How to read your labor and delivery records

Before you start

Set aside several sessions. Do not try to read it in one.

Get a highlighter and sticky tabs. Number the pages if they are not numbered.

Read with someone if you can. Reading your own birth record is not a neutral activity, and people often find it harder than they expected.

The fetal monitoring strip

Two lines. The baby's heart rate on top. Contractions underneath. Time runs left to right, with a timestamp printed along the paper.

Four things to read

Baseline rate. The average heart rate over 10 minutes. Normal is 110 to 160 beats per minute. ¹

variability. The small wiggle in the line from moment to moment. A flat line means absent variability. Moderate variability is a reassuring sign and is linked to the absence of significant acid build-up at that moment. ¹

Accelerations. Brief rises in heart rate. Generally a good sign.

Decelerations. Drops in heart rate. The shape and timing matter more than the depth.

• Early: mirrors the contraction. Head compression. Not concerning.
• Variable: an abrupt drop. Usually cord compression.
• Late: starts after the contraction begins and recovers after it ends. Repeated late decelerations suggest the placenta is not delivering enough oxygen during contractions. ¹
• Prolonged: lasts two minutes or more. Needs immediate assessment.

Count the contractions

Pick any 10-minute window. Count the peaks. More than five, averaged over 30 minutes, is tachysystole. ¹

The three categories

Category I is normal. Category II is everything in between, and it calls for evaluation and reassessment. Category III is abnormal and calls for prompt action. ^{1 4}

What to write down

The times when anything changed. Then look for those same times in the nursing notes.

The labor flow sheet and nursing notes

This is the running record of the labor.

On the flow sheet

• Cervical dilation at each examination, with the time.
• Station, meaning how far down the baby is.
• Contraction frequency.
• Your blood pressure, pulse and temperature.
• Medicines running, and their rates.

In the nursing notes

Nurses write what they see and what they do. These entries are often the most informative part of the whole record.

Look for:

• Descriptions of the tracing.
• What was done: position change, fluids, oxygen, stopping oxytocin.
• The time a physician was notified, and how.
• The time the physician arrived or responded.
• Anything you said, and how it was recorded.

Put the two together

Take the times you noted from the strip. Find those same times in the notes. What was written down at the moment the tracing changed is the core of understanding a labor record.

The medication and infusion records

Every drug, every dose, every time.

oxytocin. The record shows the starting rate and every change. Put it next to the strip. Compare the rate with the contraction pattern. ¹

Magnesium. Note which indication it was given for. Preventing seizures in preeclampsia is one use. Protecting the baby's brain before 32 weeks is a different one. ^{5 6}

Antibiotics. Note the drug and the time of the first dose. Compare it with the time of delivery. ⁷

Steroids, if the baby was born early. Note how many doses and when. ⁸

The operative report

Written after a cesarean or an assisted delivery.

Look for:

• The indication. Why it was done.
• The times. Decision, incision, delivery. The gap between decision and incision is one of the first things a reviewer looks at. ⁹
• The type of uterine incision, which matters for any future pregnancy. ¹⁰
• For an assisted delivery: which instrument, the station and position of the head, how many pulls or attempts, whether a vacuum cup detached, and whether more than one instrument was used. ¹¹
• Any laceration to the baby.
• Estimated or measured blood loss. ¹²
• Any tear, and its degree. ¹³

If there was a shoulder dystocia, there should be a separate note listing each maneuver in order with times. ¹⁴

The Apgar score

A score from 0 to 10, given at 1 and 5 minutes, and at 10 minutes if the earlier scores were low.

Five things, each scored 0, 1 or 2: color, heart rate, reflex response, muscle tone, and breathing.

What it means

It describes the baby at that moment. Professional guidance says plainly that it should not be used on its own to diagnose asphyxia or to predict outcome. ²

A low 1-minute score with a normal 5-minute score is common and usually means the baby needed a moment.

A score that stays low at 5 and 10 minutes carries more information, and the 10-minute score is the one most linked to outlook. ²

The Apgar explainer walks through each component.

The cord blood gas

Blood taken from the umbilical cord right after birth. It measures how much acid built up in the baby's blood, which reflects the oxygen supply near the end of labor. ³

The numbers

pH. Lower means more acid.

base deficit. Larger means more acid built up.

lactate. An acid the body makes when cells run short of oxygen.

Two samples are usually taken, arterial and venous. The arterial sample reflects the baby. Check that both were taken, because a single sample can be mislabeled.

Professional guidance describes a pH below 7.0 with a base deficit of 12 mmol/L or more as one of the findings associated with an acute event around the time of birth. ³

A normal cord gas makes injury during labor much less likely, and that is useful information too.

The cord gas explainer walks through it.

The newborn resuscitation record

A timed record of the first minutes.

Look for:

• The time of birth.
• The time positive pressure ventilation started. Effective ventilation is the core of newborn resuscitation, so this time matters most. ¹⁵
• Heart rate readings over time.
• The time chest compressions started and stopped, if they were needed.
• Medicines given, with doses and times.
• The time of intubation, if done.
• Temperature.
• Who was present, and when they arrived. ¹⁶

The placental pathology report

This is a laboratory report on the placenta after birth, and it is usually filed separately from both charts.

It is 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, which supports chorioamnionitis.
• Clots in the placental vessels.
• Long-standing poor blood flow, which fits growth restriction or preeclampsia. ⁵
• Evidence of placental abruption.
• Abnormal cord insertion or a true knot.

If the placenta was not sent to pathology, that absence is itself worth noting.

The NICU record

Large, repetitive, and written in shorthand. The glossary and records decoder translates the abbreviations.

What to pull out

Daily notes. The plan each day and what changed.

Blood gases and ventilator settings over the first days.

Every bilirubin value with the time and the baby's age in hours. Plot them against the thresholds. ¹⁷

Every glucose value with the time. ¹⁸

Head ultrasound reports, with dates. ¹⁹

MRI report. Ask which parts of the brain are described, and read the impression at the end.

EEG reports, including whether there were electrical seizures with no visible movement. ²⁰

Hearing screening result and the method used. ²¹

The discharge summary, which is the team's own account of what happened. Read it first, then check it against the daily notes.

Putting it together

Build a single timeline. One line per event, in time order, pulling from every document.

• 02:10 Admitted, 4 cm.
• 06:45 Oxytocin started at 2 milliunits.
• 09:20 Strip shows repeated late decelerations.
• 09:55 Nursing note: physician notified.
• 10:40 Physician at bedside.
• 11:05 Decision for cesarean.
• 11:52 Delivery.

That timeline is what a reviewer builds first, and you can build it yourself.

Then note the gaps: places where the strip changed and nothing was written, or where a decision was made and the delivery took longer than expected.

What a timeline cannot tell you

Whether the care met the standard. That question needs a physician expert who reviews the whole record and knows what a reasonable clinician would have done in the same situation. Professional guidance is clear that no single finding establishes the cause of newborn brain injury. ³

What your timeline does is let you ask precise questions, of your doctors and of anyone else.