self-assessment form

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Use these questions to assess your performance, reflect on what you did well and what you can improve in the future

Guidelines to help you assess your performance

  • Facilitates Relationship
    • takes responsibility for negotiating an effective partnership
    • maintains comfortable rapport with the woman
    • establishes trust
    • is responsive to the needs expressed by the woman
    • maintains professional manner and presentation
  • Assesses
    • assesses woman’s own knowledge and experience
    • identifies woman’s needs and responds
    • recognises woman’s social, cultural and health context
  • Shares Information
    • displays an accurate knowledge base
    • provides quality evidence based information
    • appropriate options offered
    • communicates clearly and effectively
    • establishes woman’s understanding
  • Conclusion
    • brief summary of information provided
    • establishes availability for ongoing discussion/advice
    • documents discussions, assessments and actions


Specific guidelines to help you assess your actions

  • Assesses woman’s condition
    • general condition and how she is coping
    • history of contractions since the last check-up: how often they are, how long they last, how strong they are, can she talk through them?
    • has she had a show, what does it look like?
    • has she ruptured her membranes? what colour is the liquor?
    • is she managing to eat and drink?
    • is she passing urine and had normal bowel movements
    • how the baby has been moving
    • physical assessment including blood pressure, respiration, temperature, pulse
    • abdominal palpation to include assessment of contraction length, strength and frequency.
    • abdominal palpation to assess lie, presentation, position and decent of baby
    • assessment of baby's health to include monitoring baby's heart rate
    • vaginal assessment to include cervical dilatation, effacement, position, consistency and application. **Presentation part, position, station and attitude. Presence of moulding, caput, liquor and cord.
    • what support and comfort measures does she need?
    • appropriate equipment ready, including emergency resuscitation equipment and medication
    • confirm second stage of labour
    • support of mother during second stage of labour including position, comfort measures, ongoing monitoring of mother and baby's health, when and how to push, progress
    • monitoring of progress
    • assessment of baby's condition when born including apgar score
    • assessment of mother's condition once baby is born including blood loss
    • reviews history and background from woman’s notes, exclude risk factors
    • reviews careplan
  • Sharing information
    • possible need for vaginal examination
    • findings of all assessments
    • ongoing monitoring of health of mother and baby, as well as progress of labour
    • need for food and drink
    • how to stay comfortable and mobile
    • what to expect in the second stage of labour including how to birth her baby - position, how to push, comfort measures,progress
    • things that will necessitate further assessment eg delayed progress
  • Plan for ongoing care
    • confirm second stage of labour
    • mother to push as body dictates
    • mother to birth in comfortable position that encourages descent of fetal head
    • mother to mobilize at will
    • monitor baby's heart rate every 5 minutes
    • monitor color of liquor
    • assess mother's progress and health as required
    • ensure skin-to-skin once baby is born
    • provide ongoing support, comfort measures and reassurance as required
  • Concludes discussion appropriately
    • briefly summarize advice and plan of action
    • ensure woman’s understanding
    • emphasize her choice about plan of action
    • make sure she knows you will be providing ongoing support
  • Documents discussion including advice and plan for ongoing care
    • date, time, signature
    • information woman shared with you
    • advice you gave woman
    • plan of action