Client_____________________________________________________Partner_______________________________EDD_____________Weeks_______
Initial Labor Exam Date_____________Time_____________
Contractions: Onset Date/Time____________Frequency_________Duration________Intensity_______________ Bleeding__________Amt___________
Membranes: ٱ Intact ٱ Ruptured Date?Time__________Fluid Color__________Amount__________Edema______ DTR_______Last Meal___________
Temperature__________ ٱ Nausea ٱ Vomiting B/P___________ Pulse__________ Respiration ___________ Heart____________ Lungs____________
Dilation______Effacement______Station_________Presentation__________________FHT_________Fetal Movement____________EFW____________
Comments:___________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________

Labor Record

B/P

I/O

Comments

P

T

In

time

FHT

CX

Signatures/Initials: