I would like to be free to walk around during labor.
I wish to be able to move around and change position 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 like to wear contact lenses or glasses at all times when conscious. MONITORING
I do not wish to have continuous fetal monitoring unless it is required by the condition of the baby.
I do not want an internal monitor unless the baby has shown some sign of distress. LABOR AUGMENTATION/INDUCTION
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 (walking, nipple stimulation) before pitocin is administered. ANESTHESIA/PAIN MEDICATION
I realize that many pain medications exist I’ll ask for them if I need them. I would like to have natural labor and reserve epidural if needed. CESAREAN
Unless absolutely necessary, I would like to avoid a 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.
If a Cesarean delivery is indicated, I would like to be fully informed and to participate in the decision-making process.
I would like (coach) present at all times if the baby requires a Cesarean delivery.
If the baby is not in distress, the baby should be given to (coach) immediately after birth. EPISIOTOMY
I would prefer not to have an episiotomy unless absolutely required for the baby’s safety.
I would appreciate guidance in when to push and when to stop pushing so the perineum can stretch.
I would like a local anesthetic to repair a tear or an episiotomy. DELIVERY
I would like (partner) and/or nurses to support me and my legs as necessary during the pushing stage.
I would like a mirror available so I can see the baby’s head when it crowns.
Even if I am fully dilated, and assuming the baby 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 have the baby placed on my stomach/chest immediately after delivery. IMMEDIATELY AFTER DELIVERY
I would like to have (coach) cut the cord.
I would like to hold the baby while I deliver the placenta and any tissue repairs are made.
I would like to have the baby evaluated and bathed in my presence.
I plan to keep the baby near me following birth and would appreciate if the evaluation of the baby can be done with the baby on my abdomen, with both of us covered by a warm blanket, unless there is an unusual situation.
If the baby must be taken from me to receive medical treatment, (coach) or some other person I designate will accompany the baby at all times.
I would prefer to hold the baby rather than have (him/her) placed under heat lamps. POSTPARTUM
Unless required for health reasons, I do not wish to be separated from my baby.
I would like to have the baby “room in” and be with me at all times. BREASTFEEDING
I plan to breastfeed the baby and would like to begin nursing very shortly after birth.
Unless medically necessary, I do not wish to have any bottles given to the baby (including glucose water or plain water).
I do not want the baby to be given a pacifier.
I would like to meet with a Lactation Consultant. PHOTO/VIDEO
I would like to take still photographs during labor and the birth. OTHER
I would prefer that no students, interns, residents or non-essential personnel be present during my labor or the birth.