Client's Full Name
*
Client's Email
*
Time
*
Date
*
Gestational Age
Stage of Labor upon Arrival
*
1st Stage Early Labor
1st Stage Active Labor
1st Stage Transition
2nd Stage Pushing/Delivery
3rd Stage Placenta Delivery
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Contraction rate in the last hour
*
2 Hour Birth Log
Client Mood
*
Happy and Confident
Calm and Content
Anxious but Coping
Overwhelmed
Tired but positive
Concerned about progress
Excited about progress
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Time of last meal
*
Nausea/vomiting
*
Yes
NO
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Comfort Measures Provided
*
Dilation
*
Effacement
*
Station
*
Medical Interventions
*
None
Antibiotics
Antiemetics (Nausea meds)
Antihypertensives or magnesium sulfate
Artificial rupture of membranes
Cervical ripening agents
Cesarean Birth (C-section)
D&C
Emergency Transfer
Epidural anesthesia
Episiotomy
External fetal monitoring
Forceps
General anesthesia
Internal fetal scalp electrode
Intrauterine catheter
IV fluids
IV Pitocin
IV Other
Local anesthesia
Manual stretching of perineum
Mechanical ripening
Spinal block
Nitrous oxide
Narcotic analgesia
Repair of perineal tears
Vaccum
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Birth Outcome
*
Vaginal
Cesarean
Vaginal Assisted
N/A
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APGAR Score 1
*
APGAR Score 1
*
0
1
2
3
4
5
6
7
8
9
10
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APGAR Score 2
*
APGAR Score 2
*
0
1
2
3
4
5
6
7
8
9
10
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Immediate postpartum complication
*
None
Postpartum hemorrhage
Retained placenta or membranes
Uterine atony (uterus not contracting properly)
Infection
Other
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Time of Baby's First Feed
*
Baby's Weight
*
Other Intake Notes
*
Charting personnel
Personnel Signature
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