Reading Your Records guide
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The short answer
Print this and keep it beside the records while you read them.
Start with three documents: the fetal monitoring strip, the cord blood gas result and the Apgar scores. Together they tell you most of what the record says about how your baby was doing at birth.
The numbers, up front
- The strip is a timed record
- Electronic fetal monitoring produces a continuous record of the baby's heart rate next to contractions 1
- The Apgar score
- Describes the baby at 1 and 5 minutes. Guidance says it should not be used alone to diagnose asphyxia or predict outcome 2
- The cord gas
- Measures acid build-up at birth, which reflects the oxygen supply near the end of labor 3
- No single test settles cause
- Guidance states that cause and timing are worked out from a pattern of findings taken together 3
The monitoring strip
Baseline rate. The average over 10 minutes. Normal is 110 to 160 beats per minute.
Variability. The small wiggle from moment to moment. Moderate variability is reassuring.
Accelerations. Brief rises. Generally a good sign.
Decelerations. Early ones mirror the contraction and are not concerning. Variable ones are abrupt drops, usually cord compression. Late ones begin after the contraction starts and recover after it ends.
Count contractions. Pick any 10 minute window and count the peaks. More than five, averaged over 30 minutes, is tachysystole.
Write down the times when anything changed.
The notes beside it
Take the times from the strip and find them in the nursing notes.
Look for what was seen, what was done, when a physician was notified, when they responded, and the time any decision was made. 5
The numbers at birth
Apgar at 1, 5 and 10 minutes. The 10 minute score is the one most linked to outlook. 2
Cord blood gas, arterial and venous. pH, base deficit, lactate. Guidance describes an umbilical artery pH below 7.0 with a base deficit of 12 mmol per litre or more as one of the findings associated with an acute event around the time of birth. 3
Resuscitation record. The time of birth, the time ventilation started, the time compressions started, and who was present. 6
The placental pathology report
Usually filed separately from both charts, and often the most informative document in the whole record, because it describes the weeks and months before labor rather than the hours during it. 3
It can show infection of the membranes, clots, long-standing poor blood flow, and evidence of abruption.
Build one timeline
One line per event, in time order, pulling from every document.
Time / what happened / which document it came from
A timeline lets you ask precise questions. It cannot tell you whether the care met the standard. That takes a physician expert who reviews the whole record. 3
Where these facts come from
- American College of Obstetricians and Gynecologists. Practice Bulletin 106, Intrapartum Fetal Heart Rate Monitoring: Nomenclature, Interpretation, and General Management Principles. 2009. www.acog.org/clinical/clinical-guidance/practice-bulletin. Link checked September 3, 2026.
- American Academy of Pediatrics and American College of Obstetricians and Gynecologists. Committee Opinion 644, The Apgar Score. 2015. www.acog.org/clinical/clinical-guidance/committee-opinion. Link checked September 3, 2026.
- American College of Obstetricians and Gynecologists and American Academy of Pediatrics. Neonatal Encephalopathy and Neurologic Outcome, Second Edition. 2014. www.acog.org/clinical/clinical-guidance/task-force-report/ar. Link checked September 3, 2026.
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Obstetrics and Gynecology. The 2008 NICHD Workshop Report on Electronic Fetal Monitoring. 2008. www.nichd.nih.gov/. Link checked September 3, 2026.
- American College of Obstetricians and Gynecologists. Practice Bulletin 116, Management of Intrapartum Fetal Heart Rate Tracings. 2010. www.acog.org/clinical/clinical-guidance/practice-bulletin. Link checked September 3, 2026.
- American Heart Association and American Academy of Pediatrics, Circulation. Neonatal Life Support: 2020 American Heart Association Guidelines for CPR and Emergency Cardiovascular Care. 2020. www.ahajournals.org/doi/10.1161/CIR.0000000000000902. Link checked September 3, 2026.