feasibility study of birthing center in tuguegarao city

7/29/2019 Feasibility study of birthing center in tuguegarao city

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A

FEASIBILITY STUDY

on

PUTTING UP BIRTHING CENTER IN EACH BARANGAY IN

TUGUEGARAO CITY


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NORMA E. AGUSTIN

EXECUTIVE SUMMARY

Historically, most women gave birth at home without medical intervention.

These births were generally attended by a midwife, local family physician, or

members of the birthing woman's family. At the onset of the Industrial Revolution in

the 19th century, giving birth at home became more difficult due to congested

living spaces and dirty living conditions. This drove urban and lower class women to

newly available hospitals, while wealthy and middle-class women continued to labor

at home. In the early 1900s there was an increasing availability of hospitals, and

more women began going into the hospital for labor and delivery. A high level of

comparison is always made on traditional hospital births with home-like settings

in or near conventional hospital labor wards, home-like settings had a trend towards

an increase in spontaneous vaginal birth, breastfeeding at six to eight weeks, and a

positive view of care.

The question of whether advanced hospitals or small low technology

maternity units are the optimal setting for delivery of low risk women has been

discussed for many years. During the last few decades births have been centralized

to larger units in many Western countries. However, emphasis has recently changed

to women's preferences, and many low risk women want the experience of giving

birth in low technology maternity units. This new trend again raises the issue of

safety according to place of birth, and calls for reliable studies.

Safety may be addressed by direct comparisons between different levels of

maternity units, but such studies have a great potential for bias. Women with

expected increased risk of adverse outcome will be referred to larger maternity

units, and studies may lack sufficient information on key risk factors to make proper

adjustments. Furthermore, different maternity units may also record risk factors

differently, and judged from a previous study the largest units seem to under-report

risk factors.

One possible way to circumvent these potential biases is to study outcome

according to organization of delivery care (i.e. to availability of maternity units of
http://en.wikipedia.org/wiki/Midwifehttp://en.wikipedia.org/wiki/Midwife


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different levels of care in a particular geographical area). With the assumption that

the distribution of maternal and fetal risk factors are similar between the different

geographical areas, differences in outcome may be explained by differences in

organization of delivery care. Although such a design may avoid the most serious

biases in studies comparing maternity units, others may be introduced. However, if

results are consistent across different study designs, they are more likely to be true.

Birthing centers are needed today because women are not as free as they

wish when they are in hospitals. Women, if at home however, are not as safe as

when they are in the hospital. The prime purpose of delivering in a birthing center is

to have a safe labor with the comfort which cannot be found in hospitals.

A birthing center is a healthcare facility, staffed by nurse-

midwives, midwives and/obstetricians, for mothers in labor, who may be assisted

by former. By attending the laboring mother, the healthcare providers can assist the

midwives and make the birth easier. The midwives monitor the labor and well-being

of the mother and fetus during birth. Should additional medical assistance be

required, the mother can be transferred to a hospital.

A birth center presents a more home-like environment than a hospital labor

ward, typically with more options during labor: food/drink, music, and the

attendance of family and friends if desired. Other characteristics can also include

non-institutional furniture such as queen-sized beds, large enough for both mother

and father and perhaps birthing tubs or showers for water births. The decor is

meant to emphasize the normality of birth. In a birth center, women are free to act

more spontaneously during their birth, such as squatting, walking or performing

other postures that assist in labor. Active birth is encouraged. The length of stay

after a birth is shorter at a birth center; sometimes just six (6) hours after birth, the

mother and infant can go home.

Birthing centers shall very well serve its purpose because of the current

population we have and the lack of hospital numbers available. If each and every

barangay has at least one birthing center, then the costs and the time attending to

normal and uncomplicated births would be reduced.

As this would be considered a major business proposal, for it aims to put up

at least one birthing center in every barangay in Tuguegarao City, this feasibility

study shall have a budget of P150,000,000.00.
http://en.wikipedia.org/wiki/Midwiferyhttp://en.wikipedia.org/wiki/Midwiveshttp://en.wikipedia.org/wiki/Obstetricianhttp://en.wikipedia.org/wiki/Childbirthhttp://en.wikipedia.org/wiki/Labor_and_Deliveryhttp://en.wikipedia.org/wiki/Labor_and_Deliveryhttp://en.wikipedia.org/wiki/Water_birthhttp://en.wikipedia.org/wiki/Midwiferyhttp://en.wikipedia.org/wiki/Midwiveshttp://en.wikipedia.org/wiki/Obstetricianhttp://en.wikipedia.org/wiki/Childbirthhttp://en.wikipedia.org/wiki/Labor_and_Deliveryhttp://en.wikipedia.org/wiki/Labor_and_Deliveryhttp://en.wikipedia.org/wiki/Water_birth


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TECHNOLOGY

The safety of birth center care for low-risk women is an important issue, but it

has not yet been studied in randomized controlled trials.

In pre-industrial societies birth and death were essentially social affairs

involving cultural traditions developed over centuries. They took place in clan, tribe,

or other familial group supported by neighbors. Two factors resulted in people

transferring their control and management of then natural processes of life to the

hospitals and nursing home. First, was the break-up of extended family with

increasing urbanization and for the necessity of the institutional substitutes to care

for the sick, the aged, the dying and those born. Second was the emerging belief in

the power of science and the development of medical care. The belief was in the

promise, on the one hand, of a painless and safe birth, and, on the other, in the

power to prolong life.

The locating of birth and death in hospital environments removed them from

the realm of family responsibility and generational knowledge; it identified them as

pathological functions placed under the domination and control of the medical

profession. Indeed, as rites of passage became enclosed within the hospital walls,

medicine took on much the power attributed to religion. Judgment about each new

piece of medical knowledge or technology, as well as the efficacy of its application,

became the domain of the expert. At the same time, the role of the family and other

laymen in birth and death decisions were reduced.

MARKET FEASIBILITY

The target market of this business are the families who have an expecting

mother who is not in a complicated pregnancy. They shall be considered the usersas well as the consumers.

The charge for each patient shall be PhP60,000.00 inclusive of medicines,

accommodation and food.

As to competitions, considering that this would be project which is a first of

its kind and shall likewise offer and affordable birthing services, the target market is


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sure to be choosing birthing centers over private hospitals and crowded public

hospitals.

On 18 October 2009, around 6 am, a 21 year old woman, who was then 32

weeks pregnant felt her water just broke. Said woman though not feeling any hurt

on any part of her body, was rushed to the hospital for reason that she might be

about to give birth. She lives in Cataggaman Pardo but was rushed to the nearest

hospital called the Peoples Emergency Hospital which was a 30 minute ride from

their house. However, upon their arrival on the said hospital, they were informed

that there are no public doctors on duty as it was a Saturday. So she was then again

rushed to another public hospital, this time, the Cagayan Valley Medical Center,

which was again, a 30 minute ride from the Peoples Emergency Hospital. There was

no other choice for said woman belongs to a poor family who cant afford a private

hospitalization. Upon their arrival on the said hospital, still, the woman doesnt feel

any hurt but there is continuous coming out of water from her. Although this was

the situation, the doctors asked her if she could wait for a while as they are

attending to someone, who is also about to give birth like her, the difference is, this

other woman is screaming in pain. As requested, she patiently waited while filling

up her admission form. At around 10 am, she was admitted and taken inside the

delivery room where all her friends and relatives, including her husband, were

forbidden to accompany her. She was placed in a room where she was with women

like her, about to give birth. At exactly 8:39 pm of that same day, she gave birth to

a baby girl. Said baby girl, being premature, only weighed 1.38 kg. and was only as

big as a one litre of coke. Because of the size and prematurity of the baby, the

doctors deemed it best to confine said baby in the hospital as there was a danger of

this child not to survive. For 28 days, said child stayed in the hospital with all the

tubes connected to her and medicines as well as vitamins, injected. It can only be

imagined what a first time mom had to go through with that experience. Good

thing, the baby is now a healthy one year and 9 months old toddler.

Although the above example cannot be performed in a birthing center as it

was a premature birth, it shows that women would prefer delivering at a birthing

center because in there, their relatives would be allowed to accompany them as

giving birth is something crucial for a woman such that she would be needing the

presence of her loved ones. Since this service is needed with our current population


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and the number of women who chooses home-birth than hospital birth, than there

would be no difficulty in introducing this project.

With the innovations in technology and the growing number of nurses and

midwives who are unemployed, this project shall, not only lessen the burden of

conducting deliveries in hospitals but also give employment opportunities to our

professionals.

TECHNICAL FEASIBILITY

This project is intended to put up at least one birthing center in every

barangay in the City of Tuguegarao to wit:

Annafunan East Centro 10Annafunan West Centro 11

Atulayan Norte Centro 12Atulayan Sur Dadda

Bagay Gosi Norte

Buntun Gosi SurCaggay Larion Alto

Capatan Larion Bajo

Carig Norte LeonardaCarig Sur Libag Norte

Caritan Norte Libag SurCaritan Sur Linao Norte

Caritan Centro Linao EastCataggaman Viejo Linao West

Cataggaman Nuevo Linao SurCataggaman Pardo Namabbalan Norte

Centro 1 Namabbalan SurCentro 2 Pallua Norte

Centro 3 Pallua SurCentro 4 Pengue Ruyu

Centro 5 San GabrielCentro 6 Tagga

Centro 7 TanzaCentro 8 Ugac Norte

Centro 9 Ugac Sur

CONSTRUCTION COSTS

FACILITIES ESTIMATED AMOUNT200 sq.m. lot (P300,000.00) x 49 brgy. PhP14,700,000.00

Construction of the center PhP24,500,000.00


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(P500,000.00) x 49 brgy.Facilities (P500,000.00) x 49 brgy. PhP24,500,000.00Medicine (P200,000.00) x 49 brgy. PhP9,800,000.00

Staff PhP7,000,000.00Advertising and promotion PhP10,000,000.00

Total PhP90,500,000.00


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Each birthing shall be put up in a 200 sq.m. area of land and shall be totally

concrete. It shall be adjacent to the barangay health center. It shall provide for:

Career Opportunities and Employment Outlooks for:

a. Nurses

b. Midwives

c. Medical technologist

d. Obstetricians

e. Others who shall be performing administrative and supervisory

functions

Personnel Salary/month4-5 nurses will be taken in as

volunteers

n/a

2 resident Midwives PhP20,000.00 each1 resident medical technologist PhP20,000.00

1 resident Obstetrician PhP20,000.003 personnel for administrative

functions PhP13,000.00 each

Facility and Personnel Requirements

a. All those which shall be hired in each birthing center must have at

least one year experience or if not, must have attended vast seminars

in connection thereof;

b. Each birthing center must be able to accommodate 3-5 expectants.

Like clinics, birth centers arose as alternatives to heavily institutionalized

health care. Today, use of birthing centers must be covered by health insurance.

Several of the practices which must be innovated in birth centers and begin to enter

the mainstream hospital labor and delivery floors must include:

Bathtubs for babies

Showers for mothers rooming in of the infant after birth

delivery beds

lounge areas for visitors

lounge areas for family members to stay with the mother during labor and

birth
http://en.wikipedia.org/wiki/Water_birthhttp://en.wikipedia.org/wiki/Water_birthhttp://en.wikipedia.org/wiki/Water_birth


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There are certain requirements that a woman needs to meet in order to be

able to birth at a birth center. First, she must have an uncomplicated, low-risk

pregnancy.Twins, vaginal births after cesarean section, and breech babies are not

allowed to be delivered at free-standing birth centers. Free-standing birth centers

require hospital backup in case complications arise during labor that require more

complex care. However, even if a delivery can not happen at the birth center due to

a high-risk pregnancy, birth center midwives might provide prenatal care up to a

certain week of gestation or at the hospital alongside an obstetrician.

Competency assessment relies on standards to measure competent practice.

The competency standards that would be used must be sufficient for professional

status and state-sponsored recognition. A review of sociological theories relating to

standards-setting and professionalization provide a means for understanding this

standard.

William Baer describes the role of professional expertise and standards in

alleviating uncertainty in significant areas of life. Standards are a key mechanism

for controlling expertise and entry into the profession. They are formal, codified

rules linking professional identity, values and knowledge to action. Standards can

take various forms. The choice of the form in which the standard is expressed may

be the result of happenstance, history, or ignorance of other possible choices.

Standards that are expressed in terms of required inputs, such as educational

level, are calledprescription standards. Prescription standards have the advantage

of being commonly understood and based on tried and true principles that result

in the least amount of uncertainty within the profession and for the public. However,

such standards deny the validity of alternatives, resulting in less innovation in

meeting the professions goals.

FINANCIAL FEASIBILITY

Expected sales for one year is PhP141,120,000.00. There being an expected

at least 4 deliveries in each barangay per month for a total of 2,352 births

multiplied by PhP60,000.00 each which is the charge for every patient.

Half the sale for the first two years shall be taken as a return for the

expenses incurred in the construction costs. The other half shall be used for the

continued operation of the centers.
http://en.wikipedia.org/wiki/Twinshttp://en.wikipedia.org/wiki/Cesarean_sectionhttp://en.wikipedia.org/wiki/Breech_birthhttp://en.wikipedia.org/wiki/Twinshttp://en.wikipedia.org/wiki/Cesarean_sectionhttp://en.wikipedia.org/wiki/Breech_birth


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ORGANIZATIONAL FEASIBILITY

Overall Organizational Structure:

PILI NI NANAY

BARANGAY BIRTHING CENTER

Center Director/Chief Executive

Birthing Center

Lawyer/Attorne

Human

Resources

Patient

Advocacy

Records Officer

Financial

Officer/AccountOperations

Officer

Center

Manager for

nurses Medical

Technologi

midwives obstetricia

n

Administrati

ve


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Walking area for mothers

REGULATIONS/ENVIRONMENTAL ISSUES

STAFFS AREA

STAFFS AREA

Lounge

forvisi t

ors

Receiving

area

AdmittingSection

Delivery

DeliveryLounge for family


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The barangay birthing center shall first secure an Environment Compliance

Certificate from the DENR as well as the necessary permit to operate. The wastes

shall be disposed of in the manner prescribed by law.

CRITICAL RISK FACTORS/SWOT ANALYSIS

Thestrength of this project is that it would be a breakthrough in the

services offered by the private sectors as well as the government. If this would be

implemented, there would be less worries for moms who do not wish to trouble

themselves with the atmosphere of hospitals. The would-be fathers would likewise

be unburdened with the worries he experience during the labor of his wife.

The weakness however, is that, in puting up this kind of service, a large

amount of money would be spent.The opportunities present are that it will increase employment. Our nurses

would have a place to practice what they have studied. It would also be a chance

for the government to improve the current technology which would assist in

delivering of babies.

The threat however, there would be cases when it is difficult to determine if a

pregnancy is complicated or not. And if this is not determined, then there would be

a chance that a woman with a high-risk pregnancy would give birth in a birthing

center. And if this so happens, then the possibility of that woman and her baby notimmediately given medical attention would occur.

START-UP SCHEDULE/TIMELINE OF ACTIVITIES

Securing of building permits and registration of business

Construction of Centers

Information dissemination and advertisements

Processing of Necessary Permits

Installation of Birthing facilities

Employment of midwives and nurse aids and other staffs

The Pili ni Nanay Birthing Center is expected to start its operation in 24

months time.


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DESIRABILITY

Humanized birth puts the woman in the center and in control, focuses on

community based primary maternity care with midwives, nurses and doctors

working together in harmony as equals, and has evidence based services.

Professional midwifery is at a crossroads at the dawn of the 21st century.

Historically, direct-entry midwives and nurse-midwives have developed separate

educational philosophies, professional structures and practice styles. Generally, this

feasibility study aims to conduct the viability and practicability of putting at least

one birthing center in every Barangay in the City of Tuguegarao.

Specifically, this study aims to:

1. Decrease the rate of maternity mortality rate in the city;

2. Reduce the percentage of neonatal complications and deaths;

3. Increase the awareness of the society on the importance of safe delivery;

4. Reduce expenses on deliveries;

5. Foster breastfeeding on six to eight weeks;

6. Reduce the expenses of the citizens for maternity care;

7. Promote the involvement of citizens in deciding and suggesting ways of

improving birthing systems in the city; and

8. Encourage couples to get involved in family planning.

With these end goals, the researcher recommends the realization of this

business. The results would suggest that birth center care is effective in

identifying significant maternal complications and as safe for women as

standard maternity care.


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Norma,

We are about ready to send you and Danilo and your mom, Narda 2 balikbayan boxes. We are finishing

packing and will soon schedule for pick-up with LBC to ship to the Phil. We estimate that you will receivethem in a month (around Sept 15, 2011). Please follow-up few days before Sept 15, at least in 3 weeks

just to make sure that you are aware of it. Sometimes, when the boxes arrive, LBC keep them there andif not picked-up or claimed immediately sometimes gives them a chance to open them and get some ofthe stuff; this is what we are trying to avoid. Note that the boxes are filled to the brim/ jam packed. Wehave included your requests of vitamins, Tylenol, raisins and chocolate (no raisins in chocolate). Wehave also included baby aspirin for your mom for her high blood pressure. If she feels like she is havinghigh blood pressure, (headache and batok is hurting is a sign), then let her take 1 tablet a daycontinuously until she feels well. We have also sent Christophers old laptop to give you Norma aspromised before; this is placed on Danilos box. We tried to separate the items into two boxes, one forNorma, one for Danilo with Nardas stuff distributed on both boxes. Please give Narda hers. Some of thestuffs are labeled, some are not. Note that the clothes are not labeled since we do not know who fits whoand so just divide accordingly as to who fits on both boxes. Bahala na kayo Norma, Danilo and Narda na

mag-share sa mga padala.

Regarding the extension house, please decide among yourselves. You make the decision. Just makesure that if you are renting it to students, please make them aware that they are sharing with others whowill be coming. How many students do you think can it accommodate and how much per student? Doyou need to provide for bunk beds etc? Please give us update. How about the neighbors, especially onthe back/side, are they still trying to get a portion of the lot?

This is all. Let us know when you get the boxes. So long.

feasibility study of birthing center in tuguegarao city

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