INITIAL LABOR EXAMINATION

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LABOR RECORD

MOTHER: ________________________________________________ DATE: _____________
Labor Onset: Latent _________________________ Active ____________________________
Baby's Position _____________________________ EDD _____________________________
Membranes ________________________________ Usual FHTs _______________________
Concerns _________________________________ Midwife ___________________________
Comments ___________________________________________________________________
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TIME	BP/Pulse	FHTs	Fetal Position	Urinalysis	Contractions	Internal Exam

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INITIAL LABOR EXAMINATION

MOTHER ______________________________________________ DATE ________________
TIME ____________PLACE____________EDD____________RELIGION_________________
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History of labor prior to examination:

Date___________Time__________Comments_______________________________________
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Pre-examination observations:
Contractions: Every_________minutes, lasting________seconds. Intensity:______________
Breathing being used: ___________ Emotional state: _____________ Show: _____________
SROM:______________________ Date: _______________ Time: _______________________
Description & color of amniotic fluid: ______________________________________________


Examination Results:
Uterine Height: __________cms. Fetal position:_____________Fetal motion:______________
FHT (+): _____ , _____ , _____ , _____ , _____ , _____ / 5 Seconds X 2=_________FHTs/minute
FHT rhythm: (Regular), (Irregular). Placental sounds (o) _______________________________


Vaginal Exam:
Show:___________ Dilation:___________ Effacement:____________ Station:_____________
Membranes: Amnion _________________________ Chorion ___________________________
Presenting Position ________________ Placement of Cervix ___________________________


Vital Signs:
Blood Pressure: _______________________ Pulse: ____________________________ / minute
Temperature: _______°C/F. Reflexes: __________Respirations: _________________________


Blood Work:
Hemoglobin ___________g/dL. Hct _________%/L. Blood Type & Rh Factor:_______________
Date Last Checked: __________________ Other Blood Work: ___________________________


Nutrition:
Last Bowel Movement: Date: __________ Time: _________   (morning)  (afternoon)  (evening)
Last Urination: Date: _________________ Time: _________   (morning)  (afternoon)  (evening)
Last Meal Eaten: Date: _______________ Time: _________   (morning)  (afternoon)  (evening)
Type: (breakfast) (lunch) (dinner) (snack) (other: _____________________________________)
Describe what was eaten: ________________________________________________________


Urine Analysis:
Date: ________________________________________ Time: ___________________________
Color: _______________________________________ Odor: ___________________________
Clarity: ______________________________________ Protein: __________________________
Glucose: ____________________________________ Ketones: _________________________
pH:_________________________________________ Leukocytes: ______________________
Nitrite: ______________________________________ Bilirubin: _________________________
Urobilirubin: _________________________________ Blood: ___________________________
Specific Gravity: ______________________________ Hemoglobin: ______________________
Comments: ____________________________________________________________________

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LABOR PROGRESS NOTES

MOTHER_________________________________________ EDD_________________________


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