History

When managing women in labour, NICE guidance³ suggests:

“Treat all women in labour with respect. Ensure that the woman is in control of and involved in what is happening to her and recognise that the way in which care is given is key to this. To facilitate this, establish a rapport with the woman, ask her about her wants and expectations for labour, and be aware of the importance of tone and demeanour and of the actual words used³.”

Sources for the history can include the mother, birth partner or attending persons, antenatal screening notes, and the assigned midwife/maternal services.

Key components in the history:

• Gravidity/Gravida (Total number of pregnancies, regardless of outcome)
• Parity/Para (Number of pregnancies carried over 24 weeks)
• Past medical and surgical history

Current pregnancy

• Gestational age/due date? (If unknown, can be calculated using first day of last menstrual period, subtract 3 months and add 1 week)
• Number of babies expected to be delivered.
• Any complications during pregnancy? (E.g., hypertension, diabetes)
• Any known congenital abnormalities?
• Any maternal infections? Any fevers?

Previous pregnancies

• Any complications with previous pregnancies/births?

Since start of “labour” symptoms

• Are there contractions? When did contractions start? What length? What strength? How frequent?
• Any leaking of fluid or bleeding PV? (Timings essential – consider normal show vs heavy bleeding e.g. Placenta praevia)
• Have the membranes ruptured? When in relation to start of contractions? (If PROM >24 hours before onset of contractions there is increased risk of neonatal sepsis)
• What is the colour of the amniotic fluid? (Dark green/brown staining may suggest excess meconium)
• When was the last time the patient felt the baby move? How have movements been in the last 24 hours?
• Any alcohol or illicit drug use?