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This Health Record book is an important book for recording your health during your pregnancy Remember to take this book with you to Your family health nurse Immunization appointments Your doctor practice nurse and other health professionals The hospital including for emergencies How to use Fill in by yourself Fill in with your doctor If anyone picks up or finds this handbook please return it to the right address
Your Contact Information Mother You Name Email Address Cell Phone Home Phone Home Address Occupation Father Name Email Address Cell Phone Home Phone Home Address Occupation Secondary Contact Name Email Address Cell Phone Home Phone Home Address Occupation Relationship to mother Preferred Local hospital Insurance Company Policy
Useful Phone Numbers Fire Police Ambulance Rescue Poison Control 1 800 222 1222 All Emergencies Mother s Health Care Provider Provider s After Hour Hospital Birth Center Other
Health History of You and Your Family Pregnancy History Pregnancy Delivery abortion Place Sex Weight 1 Complications g 2 g 3 g 4 g 5 g 6 g History of Illness Diabetes Heart Disease Anemia Hypertension Asthma History of Surgery in the year at Hospital in the year at Hospital in the year at Hospital in the year at Hospital
Health History of You and Your Family History of Drug Allergy Name of the drug Symptom Name of the drug Symptom Name of the drug Symptom History of menstruation cycle Regular menstruation at every days History of Illnesses and Pregnancies of Family Members Diabetes Multiple pregnancy Heart Disease Seizure Mental retardation Hypertension Asthma Congenital anomaly Medicines in use Name Symptom Name Symptom Name Symptom Name Symptom
Your Work Home Environment Environment Are you stressed out Where are you on a scale of 0 10 Least Most 0 1 2 3 4 5 6 7 8 9 10 Do you have any concerns related to pregnancy and delivery in the past Any other concerns Do you drink alcohol Do you smoke Does anyone who live with you smoke DRINKING AND SMOKING WILL HARM YOUR BODY AND THE BABY Herbs and any supplements Does your husband partner has any health conditions
Your Work Home Environment Occupation Duties Length hr s Transportation Commuting time hr s mins Maternity Leave From To Any concerns about your work environment Housing Single house Apartment Duplex Any Noise Problems Any concerns about your home environment LET S TALK ABOUT YOUR CONCERNS WITH YOUR CARE PROVIDER
From To
If you feel faint sit or lie down for a short time stand up slowly eat regularly
From To
A glass of warm water in the morning helps get the digestive system off to a good start
From To
Make a plan with your partner and doctor setting out how you would like to give birth
From To
Itching can be a problem in pregnancy It may help to use cotton underwear
From To
Tell your doctor if you have pains or cramps in your lower tummy lower back or pelvis
From To
It s normal to feel breathless irritated and nervous Make sure you relax your mind
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Talk to your partner family and friends about how they can help after you had baby
From To
Allow your partner to be involved Take rest Laugh and enjoy your baby
Prenatal Health Care Visit Date Weight Blood Pressure Blood Sample kg Notes from the visit 4 8 Date Weight Blood Pressure Baby s heart beat check kg Notes from the visit 10 12
Prenatal Health Care Visit Urine Sample Pap test Ultrasound weeks Blood Sample Urine Sample weeks Ultrasound
Prenatal Health Care Visit Date Weight Blood Pressure Baby s heart beat check kg Notes from the visit 12 16 Date Weight Blood Pressure Baby s heart beat check kg Notes from the visit 16 20
Prenatal Health Care Visit Urine Sample Abdomen measured Ultrasound cm weeks Urine Sample Abdomen measured cm weeks Ultrasound
Prenatal Health Care Visit Date Weight Blood Pressure Baby s heart beat check kg Notes from the visit 2O 24 Date Weight Blood Pressure Baby s heart beat check kg Notes from the visit 24 28
Prenatal Health Care Visit Urine Sample Abdomen measured Ultrasound cm weeks Urine Sample Abdomen measured cm weeks Ultrasound Blood Glucose
Prenatal Health Care Visit Date Weight Blood Pressure Baby s heart beat check kg Notes from the visit 28 32 Date Weight Blood Pressure Baby s heart beat check kg Notes from the visit 32 34
Prenatal Health Care Visit Urine Sample Abdomen measured Ultrasound cm weeks Urine Sample Abdomen measured cm weeks Ultrasound
Prenatal Health Care Visit Date Weight Blood Pressure Urine Sample Dilation cm kg effacement Notes from the visit 34 36 Date Weight kg Blood Pressure Urine Sample Dilation cm effacement Notes from the visit 37
Prenatal Health Care Visit Ultrasound Abdomen measured Group B Strep Infection Screen Position of Baby Baby s heart beat check Position of Baby Baby s heart beat check cm weeks Ultrasound Abdomen measured Group B Strep Infection Screen cm weeks
Prenatal Health Care Visit Date Weight Blood Pressure Urine Sample Dilation cm kg effacement Notes from the visit 38 Date Weight kg Blood Pressure Urine Sample Dilation cm effacement Notes from the visit 39
Prenatal Health Care Visit Ultrasound Abdomen measured Group B Strep Infection Screen Position of Baby Baby s heart beat check Position of Baby Baby s heart beat check cm weeks Ultrasound Abdomen measured Group B Strep Infection Screen cm weeks
Prenatal Health Care Visit Date Weight Blood Pressure Urine Sample Dilation cm kg effacement Notes from the visit 40 Date Weight kg Blood Pressure Urine Sample Dilation cm effacement Notes from the visit 41
Prenatal Health Care Visit Ultrasound Abdomen measured Group B Strep Infection Screen Position of Baby Baby s heart beat check Position of Baby Baby s heart beat check cm weeks Ultrasound Abdomen measured Group B Strep Infection Screen cm weeks
Prenatal Health Care Visit Date Weight kg Notes from the visit Oth Date Weight kg Notes from the visit Oth
her her Prenatal Health Care Visit
Labor and Delivery Time and Place Hour of labor Time of labor Place of delivery Time of delivery Total week of pregnancy of delivery Method of delivery Vaginal Complication of delivery People presented at delivery Doctor Nurses Family members Ceseran Section
Labor and Delivery Write down how the delivery went
Baby s Care Name Gender Boy Girl Single Twin More Body Birth weight Length Head circumference Age at discharge Blood Type A B AB RH Factor O Other Hearing test Yes Circumcision No Jaundice Yes Yes No Newborn screening heel stick No Yes No Apgar Scores Hepatitis B shot given ASK FOR A VISIT FROM THE LACTATION SPECIALIST BEFORE YOU LEAVE THE HOSPITAL
HELLO WORLD
About Me BIRTHDAY TIME OF BIRTH WEIGHT LENGTH HAIR COLOR EYE COLOR PARENTS MESSAGE
Baby s Footprints
Special Dates Record your special dates in your pregnancy Date I break the news to my partner Date First time I feel my baby moves Date Date
Date Date Date Date Date
Message Board Let s get messages from people around you for your newborn baby
If you are physically and mentally healthy then the baby will be healthy and happy