In General:Ideally, if all goes smoothly, I hope that the midwife who attends me in labour will
- support and encourage me, using her experience to guide me through labour and offer suggestions, including reminding me to move often and ideas for positions that may help with pain and progression (as I tend to stick in one spot and would rather move and help with labor rather than stay in one position).
I would like to remain active and use whatever position I find comfortable. Please encourage me to stay off my back!
I may wish to move throughout the house and to use shower from time to time, but would prefer to use the birth tub as labor progresses to transition, to prepare for pushing.
I would like to minimize internal examinations
Please do not offer to break my waters, and please be very careful to avoid doing so during any internal examinations.
If the baby appears to be poorly positioned or labour is not progressing well for some reason, I would appreciate it if you could suggest changes of position or movements which might help.
I would like to have soft music playing during the labour
I would like hushed voices once I reach the end of the active stage of labor and during transition, I need quiet and calm in order to work with my body and all loud noises will be a distraction.
I would like to be encouraged to eat and drink during labor, but fluids more readily available than food as I don’t always feel like eating during labor, but am usually very thirsty.
Birth CompanionsThe following people may come to my home during the labour or birth:
My husband Michael
My oldest child James as long as he is quiet and calm
My mother Mary and her care taker Chris or Husband Bill (who will more than likely be taking care of the kids at the time though).
If Michael’s parents are present they may be allowed as long as they do not bring any negative energy into the room.
I do not wish to have any other family members present than the ones listed above.
If you will be using a birth pool:I would like to have a water birth if possible and would appreciate your support in encouraging me to give birth underwater.
Pain relief:I obviously do not want any pain medication but options on different breathing methods or positions is welcome for pain management while in labor.
The birth:I would like to inform you of when I am ready to push, and if the urge is not too overwhelming will allow an internal exam to confirm that I am fully dilated, but I do not wish to wait if the urge if overwhelming.
I would like to give birth in the birthing tub
I would like to give birth in an all fours or upright squatting position if possible, I do not want to be on my back and I want to be encouraged to stay off my back. I would also like any and all ideas to help minimize tearing.
I would like perineal massage if possible in the position I am birthing in, and other techniques to minimize tearing.
I would like Michael to catch the baby if he is willing otherwise I would like her handed to me as soon as she is born.
I would like the lights dimmed when my baby is born, and for the minimum amount of noise to be made. I hope that it will be a gentle entry into the world.
Third Stage:Please do not cut the cord until it stops pulsating, and only offer help delivering the placenta if I ask for it.
If I give birth in the pool, I would like to get out of the water for the third stage.
We do not wish to keep the placenta
Care of the baby:I would like to breastfeed my baby as soon as possible after the birth
I would like to keep the baby unclothed and close to my skin immediately after birth, to maximize skin-to-skin contact
Please do not administer prophylactic Vitamin K after the birth. If the birth is traumatic for the baby or there is some other risk factor for HDN, I will be happy to discuss this with the midwife and allow vitamin K if we both decide it is appropriate.
Repair of the Perineum, if necessaryI would prefer to avoid stitches on small tears, but larger tears I would like to have stitched.
In case of transfer to hospital:If transfer by ambulance becomes necessary, please do not strap me in on my back - I would prefer to be on my side, to make contractions easier to deal with
Please do not offer any type of pain medications including narcotics and/or epidural.
I do not agree to student doctors being present during my treatment
I do not consent to the antibiotic eye ointment being administered
My daughter is not to receive any vaccinations, I will sign the waiver.
I would like to avoid a caesarean section if it is at all possible, as I do not want to enter future labours with a scarred uterus. I particularly would like to avoid a caesarean just for slow progress. If labour is simply taking a long time but my baby is not in immediate danger, please would you encourage me to keep going and perhaps to try changes of position or movements which might help. Please do not offer a caesarean unless my baby is in danger.
I do not consent to the use of pitocin, but will try it before consenting to a caesarean.
If a caesarean section becomes necessary, I would prefer to remain awake with epidural or spinal block anesthesia. I would like my partner to stay with me at all times, and would like to breastfeed the baby as soon after birth as possible.
Note: I have spina bifida occulta on my L3 vertebrae.
If there are problems after the birth:
Please do not admit my baby to Special Care simply for observation, but only if there is a specific reason for concern.
Baby FeedingI will be breastfeeding and under NO CIRCUMSTANCES is my child to receive ANYTHING but my breastmilk! No exceptions! I do not want her to have formula of any kind as my colostrums will do her more good than formula will and yes I’ll have enough of it to help with any sugar problems, and in the case of jaundice I do not give, and will not give consent to a formula supplementation.
My baby is also not to have any artificial nipples, no paci’s!