I would prefer dim lights, and a quiet atmosphere.
I prefer only my husband and mother be allowed in my room during labor.
I would like to maintain mobility, having the option to labor in the shower, use a birth bar and/or change positions at will throughout labor.
I would like to be able to have fluids by mouth throughout the first stage of labor.
I would prefer to keep the number of vaginal exams to a minimum.
I would prefer not to have an IV, unless medically necessary.
I would prefer not to have to wear a hospital-issued gown; I will purchase and bring my own.
During labor, I do not wish to have continuous fetal monitoring unless it is required by the condition of my daughter.
In the pushing stage, I am fine with an external electronic monitor.
I do not wish to have the amniotic membrane ruptured artificially unless signs of fetal distress require internal monitoring.
I would prefer to be allowed to try changing position and other natural methods.
I would like to avoid drugs such as Pitocin.
I do not want any kind of anesthesia offered to me during labor, though I would like it available if I specifically request it.
If I ask for pain relief, please feel free to offer nonmedical choices forcoping and/or remind me how close I am to the birth.
Should I decide to get anesthesia, I would prefer a patient-controlled epidural analgesia (PCEA).
I would prefer not to have an episiotomy unless absolutely required for the baby's safety; I’d like to use perineal massage, warm compresses and positioning as much as possible.
Even if I am fully dilated, and assuming my daughter is not in distress, I would like to try to wait until I feel the urge to push before beginning the pushing phase.
I would like to use foot pedals or a birth bar during the pushing stage.
I would prefer not to use vacuum extraction or forceps unless my daughter is in distress.
I would like a mirror available so I can see my daughter's head when it crowns.
I would like my husband to be able to help “catch” our daughter should he choose.
In Case of Cesarean
If my primary care provider determines that a Cesarean delivery is indicated, I would like to obtain a second opinion from another physician if time allows.
I would only like a Cesarean if all other options have been exhausted.
I would like my husband present at all times if my daughter requires a Cesarean delivery.
I wish to have an epidural for anesthesia.
I would like my hands left free so I may hold my husband’s hand and touch my daughter after birth.
If my daughter is not in distress, my daughter should be given to my husband immediately after birth.
I would like our plans outlined here for after the birth to be followed as closely as possible.
I would like to have my daughter placed on my stomach/chest immediately after delivery.
I would like to bond with my daughter before her medical exams and procedures.
I would like to have my daughter examined and bathed in my presence.
I would like my husband to cut the cord after it stops pulsating.
I would like to deliver the placenta spontaneously rather than having a routine shot of Pitocin.
If my daughter must be taken from me to receive medical treatment, my husband or some other person I designate will accompany my daughter at all times.
After the birth, I would prefer to be given a few moments of privacy to attempt to urinate on my own before being catheterized.
I would like to donate the umbilical cord blood.
Please remove my IV/Heparin lock/catheter as soon as possible after the birth.
Please note I am likely Rh incompatible with my daughter, and will need a Rhogam shot after the birth.
I would like to breastfeed as soon as possible after delivery.
Unless medically necessary, I do not wish to have any bottles given to my daughter (including formula, glucose water or plain water).
I do not want my daughter to be given a pacifier.