This is an official Northern Trust policy and should not be edited in any way

Please note that the policy library on Staffnet will contain the most up to date version of Trust policies
Reference No: NHSCT/16/1049
Title: Labour – Care of Women
Key words within Labour, latent phase, first, second, third stage, observations,
policy (max 10 monitoring, management
words)
Policy Author(s): Shona Hamilton, Consultant Midwife
Cathy Hamilton, Practice Development Midwife/Supervisor of
Midwives
Dr Frances Stewart , Consultant Obstetrician
Responsible Marie Roulston, Director of Women, Children and Families
Director: Division
Policy Type: Trust Wide ☒ Directorate Specific ☐ Clinical ☒
Policy Yes ☒ No ☐ NHSCT/13/667 Care of Women in Labour
Replacement:
Directorates Finance ☐ Medical & Governance ☒
policy to be Children’s ☐ Mental Health & Disability ☐
issued to: Human Resources ☐ Acute Hospital Services ☒
Primary & Comm Care ☐ Nursing & User Exp ☒
Planning, Performance Management & Support Services ☐

Target Audience, This policy is directed to midwifery and obstetric staff working
ie, specific staff with women in maternity; both in the hospital and community
groups setting.
Approved by: Dr Kate Scott and Mrs Suzanne Pullins 31 October 2016
Co-chairs, Clinical and Social Care
Policy and Guidelines Committee
Operational Date: 2 November 2016
Review Date: 31 October 2019
Policy Library Clinical & Social Care
Categories: Hospital (incl Comm Hosp) ☒
(Please tick as Children’s Hospital & Community ☐
appropriate) Children’s Nursing ☐
Mental Health, Learning & Physical ☐
Disability
Community ☐ Estates ☐
Maternity & Gynae ☒ Human Resources ☐
Health & Safety ☐ Major Incident Plan ☐
Palliative Care ☐ Information Management ☐
Infection Control ☐ Allied Health Professions ☐
Family Planning ☐ Trust Wide ☐
Finance ☐
Safeguarding Children ☐
NHSCT Vision
To deliver excellent integrated services in partnership with our community.

Care of Women in Labour

Care of Women in Labour Version 3_0 Page 1 of 23

Contents Page

1.0 Summary of Policy 3

2.0 Responsibilities 3

3.0 Policy Statement 3

3.1 Latent phase of labour 5
3.2 First stage of labour 6
3.3 Second stage of labour 10
3.4 Third stage of labour 12
3.5 Care of baby following birth 14

4.0 Monitoring (including audit) 16

5.0 Evidence Base/References 16

6.0 Personal & Public Involvement (PPI)/Consultation Process 17

7.0 Equality, Human Rights & DDA 17

8.0 Alternative Formats 18

9.0 Sources of advice in relation to this document 18

10.0 Policy Sign Off 18

11.0 Appendices/Attachments 19

Appendix 1 – HART Tool

Appendix 2 – Regional Normal Birth Pathway (GAIN)

Care of Women in Labour Version 3_0 Page 2 of 23

1.0 Summary of Policy

Birth is a life changing event and the care given to women during labour has the
potential to affect them both physically and emotionally in the short and longer term,
(National Institute for health and Clinical Excellence (NICE) 2007, 2014). Care in
labour should be aimed towards achieving the best possible outcome for mothers
and babies in all care settings. Throughout this guideline, key practice points are
highlighted to facilitate woman-centred care.

Aim

This guideline will provide a clear evidence based framework for all midwives,
student midwives, obstetricians, midwifery support workers and nursing auxillaries to
deliver safe, women centred, effective care. It includes guidance on all the stages of
labour and reflects evidence based recommendations from Intrapartum care for
healthy women and babies. NICE Clinical Guideline 190. London: National Institute
for Health and Clinical Excellence; 2014.

2.0 Responsibilities

Directors and Assistant Directors are responsible for ensuring that the policy is
disseminated and implemented in the appropriate areas across their division.

Ward Managers are responsible for ensuring that staff are aware of the guideline
and it is available for use within their department. They are responsible for
departmental induction of new staff to the guideline and its implementation within
their clinical setting.

Individual professionals are individually accountable for the application of the

guideline.

3.0 Policy Statement

This guideline provides advice for the care of women during the:

 Latent Phase of labour;

 First stage of labour;
 Second stage of labour; and
 Third stage of labour.

Practice Point: Women express the following needs - they want:

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Women in staff
Labour Version 3_0 providing care during the birthing Page
process;
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 To have one-to-one care from a midwife throughout labour and birth;

 To receive personalized care, be treated with kindness, support and
Communication

All women in labour should be treated with respect and should be in control of and
involved in what is happening to them, and the way in which care is given is key to
this. To facilitate this, healthcare professionals and other caregivers should establish
a rapport with the labouring woman, asking her about her wants and expectations for
labour, being aware of the importance of tone and demeanour, and of the actual
words they use. Listen to the woman’s story, considering her emotional and
psychological needs and expectations for labour. If the woman has a written birth
plan, read and discuss this with her. If she does not have a written birth plan,
discuss any wishes she may have at this time. This information should be used to
support and guide her through her labour (NICE 2007, 2014).

All midwives and obstetricians should review the Maternity Hand Held Record
(MHHR) including all antenatal investigations. This should enable the health
professional to make a full identification of any maternal or fetal risk factors which will
impact on the plan of care. Any identified risk factors should be recorded in
‘Intranatal Risk Factors’ sheet in MHHR following discussion with the mother.

Maternal observations to be carried out when women present in labour:

 Physical observations should always be taken and recorded within the

OEWS; to include temperature, blood pressure, pulse and urinalysis.
 Length, strength and frequency of contractions.
 An abdominal palpation should be undertaken to include fundal height, lie,
presentation, position and station
 Vaginal loss should be assessed for a show, liquor or any blood loss.

Care of Women in Labour Version 3_0 Page 4 of 23

  The use of admission cardiotocograph (CTG) in a low risk pregnancy is not
recommended (“Guideline for Midwifery and obstetric staff Intermittent
Auscultation and Continuous Electronic Fetal Monitoring Guideline, 2016)
 Auscultate the fetal heart and document as a single rate
 Vaginal Examination
 If the woman does not appear to be in established labour, after a period of
assessment, it may be helpful to offer a vaginal examination particularly if she
is considering returning home. Explain the reason for this examination and
ensure consent obtained and the woman’s privacy, dignity and comfort is
maintained (Department of Health, 2003).
 Maternal assessment and observations should be documented clearly within
the MHHR.

3.1 The Latent Phase of Labour

Definition

“A period of time, not necessarily continuous, when: there are painful contractions,
and there is some cervical change, including cervical effacement and dilatation up to
4 cm”. NICE (2007, 2014)

 The timely diagnosis of active labour is problematic both for women and their
caregivers (Lauzon and Hodnett, 2004). A mistaken diagnosis can lead to a
subsequent diagnosis of labour dystocia and a consequent cascade of
interventions.
 A long latent phase can often be a discouraging and exhausting experience
(Simkin and Ancheta, 2000), and women clearly need good consistent
psychological support.
 Communication, reassurance and education are vital.
 Women should be encouraged to maintain normal everyday activity.
 Labour wards may not be the appropriate environment for women in the latent
phase (Bailit et al. 2005; Klein et al 2004; Holmes et al. 2001).

Care in the latent phase of labour:

Care of Women in Labour Version 3_0 Page 5 of 23

  Some women have pain without cervical change. Although these women are
described as not being in labour, they may well consider themselves “in
labour” by their own definition.
 Women who seek advice or attend hospital with painful contractions but who
are not in established labour should be offered individualised support and if
required analgesia.
 Midwives and obstetricians should enquire about the baby’s movements
including any changes.
 Alternative coping strategies for the latent phase of labour should be
discussed with the woman and her partner and should include mobilisation,
use of alternative positions and hydrotherapy.
 Women should be offered the opportunity to return home or alternatively
remain in hospital.
 The woman and her partner should be shown how to summon help and
reassure her that she may do so whenever and as often as she needs.
 All care should be documented contemporaneously within the MHHR and
observations recorded within the “Antenatal observation chart for care of
women in early labour”, see Appendix 3 in NHSCT “Induction of Labour” 2013
guideline.
 If any deviations are noted during this assessment and care then refer to the
most appropriate health professional and the labour ward coordinator.
 If women are under midwifery led care and regular uterine contractions persist
greater than 12 hours transfer to Consultant led care.

3.2 First stage of labour

Support in labour - a woman in established labour should receive supportive one-

to-one care and should not be left on her own except for short periods or at the
woman’s request.

Women should be encouraged to have ‘birth partners’ of their choice to support them
during labour and birth.

Practice Point:
Always review the antenatal notes, including screening tests and “Grow
Care of Women in Labour Version 3_0 Page 6 of 23
Chart”
Midwifery Led Criteria for Labour:
Care during first stage of labour

Definition; when there are regular painful contractions, and there is progressive
cervical dilatation from 4 cm (NICE, 2007, 2014).

Maternal Monitoring

Commence partograph and complete intrapartum risk factors in MHHR and ensure
all records completed contemporaneously:

 4 hourly temperature and Blood Pressure. (These observations may need to

be repeated more frequently if there is any concern regarding the
observations recorded or any pre-existing condition, or risk factors which
requires the temperature or blood pressure to be recorded more frequently.)
 Refer to NHSCT “Water for Labour and Birth Guideline” (2011) if labouring in
water.
 Pulse hourly (or more frequently of there is any abnormality detected with the
FH to ensure differentiation between the 2 heart rates (Guideline for Midwifery
and obstetric staff: Intermittent Auscultation and Continuous Electronic Fetal
Monitoring Guideline, 2016).

Care of Women in Labour Version 3_0 Page 7 of 23

  Abdominal palpation for descent and position 4 hourly and prior to vaginal
examination.
 Vaginal examination as required (typical progress ≥1cm in 2hrs cervical
dilatation). When a woman only has minimum dilatation i.e. 2cm in 4 hours,
then advantages and disadvantages of artificial rupture of membranes should
be discussed and a plan of care documented.
 Assess PV discharge/liquor/colour.
 Encourage women to pass urine regularly.

Fetal monitoring:

 Method of auscultation made using “Guideline for Midwifery and Obstetric

staff :Intermittent Auscultation and Continuous Electronic Fetal Monitoring
Guideline,2016”
 Fetal heart rate 100 -160 bpm clear and regular on auscultation.
 Intermittent auscultation for 1 minute every 15 minutes immediately after a
contraction and record as a single rate in the partograph.
 Palpate the woman’s pulse to differentiate between heart rates
 Be aware of a rising or changing baseline as an indicator of potential fetal
compromise.

Presence of meconium

As part of ongoing assessment, document the presence or absence of significant

meconium. This is defined as dark green or black amniotic fluid that is thick or
tenacious or any meconium-stained amniotic fluid containing lumps of meconium
(NICE, 2014).

If significant meconium is present, ensure that:

• Healthcare professionals trained in fetal blood sampling are available during

labour and
• Healthcare professionals trained in advanced neonatal life support are readily
available for the birth (NICE, 2014)
• Electronic fetal monitoring is advised

Care of woman in first stage of labour:

Care of Women in Labour Version 3_0 Page 8 of 23

  Women should be encouraged to move and adopt whatever position they find
most comfortable throughout labour.
 Women may drink/eat a light diet during established labour and should be
informed that isotonic drinks may be more beneficial than water however if
they have received opioids or develop risk factors that make a general
anaesthetic more likely, this should be avoided.
 Consider use of input/output chart as appropriate/required. If patient is aged
under 16 years refer to Paediatric Fluid Balance Chart.
 Antacids should not be given routinely to low-risk woman but consider for
women with risk factors; refer to Midwives Exemptions (DHSSPS et al, 2014)
 Women should be supported with their choice of pain relief; the choice of
water should be encouraged (refer to NHSCT Waterbirth Guideline).
 In normally progressing labour, early amniotomy and the use of oxytocin
should not be used routinely.
 Refer to the most appropriate health professional and the labour ward
coordinator at any stage during care when complications arise. When the
midwife is the lead professional within the MHHR, referral to our obstetric
colleagues should be made using the HART Tool in Appendix 1.

Practice Point:
Where delay in first stage of labour is suspected, consider the following to
determine progress.

 Has the cervix moved from the posterior to an anterior position,

effaced, dilated and is there any descent of the head?
 Consider woman’s position and mobility
 Parity
 Rate of change uterine contractions

If delay in the established first stage of labour is suspected amniotomy

should be considered for all women with intact membranes, after
explanation of the procedure and advice that it will shorten her labour by
about an hour and may increase the strength and pain of her contractions

3.3 Second stage of Labour

Care of Women in Labour Version 3_0 Page 9 of 23

Definitions of Second Stage, (NICE, 2007 2014)

Passive second stage of labour:

 The finding of full dilatation of the cervix prior to or in the absence of

involuntary expulsive contractions.

Active second stage of labour:

 Vertex is visible.
 Expulsive contractions with a finding of full dilatation of the cervix or other
signs of full dilatation of the cervix.
 Spontaneous active maternal effort following confirmation of full dilatation of
the cervix in the absence of expulsive contractions.

Parous women:

Birth would be expected to take place within 2 hours of the start of

the active second stage in most women

Diagnose delay in the active second stage when it has lasted 1

hour and refer the woman to a healthcare professional trained to
undertake an operative vaginal birth if birth is not imminent

Care of woman in second stage of labour

Care of Women in Labour Version 3_0 Page 10 of 23

All observations including FHR should be documented on the partograph.

Observations by a midwife in the second stage of labour include:

 Hourly blood pressure and pulse.

 Continued 4-hourly temperature.
 Vaginal examination offered hourly in the active second stage or in response
to the woman’s wishes (after abdominal palpation and assessment of vaginal
loss).
 Half-hourly documentation of the frequency of contractions.
 Frequency of emptying the bladder.
 Ongoing consideration of the woman’s emotional and psychological needs.

These observations may need to be repeated more frequently if there is any concern
regarding the observations recorded or any pre-existing condition, or risk factors
which requires the temperature or blood pressure to be recorded more frequently.

Where any of the maternal observations are recorded outside of normal parameters,
the midwife must notify and inform both the labour ward coordinator and the
appropriate medical officer; this should include any anticipated paediatric support.

Fetal monitoring:

 Intermittent auscultation of the fetal heart should occur after a contraction for
at least 1 minute, at least every 5 minutes and palpate maternal pulse every
15 minutes to differentiate the two heart rates and record in Partogram.

When the midwife is the lead professional any concerns regarding

maternal progress or fetal condition should be referred to obstetric
colleagues utilising the HART Tool (Appendix1)

Practice Point:
Women should be discouraged from lying supine or semi-supine in the
second stage of labour and should be encouraged to adopt any other
position that they find most comfortable

Women should be informed that in the second stage they should be guided
by their own urge to push

If pushing is ineffective or if requested by the woman, strategies to assist

birth can be used, such as support, change of position, emptying of the
bladder and encouragement

3.4 Third stage of Labour

Care of Women in Labour Version 3_0 Page 11 of 23

 Definition of the third stage

The third stage of labour is the time from the birth of the baby to the expulsion of the
placenta and membranes, (NICE, 2007, 2014).

Practice Point:
Midwives should be knowledgeable about the advantages and
disadvantages of both active and physiological management of the third
stage of labour in order to help the woman make an informed decision
about her plan of care. Physiological third stage is not offered routinely,
however the woman’s choice will be facilitated

Active management of the third stage involves a package of care which includes all
of these three components:

 Routine use of uterotonic drugs;

 Deferred clamping and cutting of the cord; and
 Controlled cord traction.

Physiological management of the third stage involves a package of care which

includes all of these three components:

 No routine use of uterotonic drugs.

 No clamping and cutting the cord until the placenta is delivered and promoting
the use of gravity to assist delivery of the placenta in a timely manner with
maternal effort (Begley et al. 2011).

Practice Point:
Care of Women in Labour Version 3_0 Page 12 of 23
Prolonged third stage
The third stage of labour is diagnosed as prolonged if not completed
within 30 minutes of the birth of the baby with active management and
Deferred Cord Clamping:

 Do not clamp the cord earlier than 1 minute from the birth of the baby unless
there is concern about the integrity of the cord or the baby has a heartbeat
below 60 beats/ minute that is not getting faster.
 Clamp the cord before 5 minutes in order to perform controlled cord traction
as part of active management.
 If the woman requests that the cord is clamped and cut later than 5 minutes,
support her in her choice.
 Record the time of cord clamping in the MHHR (NICE, 2014)

Delivery of the placenta – Active Management:

 Observe for signs of lengthening of the umbilical cord indicating placental

separation.
 Observe for signs of a small gush of blood which may indicate placental
separation.
 Note if the woman reports abdominal discomfort signifying a uterine
contraction and/or rectal pressure, which may indicate placental separation.
 Following signs of placental separation place a hand on the abdomen at the
base of the uterus to guard the uterus.
 Perform Controlled Cord Traction by pulling on the cord in a slow downward
movement.
 Pulling the cord or palpating the uterus should only be undertaken after
administration of oxytocin as part of active management.
 Check the placenta and membranes for completeness.

Care of Women in Labour Version 3_0 Page 13 of 23

  Check the umbilical cord for three vessels. If there are any concerns
regarding the number of vessels in the cord a section can be sent to the
laboratory for review.

Delivery of the placenta – Physiological Management

Women of low risk of postpartum haemorrhage who request physiological

management of the third stage should be supported in their choice.

 Ascertain maternal choice prior to delivery of the Third Stage of Labour.

 Allow time for signs of placental separation. This may be >1 hour.
 Consider putting the baby to the breast or use nipple stimulation to promote a
contraction and hence placental separation.
 Following signs of placental separation the placenta will deliver with gravity
and maternal effort.
 Following delivery of the placenta estimate and record in the maternal records
maternal blood loss.
 Check the placenta and membranes for completeness.
 Check the umbilical cord for three vessels. If there are any concerns
regarding the number of vessels in the cord a section can be sent to the
laboratory for review.

Changing from physiological management to Active Management:

 Haemorrhage.
 Failure to deliver the placenta within 1 hour.
 The woman’s desire to artificially shorten the third stage.

3.5 Care of baby after birth:

 Apgar score at 1 and 5 minutes should be recorded routinely.

 If baby born in poor condition (Apgar < or = 5@1), most appropriate health
professional needs to be called and immediate newborn life support
commenced. The time of onset of regular respirations should be recorded and
the cord double clamped to allow paired cord blood gases.
 Woman should be encouraged to have skin to skin contact with their babies
as soon as possible after birth.
 Separation of a woman and her baby within the first hour of birth for routine
postnatal procedures should be avoided, unless requested by mother or
necessary for immediate care of the baby.
 Any examination or treatment of the baby should be undertaken with the
consent and in the presence of the parents if possible.
 Initiation of breastfeeding should be encouraged as soon as possible after
birth.

Care of Women in Labour Version 3_0 Page 14 of 23

  All babies should be routinely examined by a midwife/appropriate professional
following birth to include head circumstance, body temperature, length and
weight. This should be documented in NIMATS, MHHR and PCHR book.
 Vitamin K should be offered routinely as per NHSCT/10/320.

Care of babies in the presence of meconium

In the presence of any degree of meconium:

 Do not suction the baby's upper airways (nasopharynx and oropharynx)

before birth of the shoulders and trunk
 Do not suction the baby's upper airways (nasopharynx and oropharynx) if the
baby has normal respiration, heart rate and tone
 Do not intubate if the baby has normal respiration, heart rate and tone (NICE,
2014)

If there has been significant meconium and the baby does not have normal
respiration, heart rate and tone, follow nationally accredited guidelines on neonatal
resuscitation, including early laryngoscopy and suction under direct vision (NICE,
2014)

If there has been significant meconium and the baby is healthy, closely observe the
baby within a unit with immediate access to a neonatologist. Perform these
observations at 1 and 2 hours of age and then 2-hourly until 12 hours of age (NICE,
2014)

If there has been non-significant meconium, observe the baby at 1 and 2 hours of
age in all birth settings (NICE, 2014)

Initial assessment of the mother following delivery

Observations taken following the birth of the baby should include:

 Maternal observation – temperature, pulse, blood pressure, uterine

contraction, lochia.
 Early assessment of maternal emotional/psychological condition in response
to labour and birth.
 Successful voiding of the woman’s bladder.

All observations should be recorded within the MHHR.

Early discharge from hospital should be facilitated when appropriate – see early
discharge criteria (Refer to Early Post-Natal Discharge Guideline 2013).

Care of Women in Labour Version 3_0 Page 15 of 23

If mother and baby being transferred to Postnatal Ward a handover of care to include
any risk factors must take place between 2 midwives.

4.0 Monitoring (including audit)

This guideline is periodically audited to ascertain that the appropriate midwifery care
is completed relevant to the woman’s risk.

The findings of this review of Maternity Hand Held Records (MHHR) are
subsequently shared with the midwifery teams on both sites.

5.0 Evidence Base/References

Bailit JL, Dierker L, Blanchard et al. (2005) Outcomes of women presenting in active
versus latent.

Begley CM, Gyte GML, Murphy DJ, et al (2011) Active versus expectant
management for women in the third stage of labour. Cochrane Database of
Systematic Reviews, Issue 11. Chichester: John Wiley and Sons.

Department of Health, letter from Liam Donaldson; (2003); Patient Dignity & Privacy;
Intimate examinations.

DHSSPS, HSC & NIPEC (2014) Midwives and Medicines (NI) A guide to support
your professional practice
http://www.nipec.hscni.net/MidwivesandMedicines/NIMidwives&Medicines.pdf

Early Post-Natal Discharge; NHSCT 2013

GAIN Guideline Audit and Implementation Group (2015) Guideline for admission to
Midwife–led units in Northern Ireland and Northern Ireland Normal Labour and Birth
Care Pathway. https://rqia.org.uk/what-we-do/gain/gain-guidelines/2015-16/

Guidelines for midwifery and obstetric staff in the use and interpretation of
Cardiotocography in Antenatal and Intrapartum fetal surveillance; NHSCT/09/98

Holmes P, Oppenheimer L, Wen S (2001) The relationship between cervical

dilatation at initial presentation in labour and subsequent intervention British Journal
of Obstetrics and Gynaecology 108: 1120-1124.

Induction of Labour Guideline; NHSCT 2013

Jaundice including Vitamin K Deficiency Bleeding in the Newborn – Policy; NHSCT

10/320

Care of Women in Labour Version 3_0 Page 16 of 23

Klein M, Kelly A, Koczorowski J, Grzybowski S (2004) The effect of family physician
timing of maternal admission on procedures in labour and maternal and infant
morbidity Journal of Obstetrics and Gynaecology Canada 26(7): 641-645.

Lauzon L, Hodnett E (2004) Antenatal education for self-diagnosis of the onset of

active labour at term (Cochrane Review) In: The Cochrane Library Issue 1
Chichester, UK: John Wiley and Sons.

Medicines Administration and Management Policy for Registered Nurses, Midwives

and SCPHNs; NHSCT 10/294

National Collaborating Centre for Women's and Children's Health. (2007)

Intrapartum care: care of healthy women and their babies during childbirth. NICE
Clinical Guideline 55. London: National Institute for Health and Clinical Excellence.

National Institute of Clinical Excellence (NICE, 2014) Clinical Guideline 190

Intrapartum care: care of the healthy woman and their babies during childbirth
https://www.nice.org.uk/guidance/cg190

Simkin P, Ancheta R (2000) The Labor Progress Handbook Blackwell Science:

Oxford.

Water for Labour and Birth Guideline, NHSCT/11/378

6.0 Personal & Public Involvement (PPI)/Consultation Process

This guideline has been circulated among the midwifery teams on both maternity
sites & community, labour-ward obstetrician and anaesthetist as well as the local
guideline development group. Consultation has also been invited from the paediatric
neonatologist.

7.0 Equality, Human Rights & DDA

This policy has been drawn up and reviewed in the light of Section 75 of the
Northern Ireland Act (1998) which requires the Trust to have due regard to the need
to promote equality of opportunity. It has been screened to identify any adverse
impact on the 9 equality categories.

The policy has been ‘screened out’ without mitigation or an alternative policy
proposed to be adopted.

Care of Women in Labour Version 3_0 Page 17 of 23

8.0 Alternative Formats

This document can be made available on request on disc, larger font, Braille, audio-
cassette and in other minority languages to meet the needs of those who are not
fluent in English.

9.0 Sources of advice in relation to this document

The Policy Author, responsible Assistant Director or Director as detailed on the

policy title page should be contacted with regard to any queries on the content of this
policy.

10.0 Policy Sign Off (Typed name/scanned signature sufficient)

Shona Hamilton
Cathy Hamilton
Frances Stewart
Lead Policy Author Date 31st May 2016

Mrs Sinead O’Kane

Interim AD Date 31st May 2016

Care of Women in Labour Version 3_0 Page 18 of 23

11.0 Appendices/Attachments
Appendix 1 - HART Tool
Please File at Front of Chart
AFFIX ADDRESSOGRAPH
History
LABEL HERE
Age ____________

Parity ________________ Temp _____________

Gestation _____________ Pulse _____________

Blood Pressure (BP) _______/_______

H

HB _____________

History of presenting complaint

Assessment of Current Situation

________________________________________________________________________
A ________________________________________________________________________
________________________________________________________________________
_________________________ FH _________________

Referral

Dr _________________ contacted Date_____ Time ___________

Dr __________________agreed to see this woman Date______________

R
Time __________Place _______________

Signed __________________ S/M _______________Date _________

Time____

Transfer (DR TO COMPLETE)

Is transfer agreed YES / NO

Recommendations for on-going management __________________________

T
__________________________________________________________

Dr _______________________ agrees / disagrees to assume on-going responsibility for

the care of this woman

Care of Women in Labour Version 3_0 Page 19 of 23

(Reproduced with permission from Brenda Kelly SHSCT)

Care of Women in Labour Version 3_0 Page 20 of 23

Appendix 2

Care of Women in Labour Version 3_0 Page 21 of 23

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