An Expectant Mother’s Information Sheet

Here’s a tip for pregnant women! Along with your labor bag and baby bag, make sure you bring this piece of paper with you when you go to the hospital — a filled out expectant mother’s information sheet.

Imagine this. You’re rushed to the hospital. You’re in the labor room, trying to manage the pain of your contractions. You’re probably sweating and taking deep breaths to calm yourself down. The point is, it’s not a comfortable situation. Then a nurse comes and starts asking you, “When was the date of your last menstrual period?,” “When is your birthday?,” “Is this your first pregnancy?,” etc.

You will want to clobber the nurse on the head. “Can’t you see I’m in pain now?! Can you ask me those questions later?!” You may want to scream at her. She’s just doing her job, but you have to admit, you may not be in the best situation to answer those questions — and they do ask a lot of questions.

During birth class, we were taught to bring our filled out Mother’s Information Sheet. This contains answers to questions that will routinely be asked of you. Just present the sheet to the nurse upon getting settled, and hopefully you won’t be quizzed while you’re being hooked up to an IV, dressed in a hospital gown, praying your contractions become easier… you get the picture.

Here’s a sample information sheet that you can use. I based this on the template given during birth class and the additional questions that were asked (over and over) when I was in labor.

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Expectant Mother’s Information Sheet

Name of Mother: ______________
Age: ___ Blood type and Rh Factor: ___
Name of Father: ______________
Age: ___ Blood type and Rh Factor: ___

Last menstrual period (LMP): ________
Expected Date of Delivery (EDD): ________
Age of Gestation (AOG) – number of weeks upon admittance: ____
Gravida (G) – number of pregnancy? ____
Parity (P) – number of live birth? ____

Attending OB:_________________ Contact No.:________
Attending Pediatrician:_________________ Contact No.:________

Mother’s Menstrual Cycle:
Age you had your first menstruation: ________
Are you regular or irregular on your menstrual cycle? ________
How many days do you menstruate? ________
On a heavy day, how many sanitary pads do you use? ________

Medical History:
Allergies: ________
Illnesses: ________ (Note: Indicate age when you got that illness, plus when you outgrew it, ex. asthma. Also include any pregnancy-related illnesses you may have gotten and how long ago you were diagnosed with it, ex. UTI.)
Pregnancy tests done: ________ (Note: List down and attach your recent lab results to the sheet)
Do you smoke or drink alcohol? ________
Supplementary vitamins taken: ________________
Family medical history: ________________________

Mother’s information:
Home address:________________________________
Contact no.:________________
Birthday:________________
Height:________
Weight before pregnancy: ____ Current weight:____

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In some hospitals, you could also be asked the age when you first had sexual intercourse. If you have a specific anesthesiologist, indicate it in your form as well. Now, what other questions do you think should be placed in this information sheet? What questions were asked when you were in labor?

It would help to bring several copies of this sheet, and you can hand them to the nurses as needed. You can also attach a copy of your Birth Plan to this sheet so the team is also immediately aware that you have one. I’ll tackle my approach to the birth plan in a separate post.

As I wasn’t answering the same questions over and over, I was able to concentrate on managing the pain of my contractions and talking to the doctors about what was currently going on with me and the baby. I hope this helps you as it helped me!

Photo credit: mahalie

Hi! I'm Toni Tiu, and I've been blogging at at Wifely Steps since 2003. This started as a blog to help newly weds adjust to married life. It has evolved into a home and parenting blog. I write about things close to my heart -- good eats, good reads, family, marriage, and the little things that make everyday happy.