Modified Early Obstetric Warning System (MEOWS) charts (Figure 61.1) were recommended by the UK Confidential Enquiry into Maternal Death in 2007 as a visual aid to detect trends in observations for women in the childbirth continuum. Many NHS Hospital Trusts in the UK have adapted these charts for their own use and this means that there is no standardisation of MEOWS charts; however, we will look at some of their common elements. The principle of a MEOWS chart is that a score is allocated to the findings of the observations to inform what action needs to be taken by the midwife. This can either be a numerical score or a traffic light system.

Most MEOWS charts contain an area to note the time and dates of the observations and chart respirations, temperature, pulse, diastolic and systolic blood pressure and oxygen saturations. As discussed in Chapter 57, timely completion and documentation of observations is essential in recognising trends that may indicate a woman whose condition is deteriorating. In addition to the observations, urine output and urinalysis, pain score and neurological response using AVPU or GCS are often documented.

Alert, Voice, Pain, Unresponsive (AVPU, Table 61.1) is a simple scale that allows a rapid assessment of the consciousness level of a patient, which is recommended by the UK Resuscitation Council. It is easily used by midwives who are unfamiliar with more comprehensive neurological assessment tools such as the Glasgow Coma Scale. It assesses whether a patient is alert; this means that they are conscious, coherent and able to maintain their own airway and are physiologically compensating for any illness. If a patient is only responding to voice stimuli they are likely to be feeling very unwell and need referral to a senior member of the multiprofessional team. If they only respond to pain

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