This wasn't the one you read since I hadn't posted it before but here was mine...
We would like to allow our labor and delivery to unfold naturally, with as few interventions as possible. We would like to be informed about all procedures and tests before they are performed. We want to be aware and informed of all of our options in the event of an unexpected emergency.
Our Preferences - Mom
•Minimal/no vaginal exams
•No IV
•Intermittent Fetal Monitoring
•No internal fetal monitoring
AUGMENTATION OF BIRTH
•Please do not offer to break my waters. Please be very careful to avoid doing so during any internal examinations.
•Obtain my consent before augmenting labor with any drug such as pitocin, Cytotec.
PAIN MEDICATION
•Do not offer pain medication unless I ask for it. This includes pain medication post birth.
OTHER MEDICATIONS
•No Rhogam - Mom is RH+
•No vaccines including Rubella
•No antibiotics without consent. Mom has allergies to many classes of anti-biotics including all classes of cillins (i.e., Penicillin, Augmentin, etc.).
PUSHING / 2nd STAGE
•Use of gentle, controlled pushing in whatever position feels right. Please no forced pushing.
•Even if I am fully dilated, and assuming my 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 my baby placed on my stomach/chest immediately after delivery. Please hold off on other activities unless there is a medical need to act immediately.
EPISIOTOMY / TEARS TO PERINEUM
•I do not consent to an episiotomy. Please let me tear naturally.
•In the event of tearing the perineum, I prefer to avoid having stitches if possible. If you think any tear will heal of its own accord, without stitches, please do no stitch them.
PLACENTA / 3rd STAGE
•Placenta delivered spontaneously. Please no cord traction, forced removal, or fundal pressure.
•No routine use of pitocin (IV or injected) unless there is a hemorrhage
IN CASE OF C-SECTION
•Ability to stay awake during procedure.
•Use of spinal anesthesia (instead of general or epidural)
•Please put catheter in AFTER spinal takes effect. Please remove it as soon as I can get up on my own.
•No pre-operative medications such as sedation or nausea medication.
•Please do no strap my arms down.
•Lower the screen/drape when the baby is lifted from mom or use a mirror
•Allow father to hold baby immediately after birth where mother can touch and see
•I would like to see my placenta even if it's once it's in the bag to be disposed of.
•No routine pain medication afterward unless I ask for it. No prescription strength oral pain medication (i.e., Tylenol 3, Vicodin).
•No antibiotics without consent. I have allergies to several classes of antibiotics including all cillins (i.e, Penicillin, Augmentin).
•Prefer a low transverse incision with double sutures. Please no staples.
•No shaving or enema. Trimming is OK.
•Ability to breast feed afterward ASAP.
GOING HOME
•Would like to go home as soon as possible.
Our Preferences - Baby
DELAYED CORD CLAMPING
•Delay of clamping and cutting umbilical cord until cord stops pulsing. We have no plans to donate the cord blood.
ANNOUNCING OF GENDER
•We would like to find out the sex of the baby ourselves so please let us announce it.
IMMEDIATE BONDING AND BREASTFEEDING
•We expect to hold the baby immediately after birth unless consent is obtained for a reason of medical concern. Breastfeeding as initiated by baby or as soon as possible after the birth.
NO EYE OINTMENT
•No eye ointment (i.e., silver nitrate)
NO VITAMIN K INJECTION
•We decline the routine Vitamin K injection
•We will consider oral vitamin K in the case of a c-section. Please obtain consent first.
NO NEWBORN SCREENING TEST / PKU
•We decline the routine Newborn Screening test.
CURCUMCISION
•If the baby is a boy, he will not be circumcised at the hospital. He also does NOT need to be retracted for any exam.
BATH
•Please do not bathe baby unless we ask for it. We will decide when to bathe baby later at our discretion.
NO VACCINATIONS
•We decline all vaccinations including Hepatitis B.
EVALUATION / TESTS
•All baby examinations must done in the presence of a parent
•If possible, we ask for any tests or evaluations be postponed until after the baby has nursed for the first time.
•Prefer all pediatric exams be performed in the mother's room
ROOMING IN / NO SEPERATION
•Unless required for health reasons, we do not wish for out child to be separated from us and ask that out baby "room in" with the parents at all times.
•If our baby needs any type of emergency medical treatment, X (the father) will accompany our baby at all times.
BREASTFEEDING ONLY
•We plan on breastfeeding exclusively
•No bottles, sugar water, plain water, or formula for baby
•No pacifier for baby
GOING HOME
•Would like to go home as soon as possible.