Birth is an amazing process, full of excitement, expectation and change. These are my wishes, if in a perfect world, my birth is complication free and the baby and I are healthy. In the event of complications, an emergency or necessary changes in my care I feel confident that my birth team will do everything they can to keep me informed and help to create beautiful birth memories.
Below are items that are important to me, however I am willing to accept change as it may come and the ultimate outcome is a happy healthy baby and mother.
Thank you for your part in helping me to create wonderful birth memories.
1. Members of birth team*****
I understand that there may be a limit as to the people allowed in my birthing room.
A.............
B.............
C.............
Will be my support people and I would like them to stay with me at all times
2. Medications in labor*****
It is my wish to avoid pain medication as long as possible or even go entirely without. Please do not offer medication. I will let my birth team know when I desire medication for pain.
I wish to use the following methods for pain relief first.......
A. Massage......
B. Hydrotherapy (bath or shower)......
C. Aromatherapy......
D. Music.......
E. Birth ball......
F. Position change (kneeling, hands and knees etc)......
G. Walking.......
H. Rocking chair......
If I choose an epidural I would like it to be turned off when I start pushing. (optional)
3. Medical Procedures*****
A. I wish to not have an I.V. instead if necessary have a Heplock in place......
B. I wish to have intermittent monitoring done in whatever position I am comfortable. 15 minutes every hour during early labor and 5 minutes every 15 minutes during pushing........
C. I will be eating in early labor and wish to continue to drink juice and other fluids during labor to keep hydrated........
D. I do not want an episiotomy. I would rather tear........
E. If a repair is necessary I would like a local and a running stitch used.......
4. Positions for birth*****
I understand that I will be working hard and would like the opportunity to follow my bodies lead and use positions that feel comfortable to me as long as the baby and I are tolerating labor well.
Some of the positions I would like to try are:.......
A. Standing.......
B. Side Lying.......
C. Hands and knees.......
D. Kneeling.......
E. Squatting with our without bar.......
F. Birthing stool.......
Postpartum
BABY CARE
A. After birthing my baby I would like him/her laid upon my chest so we may get acquainted..........
B. I would like to delay cord clamping for approximately one minute if possible to allow my baby to adapt to his/her new environment gently..........
C. ?-----? will be the one to cut my baby’s cord..........
D. I would like to start breastfeeding immediately or soon after birth.******** I wish to delay any procedures I have consented to for two hours, or have it done while the baby is in my arms. ********This includes antibiotic drops and vitamin K if I have approved them.
E. It is important to me that the baby and I develop a good breastfeeding relationship so I will be exclusively breastfeeding and will be rooming in with my baby. ********Please do not offer my baby a pacifier or bottle..........
F. Unless medically necessary my baby will not be going to the nursery. ********I request any exams be done in my room and my partner and ***********I will give him/her a bath when ready...........
G. If my baby needs medical attention in the nursery my partner will accompany baby and be with him/her at all times..........
H. If I have chosen a circumcision for him I require local anesthesia to be used during the procedure.
MOTHER CARE
A. After birth I would like any I.V.s, catheters, etc to be removed..........
B. I will be eating as soon as possible after birth..........
C. I wish to have my partner stay with me during my stay..........
D. I would like a consultation with a lactation consultant..........
E. Unless medically necessary I will be going home as soon as I feel ready...........
As always the goal is to be informed, to know your options and the full risks and benefits of any suggested proceedure, test, or intervention. Then being fully informed, to make the decision that is best for you, your baby, and family.
