may experience and report back?
Candidate needs to provide two of the answers below: 2
▪▪ IUCD device is expelled
▪▪ Heavy vaginal bleeding
▪▪ Lower abdominal pain
▪▪ Fever or purulent vaginal discharge
Total score: 20

Faculty Comments & Initials:

52
Daksh Skills Lab for RMNCH+A Services

Eclampsia
Equipment: IM Injection mannequin, Inj.50% MgS04 - 10 ampoules, Syringes (10 ml syringe and
22G needle)-2, Alcohol/Spirit swabs in a bowl, Kidney Tray, Knee Hammer, Ampoule of 10%
Calcium gluconate, SS large tray-1.
Scenario: A woman is admitted to a basic facility at 38weeks having just had a fit. She is semi-
conscious. Demonstrate the steps to be done by you.

Participant Name: Facilitator name:

Pre course date: Post course date:
Skills Lab Name: District, State:

Total Score
Remark
Mark Pre Post
▪▪ Call for help 1
▪▪ Check Circulation 1
▪▪ Establish and maintain airway 1
▪▪ Check Breathing 1
▪▪ Place woman in left lateral position 1
▪▪ Take the required number of MgSo4 1
and check the expiry date
▪▪ Prepare two 10 ml syringes of 5 g (10 1
ml) 50% Magnesium Sulphate
▪▪ Wash and dry hand 1
▪▪ Wear gloves 1
▪▪ Clean injection site with alcohol 1
▪▪ Administer 5 g (10 ml) by DEEP IM injection 1
in each buttock (upper outer quadrant)
▪▪ Cut the needle with hub cutter 1
▪▪ Dispose of used syringe in a proper disposal box 1
▪▪ Records drug administration in woman’s record 1
Before administering Magnesium Sulphate to a woman who is conscious,
what would you warn her about?
She may experience a feeling of warmth/irritation along IV site 2
Here the instructor would prompt : If the mother is not stabilized, what should you do next?
Refer to a higher facility if treatment not available 2
When transferring a woman with suspected eclampsia, what do you need to ensure is available?
Basic life support -Patent IV line, airway and referral slip with 2
documentation of all medication given
Total score: 20

Faculty Comments & Initials:

 53
Training Manual for Facilitators

Newborn Care Corner

Equipment: Radiant warmer, bag and mask, suction machine, oxygen cylinder, newborn
mannequin.
Scenario: A woman is in the second stage of labour and you are preparing the newborn care
corner in case it is required. You have already cleaned the surfaces and replaced the towels.

Participant Name: Facilitator name:

Pre course date: Post course date:
Skills Lab Name: District, State:

Total Score
Remark
Mark Pre Post
Demonstrate how to use the radiant warmer
▪▪ Connect plug to electricity supply 1
▪▪ Switch on the radiant warmer 1
▪▪ Check display for mode, air temperature and temperature bars 1
▪▪ Check whether probe is attached to the machine 1
▪▪ Identify servo and manual mode and select manual mode 1
▪▪ Switch to servo mode and set temperature to 36.5°C 1
▪▪ Identify and connect skin probe 1
Demonstrate how to assemble bag and mask and how to use them
▪▪ Connect mask to bag 1
▪▪ Check bag by occluding patient outlet 1
with palm and squeezing the bag
▪▪ Check quick refilling of the bag 1
▪▪ Check that the pop-up valve moves up 1
and down with a hissing sound
▪▪ Apply mask to mannequin – mouth and 1
nose is covered, not the eyes
▪▪ Connect oxygen source if required 1
▪▪ Attach reservoir if oxygen source is connected 1
(must be readily available/should ask for it if not,
so that the skill develops to look for it )
What size face mask do you use for preterm newborn?
Size 0 1
Demonstrate how to operate a foot-operated suction machine
▪▪ Place foot suction on floor, bellows on right 1
side and fluid collection jar on left side
▪▪ Place right foot on bellows and press the foot down 1
▪▪ Block the suction tubing, press the bellows 1
▪▪ Check for suction pressure 1
What is the maximum suction pressure that can be used safely in a newborn?
100 mmHg 1
Total score: 20

Faculty Comments & Initials:

54
Daksh Skills Lab for RMNCH+A Services

Essential Newborn Care

Equipment: Neonatal mannequin, 2 towels, cord clamp, ID band, scissors, cap, weighing
machine, syringe, needle and injection of vitamin K.
Scenario: You have delivered a full-term newborn, no meconium, who cried at birth. Describe the
steps you will take to provide essential newborn care.

Participant Name: Facilitator name:

Pre course date: Post course date:
Skills Lab Name: District, State:

Total Score
Remark
Mark Pre Post
Demonstrate immediate care
▪▪ Call out time of birth 1
▪▪ Receive in pre-warmed towels 1
▪▪ Place on mother’s abdomen in a prone position 1
▪▪ Assess breathing 1
▪▪ Dry baby with a pre-warmed towel 1
▪▪ Discard wet towel 1
▪▪ Cover with another pre-warmed towel and 1
place between mother’s breasts
Baby is breathing normally – when would you cut the cord?
▪▪ 1–3 minutes after birth 1
What actions would you take now?
▪▪ Place an identity wristband on the baby 1
▪▪ Cover head with cap 1
▪▪ Record the weight 1
▪▪ Give injection of vitamin K to the baby 1
▪▪ Initiate breastfeeding 1
▪▪ Maintain skin-to-skin contact 1
▪▪ Check for any congenital malformations 1
Demonstrate the steps you would take to weigh a newborn
▪▪ Place on a flat, stable surface 1
▪▪ Place a towel on the pan 1
▪▪ Adjust the scales to zero 1
▪▪ Place baby in the weigh pan 1
▪▪ Record your findings 1
Total score: 20

Faculty Comments & Initials:

 55
Training Manual for Facilitators

Newborn Resuscitation
Equipment: Neonatal mannequin; neonatal bag and mask; towels x2; stethoscope.
Scenario: A woman (38 weeks pregnant) referred to your facility has been in labour for 17 hours.
The baby is just delivered and passed to you. It is floppy, unresponsive and no meconium is visible.

Participant Name: Facilitator name:

Pre course date: Post course date:
Skills Lab Name: District, State:

Total Score
Remark
Mark Pre Post
Please demonstrate what you would do (Facilitator pass the baby to candidate)
▪▪ Clamp and cut the cord immediately 1
▪▪ Place under radiant warmer 1
▪▪ Dry and wrap in a pre-warmed towel 1
▪▪ Position baby in slight neck extension using a shoulder roll 1
▪▪ Do not suction, as there is no meconium 1
▪▪ Stimulate by rubbing the back 1
▪▪ Assess breathing and heart rate. 1
Baby is breathing, has a heart rate of 90 bpm and is blue. What would you do next, please
demonstrate?
▪▪ Choose correct size bag & mask and position 2
correctly covering mouth and nose
▪▪ Give 5 inflation breaths of 2-3 seconds each (chest must rise) 2
▪▪ Reassess the heart rate and breathing 2
The heart rate is now 70 bpm with little respiratory effort. What would you do, please demonstrate?
▪▪ Continue bagging at a rate of 40-60 breaths/ 2
min (candidate has to demonstrate)
▪▪ Provide oxygen if available 1
If oxygen and a pulse oximeter are available, what is the recommended oxygen saturation level?
▪▪ 90-95% 1
If baby is breathing well and HR>100, what would you do?
▪▪ Refer him for observational care 1
If no improvement after effective ventilation, what would you do?
▪▪ Continue bag and mask ventilation 1
▪▪ Ask someone to prepare referral to appropriate centre 1
Total score: 20

Faculty Comments & Initials:

56
Daksh Skills Lab for RMNCH+A Services

Inhaler and Nebulizer

Equipment: Nebulizer and multi-dose inhaler with spacer. Normal saline, multi-dose vials, syringes
and needles. Mannequin/volunteer.
Scenario: A boy aged one and a half, a known asthmatic, arrives in your clinic. He is short of
breath and wheezing.

Participant Name: Facilitator name:

Pre course date: Post course date:
Skills Lab Name: District, State:

Total Score
Remark
Mark Pre Post
Demonstrate the correct use of the nebulizer
▪▪ Wash hands (participant has to mention 1
it but doesn’t have to do it)
▪▪ Measure the correct dose of medication to be used 1
in the nebulized chamber (specify the dose )
▪▪ Add normal saline to make the volume up to 3 ml 1
▪▪ Connect the nebulizer tubing to the port on the compressor 1
▪▪ Turn on compressor and check the nebulizer for misting 1
▪▪ Connect the mouthpiece or mask to the T-shaped elbow 1
▪▪ Hold the nebulizer in an upright position 1
▪▪ Ensure the mask is a good fit 1
Your patient is now stabilized, How would you teach the parents how to use the multi-dose inhaler
(MDI) with spacer? Please demonstrate your teaching
▪▪ Check expiry date 1
▪▪ Shake the container 1
▪▪ Remove the cap from the inhaler 1
▪▪ Insert the inhaler mouthpiece into the slot of the spacer 1
▪▪ Attach mask to the mouthpiece of the spacer 1
▪▪ Instruct the mother to hold the child in the proper position 1
▪▪ Place the mask over the child’s nose and mouth 2
so that there is a good seal with the face
▪▪ Press down on the inhaler canister to spray 1
1 puff of medicine into the spacer
▪▪ Allow the child to breathe normally for 5 breaths 1
Here the facilitator would prompt: How do you know the medicine
is dispersed?
▪▪ Momentary misting of the spacer and hissing noise 1
When to administer next dose?
▪▪ Wait for 2–3 minutes, shake the inhaler and repeat steps 1
Total score: 20

Faculty Comments & Initials:

 57
Training Manual for Facilitators

Kangaroo Mother Care

Equipment: Baby doll, baby clothes, bed sheet, blanket, volunteer mother if available.
Scenario: A woman has given birth in your maternity unit to a baby at 34 weeks gestation. The
baby weighs 2 kg and is pink, active, stable and breathing normally.

Participant Name: Facilitator name:

Pre course date: Post course date:
Skills Lab Name: District, State:

Total Score
Remark
Mark Pre Post
Demonstrate how you would perform kangaroo mother care (give participant clothed baby)
▪▪ Explain the procedure to the mother 1
▪▪ Ensure privacy for the mother 1
▪▪ Ensure the mother is sitting or reclining comfortably 1
▪▪ Gently undress the baby except for cap, nappy and socks 1
▪▪ Place baby prone on the mother’s chest 1
▪▪ In an upright position 1
▪▪ Between her breasts, skin to skin 1
▪▪ In a frog-like position (arms and legs flexed) 1
▪▪ Turn baby’s head to one side so airway is open 1
▪▪ Support baby’s bottom using appropriate sling or binder 1
▪▪ Cover mother and baby with blanket or shawl 1
▪▪ Ensure baby is breastfed frequently 1
What should the ideal room temperature be?
▪▪ 26-28°C 1
What are the two key components of KMC?
▪▪ Skin-to-skin contact 1
▪▪ Exclusive breastfeeding 1
What are the benefits of KMC?
▪▪ Reduces risk of hypothermia 1
▪▪ Promotes lactation 1
▪▪ Promotes weight gain 1
▪▪ Reduces infections 1
▪▪ Improves bonding between mother and newborn 1
Total score: 20

Faculty Comments & Initials: