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Form · OBS-FRM-006 · Version 1.0 · Approved by the ASF Expert Committee
Supports: Standard 12 (Obstetrics and Gynaecology), criterion 12.7
Purpose
Records the information given on place and mode of birth, the woman’s choice and any change.
How to complete
- Record the information given.
- Record the choice and any change.
- Record any alternative offered and why.
Checks
| Check | Entry |
|---|---|
| Options and risks explained (date) | Yes |
| Information given in a form understood | Yes |
| Place of birth chosen | Yes |
| Mode of birth chosen | Yes |
| Change and reason | Yes or N/A |
| Signed by woman and clinician | Yes |
Evidence
| Reference | Note |
|---|---|
| E-009 | Based on the WHO recommendations on antenatal care for a positive pregnancy experience (2016) and the WHO Standards for improving quality of maternal and newborn care in health facilities (2016). |
| E-006 | ASF Policy Framework v1.2. Adapted. |
| E-009 | ASF Expert Committee consensus. |
Change history
| Version | Date | What changed | Approval |
|---|---|---|---|
| 1.0 | the date of approval | First version | set Expert Committee approval |
E-learning for this document
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References
- Accréditation Sans Frontières (2026). ASF Policy Framework v1.2. (E-006)
- Accréditation Sans Frontières (2026). ASF Expert Committee consensus on Standard 1. (E-009)