Maternity Shift Handoff Form
Use this form to transfer essential maternity patient care information between shifts, including current status, assessment, treatments, and pending tasks.
Patient & Encounter Information
Patient Name or Initials
*
Medical Record / Chart Reference
Unit / Room
*
Date and Time of Handoff
*
 -
Month
 -
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Shift Being Handed Off
*
Day
Evening
Night
Provider or Nurse Completing Handoff
*
First Name
Middle Name
Last Name
Receiving Nurse / Shift
*
First Name
Middle Name
Last Name
Maternity Status & Admission Details
Current Status
*
Please Select
Pregnant in labor
Induction of labor
Antepartum observation
Postpartum
C-section recovery
Other
Reason for Admission
*
Gestational Age (weeks)
Gravida / Para / Para
Estimated Due Date
 -
Month
 -
Day
Year
Date
Membranes Status
Please Select
Intact
Spontaneous rupture
Artificial rupture
Unknown
Not applicable
Labor Progress / Status
Maternal Assessment
Maternal Condition Details
Latest Temperature (°C)
Latest Blood Pressure Systolic
Latest Blood Pressure Diastolic
Pain Level
1
2
3
4
5
Bleeding / Lochia Status
Please Select
None
Light
Moderate
Heavy
Not applicable
Current Contractions
Regular
Irregular
Mild
Moderate
Strong
Not applicable
Uterine Tone / Fundus Status
Please Select
Firm
Boggy
Midline
Deviated
Not applicable
Mobility / Activity Status
Please Select
Ambulating independently
Assisted ambulation
Bedrest
Limited mobility
Not assessed
IV Access Status
Please Select
No IV
Peripheral IV in place
Saline lock
Infusing
Complication or concern
Fluid Intake / Output
Allergies
No known allergies
Medication allergy
Latex allergy
Food allergy
Environmental allergy
Other
Relevant Medical / Obstetric History or Risk Factors
Complications or Concerns
Fetal / Newborn Status
Current stage
*
Antepartum/Labor
Postpartum/Newborn
Fetal heart rate / tracing summary
Fetal movement / kick counts
Fetal presentation / position
Please Select
Cephalic
Breech
Transverse
Oblique
Unknown
Other
Newborn / neonatal support involvement
None
NICU consulted
NICU at bedside
Pediatric provider notified
Other
Newborn condition / immediate post-delivery status
Feeding plan
Please Select
Breastfeeding
Formula feeding
Combination feeding
Expressed breast milk
Donor milk
NPO / hold feeds
Other
Special monitoring needs
Vital signs trending
Blood glucose checks
Respiratory monitoring
Jaundice monitoring
Temperature support
Weight / output monitoring
Other
Medications, Treatments & Procedures
Medications administered during shift
Ongoing infusions / fluids
Pain management provided
Repositioning
Breathing techniques
Heat/ice
IV analgesia
Oral analgesia
Epidural support
Other
Maternity-related treatments given
Antibiotics
Oxytocin
Magnesium sulfate
Uterotonic medication
Antiemetic
Antacid
Other
Procedures completed during shift
Response to medications / treatments
Medication due next
Hour Minutes
AM
PM
AM/PM Option
Pending Items & Next-Shift Plan
Pending items to complete
Pending lab results
Pending imaging
Pending procedure
Follow-up task
Physician instruction
Escalation trigger
Safety precaution
Discharge planning item
Unresolved issue
Priority concern
Outstanding tasks / follow-up checklist
Pending labs / results to review
Pending imaging / procedure follow-up
Physician instructions / orders to carry out
Escalation triggers and when to notify provider
Safety precautions / monitoring reminders
Handoff notes / unresolved issues and next-shift plan
Submit Handoff
Should be Empty: