Birth Preferences (sample)

BIRTH PREFERENCES (sample)

My birth team will consist of:

Self

Partner

Doula/other

It is mutually understood that the safety of baby and mother, will determine which preferences may or may not be honored. I am willing to discuss and consider all necessary care for the health and safety of myself and my child.

Thank you

1. I will be laboring at home as long as possible

2. I would like intermittent fetal monitoring   

3. I would like a saline or hep lock.

4. I would like limited vaginal exams.

5. I would like limited staff involved, no students or observers

6. I will be laboring naturally, please do not ask me if I want medication during my labor.  I will ask if necessary.

7. NO AROM (artificial rupture of membranes)

8. No Labor augmentation (no pitocin)

9. I would like to move as much as possible through my labor.

10. I plan to utilize labor tools and facilities provided by the hospital (tub, bar, peanut ball..)

11. I would like a calm setting, with dim lights, low monitor tones, and limited interruptions during my labor.

12. Please keep my partner and I informed of all medical concerns and updates, with information discussed immediately and thoroughly. Please allow me time to privately discuss any information and options with my birth team during my labor.

13. I would prefer to eat and drink at my desire during labor.

14. I would like to push spontaneously, please no "coached pushing".

15. I would like to push in positions I feel comfortable.

16. I would like a slow gentle delivery/ a hands off delivery/ to catch and lift my baby/ for my partner to catch my baby

17. I would like NO forceps or vacuum used on my baby.

18. No EPISIOTOMY, I would prefer to tear and heal naturally.

19. I would like immediate skin to skin, with baby placed on my bare chest, with a blanket over us both.

20. Please NO HAT, I would like to smell and touch my baby, which will signal my body, and my heat will regulate body temperature.  

21. I would like to delay cord clamping, so my baby can receive the much needed oxygen, iron, clotting and immunity factors, and stem cells, from the cord blood. I would like it delayed for 3 minutes/ until it stops pulsing/ until the placenta delivers

22. I would like a physiological third stage, allowing my placenta to deliver naturally.

23. I would Not like pitocin after delivery.

24. I WOULD LIKE TO KEEP MY PLACENTA

25. I would like a Quiet hour for me and my newborn immediately after birth, postponing unnecessary procedures and exams. This is a critical bonding period and important to maintain.

26. Please no baby warmer. I would like my infant on my chest.

27. Please wait to weigh my baby

28. No antibiotic eye ointment

29. NO Vitamin K/Oral Vitamin K/Yes Vitamin K

30. No vaccinations in the immediate newborn period, I will follow up with my pediatrician.

31. NO BATH. The covering will protect and nourish the skin. I do not need my newborn cleaned or wiped.

32. I will be rooming in with my baby.

33. If my baby is in the nursery and begins to cry, please return to me immediately.

34. I will be breastfeeding, please no bottles or binkies unless I ask.