Parents: Catherine and David
David and I are anticipating a natural birth for our second child. We value your encouragement and support in making this possible!
--Freedom of movement is very important to me as I plan to employ a variety of natural pain management techniques. I appreciate your assistance in making this possible through the use of a heplock and flexible monitoring.
--Please wait for me to request pain medication.
--I prefer to avoid routine vaginal exams.
--I intend to follow my natural urge to push but welcome assistance in finding effective positions.
--I welcome your support in preventing a tear but prefer a natural tear over an episiotomy. I do not consent to an episiotomy.
--Please remind me to touch my daughter's head as she is born.
AFTER THE BIRTH:
--Please place my daughter directly on my chest/stomach after birth.
--David would like to cut the cord once it stops pulsating (4-5 minutes after the birth).
--Please allow the placenta to birth without traction or routine medication and save the placenta for us to take home.
--To enhance bonding, we will delay going to the nursery until the 1 hour limit.
--We will room in. Routine procedures (bath, etc) can be done in our room/with our assistance. We will accompany our daughter on nursery visits.
--We will be breastfeeding and do not consent to the use of artificial nipples or supplements (including glucose solution and/or formula).
IN THE EVENT OF A CESAREAN:
--I would prefer a spinal for surgery and a double layer closure of the uterine incision.
--I would like to see my child as she is born and for David to hold her after she is examined.
--I would like one arm free so I can "hold" my child with assistance. I am aware of the need to maintain a sterile field and will not reach into it.
--I will initiate breastfeeding as soon as possible and appreciate your support in this.
--David will go with our child if she needs to be taken to the nursery.
Nursery Visit for Initial Weighing, etc:
-- We do not consent to erythromycin eye ointment, the vitamin K shot, or any vaccinations given to our daughter when in the nursery because of religious exemption.
-- We will be breastfeeding and do not consent to the use of artificial nipples or supplements (including glucose solution and/or formula).
-- We do not consent to our daughter having a bath after birth.