Here's the short one... The longer one is more for the OB and the on call pedi going into specific procedures should I have a "big" baby. I'll post that too, but that one is several pages as opposed to the one page below.
My Name: Anna My Due Date: November 7, 2007
My Address: XXX XXX Rd My Partner: Joshua
XXXXX, VA
My Doctor: Dr. W Other Support persons: My Mom
Pediatrician: Dr.B
Upon arrival to the hospital, I wish to have my support person(s) with me at all times.
Labor:
* I would like to be free to walk around and change position during labor.
* I would like to eat and drink during the first stage of labor.
* I do not wish to have an IV unless I become dehydrated. I will agree to a heparin lock.
* I do not wish to have continuous fetal monitoring
* I realize many pain medications exist, and will ask if I feel I need them.
* Please keep the door closed during labor.
* Please, no residents or students attending my birth.
Augmentation of labor:
If induction or augmentation is indicated, I would like to try natural techniques first with the guidance of my practitioner, such as:
* Breast stimulation
* Walking
* Herbs
* Any other non-medical methods
If medical methods are necessary, I prefer to try, in this order:
* Stripping membranes
* Rupturing membranes
I would like to avoid an episiotomy and risk tearing unless I’m having a medical emergency, and would like local anesthetic for repairs.
After Delivery:
* Unless there is a medical emergency, I would like to nurse immediately.
* Please let the cord stop pulsing before clamping, and allow my partner or support person to cut the cord.
* I will sign any necessary waivers to permit me to be with my baby continuously.
* I would like all newborn procedures delayed and preformed in my presence.
* Under no circumstances shall this child be given formula, artificial nipples, teats, pacifiers, or soothies without express written permission. Any action to the contrary will result in charges of assault.
* I will sign any waivers if needed to decline the administration of eye drops and delay vaccines.