Labor Preferences select as many as you would like by holding down the ctrl button and clicking on the options of your choice
I would like to be able to walk around during labor
I would like to use the birth ball and position changes during labor
I would like to eat to hunger and drink to thirst throughout labor
I would like the room to be kept as quiet as possible
I would like the lights to be dimmed
I prefer vaginal exams be kept to a minimum and done by the same person each time
I do not want an IV unless it becomes medically necessary
Monitoring Preferences select as many as you would like by holding down the ctrl button and clicking on the options of your choice
Please monitor me the minimum amount of time required
Please use a Doppler or fetoscope to monitor my baby's well being
I do not want internal monitors placed unless medically necessary
Please leave the electronic fetal monitor on the whole time
Labor Augmentation Preferences select as many as you would like by holding down the ctrl button and clicking on the options of your choice
If I have arrived at the hospital before active labor is set in, please send me home
I do not wish to have the amniotic membrane ruptured artificially unless medically necessary
If my labor is at a point where rupturing the amniotic membrane will help it progress and my baby is lower than 0 station, please discuss this with me
I would like to use walking and position changes before pitocin
Pain Medication Preferences select as many as you would like by holding down the ctrl button and clicking on the options of your choice
I know that pain medications are available to me. I am going to labor without them, please don't offer them to me
If I decide to use medication, I would like to start with a narcotic
If I make it to the pushing stage without medication, I would like a local numbing anesthetic on my perineum before crowning
I would like to labor without medication until it is safe me and my baby to have an epidural
I would like to have my epidural started at a low dose and ramped up as I ask for it to be
After I receive an epidural I would like to remain in an upright or fairly upright position in bed
After I receive an epidural I would like to let the baby 'labor down' before I start pushing
Cesarean Preferences select as many as you would like by holding down the ctrl button and clicking on the options of your choice
I want to avoid a cesarean section. I appreciate any suggestions you have throughout labor to help me with this
I want my primary provider present before I agree to a cesarean section unless it is a medical emergency
I want the option of getting a second opinion if a cesarean is indicated
If I do have a cesarean section I would like both my husband and doula present in the OR with me
Because the research shows there is so much benefit to baby, I want the cord to stop pulsing before it is cut in the OR
If the baby is well, I would like it to go to my husband immediately after birth
Pushing/Episiotomy Preferences select as many as you would like by holding down the ctrl button and clicking on the options of your choice
I would not like an episiotomy unless there is a medical emergency
To help avoid tearing, I would like to push and deliver in the position which feels most comfortable to me
To help avoid tearing, please have warm cloths and mineral oil ready for when my baby is crowning
Do not count while I am pushing, just give me quiet encouragement
I do not want to push until I have the overwhelming urge to do so
Delivery Preferences select as many as you would like by holding down the ctrl button and clicking on the options of your choice
I would like a mirror in the room so I can see my baby's birth
I would like the baby delivered right to my stomach
I would like my partner or doula to help with the catching of the baby
It is very important to me that the cord stop pulsing before it is cut
I would like the option of delivering with a squat bar attached to the bed
I would like to deliver in the position that is most comfortable for me at the time
I would like to hold the baby for as long as possible before measurements are taken
If the baby goes to the NICU, I want dad to go with baby
I would like to see the placenta
We have made arrangements to bank the cord blood
Breastfeeding Plans select as many as you would like by holding down the ctrl button and clicking on the options of your choice
I plan to breastfeed my baby
I plan on nursing on demand
I would like help from the nurses to get started with breastfeeding after delivery
I would like to meet with the hospital lactation consultant
Students and others in my room select as many as you would like by holding down the ctrl button and clicking on the options of your choice
I would not like any students or interns in my room at any time
It is alright with me to have students and interns in my room but please ask me frequently if it remains alright
I am fine with students and interns being in my room but I do not want them participating in the labor or delivery
I am fine with students and interns being present and participating in my labor and delivery
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