A

FEASIBILITY STUDY
on

PUTTING UP BIRTHING CENTER IN EACH BARANGAY IN TUGUEGARAO CITY

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

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 nursemidwives, 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.

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 users as 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

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

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 Annafunan West Atulayan Norte Atulayan Sur Bagay Buntun Caggay Capatan Carig Norte Carig Sur Caritan Norte Caritan Sur Caritan Centro Cataggaman Viejo Cataggaman Nuevo Cataggaman Pardo Centro 1 Centro 2 Centro 3 Centro 4 Centro 5 Centro 6 Centro 7 Centro 8 Centro 9 Centro 10 Centro 11 Centro 12 Dadda Gosi Norte Gosi Sur Larion Alto Larion Bajo Leonarda Libag Norte Libag Sur Linao Norte Linao East Linao West Linao Sur Namabbalan Norte Namabbalan Sur Pallua Norte Pallua Sur Pengue Ruyu San Gabriel Tagga Tanza Ugac Norte Ugac Sur

CONSTRUCTION COSTS FACILITIES

200 sq.m. lot (P300,000.00) x 49 brgy. Construction of the center

ESTIMATED AMOUNT
PhP14,700,000.00 PhP24,500,000.00

(P500,000.00) x 49 brgy. Facilities (P500,000.00) x 49 brgy. Medicine (P200,000.00) x 49 brgy. Staff Advertising and promotion

PhP24,500,000.00 PhP9,800,000.00 PhP7,000,000.00 PhP10,000,000.00

Total

PhP90,500,000.00

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 4-5 nurses will be taken in as volunteers 2 resident Midwives 1 resident medical technologist 1 resident Obstetrician 3 personnel for administrative functions 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:

Salary/month n/a PhP20,000.00 each PhP20,000.00 PhP20,000.00 PhP13,000.00 each

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

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 called prescription 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.

ORGANIZATIONAL FEASIBILITY
Overall Organizational Structure: Center Director/Chief Executive Officer

Birthing Center Lawyer/Attorne y

Human Resources Management

Patient Advocacy Services officer

Records Officer

Financial Officer/Account ant

Operations Officer

Center Manager for each

nurses

Medical Technologi st

midwives

obstetricia n

Administrati ve personnel

PILI NI NANAY BARANGAY BIRTHING CENTER

Lounge for visitors

Receiving area Admitting Section

Walking area for mothers

Delivery bed

Lounge for family members

Delivery bed

STAFFS AREA STAFFS AREA

REGULATIONS/ENVIRONMENTAL ISSUES

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

The strength 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 not immediately 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.

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.

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 receive them 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 and if not picked-up or claimed immediately sometimes gives them a chance to open them and get some of the stuff; this is what we are trying to avoid. Note that the boxes are filled to the brim/ jam packed. We have included your requests of vitamins, Tylenol, raisins and chocolate (no raisins in chocolate). We have also included baby aspirin for your mom for her high blood pressure. If she feels like she is having high blood pressure, (headache and batok is hurting is a sign), then let her take 1 tablet a day continuously until she feels well. We have also sent Christophers old laptop to give you Norma as promised before; this is placed on Danilos box. We tried to separate the items into two boxes, one for Norma, one for Danilo with Nardas stuff distributed on both boxes. Please give Narda hers. Some of the stuffs are labeled, some are not. Note that the clothes are not labeled since we do not know who fits who and 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 make sure that if you are renting it to students, please make them aware that they are sharing with others who will be coming. How many students do you think can it accommodate and how much per student? Do you need to provide for bunk beds etc? Please give us update. How about the neighbors, especially on the 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.