Maternity Care Shift Report Form
Use this form to document a maternity care shift handoff, including patient status, observations, interventions, and next-shift priorities.
Shift and Staff Information
Report Shift Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Shift Start Time
*
Hour Minutes
AM
PM
AM/PM Option
Shift End Time
*
Hour Minutes
AM
PM
AM/PM Option
Maternity Unit / Ward
*
Reporting Staff Name
*
First Name
Middle Name
Last Name
Reporting Staff Role / Position
*
Please Select
Registered Nurse
Midwife
Charge Nurse
Obstetrician
Resident Physician
Support Staff
Other
Contact Extension / Internal Callback Number
Patient and Care Context
Patient initials
Hospital chart/reference number
Room/bed number
Care stage/status
*
Please Select
Laboring
Postpartum
Antepartum
Recovery
Transfer pending
Other
Estimated gestational age or postpartum day
Clinical Status and Observations
Maternal Temperature (°C)
Pain Level (0–10)
Contraction Status
Please Select
Not in labor
Mild/Irregular
Regular
Frequent
Unknown
Other
Fetal Heart Rate / Monitoring Note
Bleeding / Lochia Status
Please Select
None
Scant
Light
Moderate
Heavy
Unable to assess
Other
Uterine Tone / Fundus Assessment
Mobility, Recovery, and Notable Changes Since Previous Shift
Medications, Interventions, and Events
Medications administered during shift
Procedures/interventions performed
IV/fluids/lines status
Breastfeeding or newborn care support provided
Complications, adverse events, or escalations/notifications
Urgent follow-up required
*
Yes
No
Handoff Notes and Next Actions
Handoff Notes Summary
*
Pending Tasks for Next Shift
Medication follow-up
Recheck vital signs
Review lab results
Monitor fetal status
Assess bleeding/lochia
Update care plan
Other
Special Instructions for Incoming Team
Report Complete and Ready for Handoff
*
Yes, the report is complete and ready for handoff
Submit Shift Report
Should be Empty: