Below is an outline of our preferences for the upcoming birth of our child. We realize that there are circumstances that may preclude some of the choices we have made, and we will be flexible should our options change.

Introducing ourselves:  

Important Issues, Fears or Concerns:

During the First Stage of Labor, my preferences are:

ENVIRONMENT

__ Wear my own clothes

__ Wear hospital gown

__ Lights kept dimmed

__ Music of my choice

__ Silence 

__ Door kept closed at all times

__ Curtain kept drawn in front of  door

SUPPORT

__ Partner present during all aspects of labor and birth

__ Doula support

__ Other family present

__ Medical students may/may not perform medical procedures

__ Limit amount of extra personnel in the room

MOBILITY

__ Change positions for comfort and progress in labor

__ Freedom to utilize shower or bath as needed for pain relief

__ Use of Birth Ball for back pain relief

VAGINAL EXAMINATIONS

__ Limited vaginal exams

__ Vaginal exams done only by nurse or doctor/midwife, no students or residents

__ Students or residents may perform vaginal examinations

*FOOD/FLUIDS

__ Eat and drink as desired during labor

__ Fluids only

__ Ice Chips only

__ IV for hydration

__ No IV

__ Heparin Lock

*Excellent article called "Nutrition During Labor" by Mary Hammond-Tooke, CNM from The Maternity Center website details the various situations in labor wherein an IV may be necessary as well as alternative options for the average healthy low-risk laboring woman.  

*ELECTRONIC FETAL MONITORING

__ Intermittent external auscultation of baby with hand-held Doppler

__ Intermittent external auscultation of baby with EFM machine

__ Continuous external/ internal auscultation of baby with EFM machine for high risk labor or

medical circumstance.

*Interpretation of the Electronic Fetal Heart Rate During Labor from the American Academy of Family Physicians.

 INDUCTION/AUGMENTATION

__ Prefer natural methods

__ Herbal products suggested by doctor or midwife

__ PGE2 Gel

__ Pitocin

__ No Amniotomy unless medically necessary

*FDA's warning regarding use of Cytotec (misoprostil) for inductions. 

Pain Relief Options:

__ Support from partner, doula, staff

__ Shower, Bath or Jacuzzi

__ Position Changes as needed

__ Birth Ball

__ Walking

__ Pelvic Rocking

__ Massage

__ Acupressure

__ Rebozo shawl or sheet for back pain or positional relief

__ Relaxation, Breathing, Visualization techniques

__ Alternate between heat/cold

__ Focal Point

__ Keep my bladder as empty as possible

__ Medication only if requested

__ Staff is requested to not offer medication throughout labor

__ Medication in Active Labor

__ Analgesics or Narcotics: _______________

__ Regional Anesthesia: Epidural*

*Epidural Risks and Side  Effects--Maternal Risks, Labor Side Effects, Baby Side Effects from the Kim James website.

During the Second Stage of Labor (Pushing), my preferences are:

POSITIONS for SECOND STAGE

__ My choice of positions

__ Utilize Squatting Bar

__ Stirrups or foot rests

__ No stirrups or foot rests

__ Natural support for legs

__ Avoid supine positioning

PUSHING TECHNIQUE

__ Spontaneous bearing down

__ Directed pushing

__ No time constraints as long as baby is fine

__ Prolonged breath-holding pushing technique with nurse or medical staff guiding the length of  effort**   

*Caution on Breath-Holding (Valsalva) pushing. (Item 4.4)

PERINEUM

__ No Episiotomy

__ Warm Compresses

__ Lubricating Oil

__ Natural tearing ok

__ Episiotomy with local anesthesia

__ Pressure Episiotomy

*How to Prevent Tearing--Mothering Magazine article (Issue 104, Jan/Feb 2001)

*Obstetric Myths Versus Research Realities: Episiotomy by Henci Goer.  Comprehensive article with major points referenced by research. (from the Online Birth Center website)  

*Much Ado About a Little Cut: Is Episiotomy Worthwhile? Obstetrics and Gynecology, April 2000, Volume 95, Number 4, Pages 616-618. 

Once the baby is born, my preferences are:

BIRTH

__ Partner to cut the cord

__ Wait until cord stops pulsating

__ Doctor or midwife allowed to Clamp and cut cord immediately**

__ Baby placed on mom right away

__ Baby cleaned off right away

*Review of Evidence on Cord Care Practices

BREASTFEEDING

__ Breastfeeding as soon as baby is ready

__ Lactation Specialists to assist me if necessary

__ If my baby and I are separated, no supplementation of formula is to be offered. I will pump breast milk and baby will be offered breast milk via syringe, cup or SNS.

__ No artificial nipples (bottles or pacifiers) are to be offered to the baby.

NEWBORN CARE

__ Baby to stay with me at all times unless there is a medical emergency.

__ Delay routine procedures (cleaning, weighing, measuring, ointment in eyes) until after my initial recovery period of at least 1-2 hours.

__ Baby to room-in with me.

__ Other: