Here's mine from this time, but it's still a work in progress and we're still undecided about a few things (vitamin K, what to do with the placenta)
In General:
Ideally, if all goes smoothly, I hope that the midwife who attends me in labor will support and encourage me, using her experience to guide me through labor and offer suggestions as needed or requested.
The labor:
I would like to remain active and use whatever position I find comfortable. I may wish to move throughout the house and to use the bath or shower from time to time. I would like to avoid internal examinations. I am willing to have one internal examination to check presentation if it seems necessary, but would like to avoid them otherwise.
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 labor is not progressing well for some reason, I would appreciate it if you could suggest changes of position or movements which might help.
I may wish to use aromatherapy/herbal remedies/homeopathy during the labor if you have any to suggest.
Birth Companions
The following people may come to my home during the labor or birth:
My husband, Tim
My daughter Allison, who will be 2y 10m old
My mother in law Pat, and my friend Kim who will be taking pictures and helping to look after Allison.
My birth companions' telephone numbers and addresses are:
XXXX
I have purchased a birth pool and will use it if it helps me. It is important that the pool temperature is comfortable for me so, unless it is outside normal safety limits, I will choose the temperature myself. I understand that I would probably want a cooler temperature during the first stage of labor, and warmer - nearer blood temperature perhaps - for the second stage.
I intend to use the pool for the first stage of labor, but have no fixed ideas about where to manage the second stage. I will decide on the day.
Pain relief:
I intend to use no drugs for pain relief, and would appreciate your encouragement to use other methods.
The birth:
I would prefer for you to examine me to let me know when I am ready to begin pushing my baby out only if I spontaneously begin pushing.
Please keep the room as quiet as possible during the second stage. I would like to minimise distractions at this time. If you need to discuss matters with someone, please do so very quietly and preferably out of earshot!
I would like to give birth wherever seems right at the time.
I would like to give birth in an upright, kneeling, supported squatting or all-fours position to give the baby maximum space to descend through my pelvis. I do not want to be on my back or semi-reclining unless that position seems right for me on the day, having tried alternatives. If I am too tired to maintain an upright position then please encourage me to lie on my side instead of my back, to allow maximum mobility in my pelvis.
When my baby is born, I would like to be bring her to my belly/chest myself, if that isn't possible, please pass her straight to me.
I would like to avoid perineal damage and would appreciate your guidance in giving birth gently to accomplish this. However, I would rather tear naturally than have an episiotomy. I would like to see or feel the head as it crowns, and my birth partner will have a hand mirror available for this.
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.
Please do not suction mucus from the baby's nose and mouth 'just in case' - only suction if necessary.
Third Stage:
I would like a physiological third stage with the cord clamped and cut when it stops pulsating. I wish no drugs to be used unless specifically indicated. It is important to me that you do not clamp the cord until it has stopped pulsating, unless you need to take emergency steps which preclude this. Please do not pull on the cord or use fundal pressure unless there is a specific indication to do so. I would like to cut the cord myself.
If I give birth in the pool, I would like to get out of the water for the third stage, but that may change on the day- please remind me that my intention was to get out of the water, but know that I may choose to stay in.
We 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 administer an injection of Vitamin K after the birth
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.
I would like to keep an open mind about my pain relief options; please suggest anything you think would be appropriate.
I agree to student doctors being present during my treatment
I would like to avoid a caesarean section if it is at all possible. I particularly would like to avoid a caesarean just for slow progress. If labor is simply taking a long time but my baby is not in immediate danger, please 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.
If a caesarean section becomes necessary, I would prefer to remain awake with epidural or spinal block anaesthesia. I do not want my arms restrained in any way. I would like my husband to stay with me at all times, and would like to hold and breastfeed the baby as soon after birth as possible, ideally immediately.
If there are problems after the birth:
If I suffer a severe post-partum hemorrhage, please do not perform a hysterectomy unless it is the only available course of action.
Please do not admit my baby to the NICU simply for observation, but only if there is a specific reason for concern.
Baby Feeding
Please do not give my baby supplements of glucose water or formula milk without my permission. I would expressly like to avoid having any formula supplements unless it is unavoidable, and certainly not in the first two days in any event.
Under no circumstances is my baby to be bottle-fed. If supplements are necessary, please give them by spoon or other method, not by bottle. Also, please do not give my baby a pacifier.
If I have trouble breastfeeding, I would greatly appreciate the help of a lactation consultant who is fully supportive of breastfeeding.
Going Home
I would like to go home as soon after the birth as I am physically able, unless I or the baby have health problems which require hospital treatment.
