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  1. #1
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    Post Birth plans

    A few weeks ago I noticed that there were a few different threads about Birth Plans and I thought it would be good to see if we can get them all in one place for future reference.

    The mods have agreed to make this a sticky, so please post copies of your Birth Plans here if you are happy to share your thoughts.

    Also - please ensure that you follow the rules about linking to other websites, or if you are copying a Birth PLan someone has provided to you that you have their permission etc.

    And finally - if you find this information of assistance when preparing your own birth plan - please consider posting your version on here too, when it is completed, to help those that come later.

    Thanks in advance!
    Last edited by Random541; 22-03-2009 at 17:01. Reason: rules and copyrights :-)

  2. #2
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    Shmoooooooosh! AKA jaxcoop
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    What a great idea, i hope people will post them as they are very important. I didn't have one, but i wish i did!

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    Great idea!!

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    Default Birth Plan for Zephani

    Support People

    DH Primary Support Person
    Mother Emergency Support Person ONLY IF DH MUST leave the room for his own health needs.

    Introduction

    We are looking forward to sharing our birth experience with you. We have created this birth plan in order to outline some of our preferences for birth. DH and I have given careful consideration to each specific request in the plan, and we feel that it represents our wishes at this time. We would appreciate you reviewing this plan, and would be happy to do so with you.

    We do realise that as labour ensues, we may choose to change our thinking and wish to feel free to do so. We understand that these choices presume a normal pregnancy and birth. Should a situation arise which constitutes a medical emergency – please know that you will have our full co-operation, after we have had an opportunity for an explanation of the medical need, and have had sufficient time to discuss the decision between ourselves. We wish to have clear and adequate explanations of all procedures, of the progress as labour as it is assessed, and of any special circumstances if they arise.

    In the absence of any such special circumstances, we ask that the following requests be honoured. Please note that I would like to wear my glasses at all times when conscious.

    Please attach this to your records. Please make this information known to all midwives who might be attending the birth of our precious baby.
    Signed: _____________________________

    Ambience
    We would prefer a quiet, soothing environment during labour, with dim lights and minimal interruptions. We would also like to use my iPod.

    Please do not permit observers such as interns, students or unnecessary staff into the room without our expressed permission. To preserve our privacy and dignity, we would prefer that everyone knock before entering.

    Inducement
    We would like to avoid induction unless it is medically necessary. If my pregnancy progresses past 40 weeks, we would prefer to base the decision to induce on the results of our baby’s health and safety, not on my own personal discomfort or impatience.
    First Stage of Labour

    · We request that all doctors and hospital staff will discuss each and every procedure with me and my husband (or emergency support person) before they are performed.
    · We request the patience and understanding of midwives to refrain from any suggestion, practice, or procedure that could unnecessarily stand in the way of us having the most natural birth possible.
    · DH (or my emergency support person) will not leave the room at anytime, please do not ask, for any reason.
    · I would like to be free to walk, change positions and use the bathroom as needed or desired.
    · I would like to be able to eat and drink throughout labour, as desired, including remaining hydrated by drinking moderate amounts of fluids (water, juice, ice chips etc).
    · Please keep vaginal exams to a minimum and request my expressed permission first.
    · As long as our baby is doing well, we prefer that fetal heart tones be monitored intermittently with an external monitor or doppler, even if the membranes have ruptured.
    · We request that there be no internal monitoring unless medically necessary
    · I would like to have access to the shower/bath.

    Pain Relief

    · We wish to try for a pain free labour and birth.
    · If I need to use drugs for pain relief my choice (in order) is massage, shower, gas, morphine and epidural as a last resort.
    · We wish to wait for five minutes after first asking for drug relief before it is administered so I can reconsider my request.
    · I have had an anaesthetic review at G Hospital. The anaesthetist’s notes are on my file.

    During Birth

    · We request that all doctors and hospital staff will discuss each and every procedure with me and my husband (or emergency support person) before they are performed.
    · We request the patience and understanding of midwives to refrain from any suggestion, practice, or procedure that could unnecessarily stand in the way of us having the most natural birth possible.
    · When I am fully dilated, and assuming our baby is not in distress, I would like to wait until I feel the urge to push before beginning the pushing phase.
    · I would like the freedom to push and deliver in any position I like.
    · I would appreciate help from DH (or my emergency support person) and staff in supporting my legs as I push.
    · I would prefer to tear naturally instead of having an episiotomy.

    Caesarean Section Delivery
    We feel very strongly that we would like to avoid a caesarean delivery. We will not agree to a caesarean without a trial labour, unless the safety of our baby is at risk. If a caesarean is necessary, we expect that all doctors and hospital staff will discuss each and every aspect of the procedure with me and my husband (or emergency support person) before the procedure is performed. I have had an anaesthetic review at G Hospital. The anaesthetist’s notes are on my file.
    · I would like DH (or my emergency support person) to be present during the surgery.
    · I would prefer an epidural for the procedure.
    · I would prefer general anaesthesia in an emergency only.
    · We would like to have a respectful atmosphere without chatter during any part of the surgical procedure.
    · If possible, I would like to breastfeed our baby immediately after the birth. If this impossible, our baby should be given to DH (or my emergency support person) immediately after the birth.
    · If our baby must go to the nursery for evaluation or medical treatment, DH will accompany our baby at all times and my emergency support person will stay with me.

    After the birth

    · We request immediate skin-to-skin contact, with our baby to be placed to the breast (if the cord length allows)
    · I would like to breastfeed our baby immediately
    · I would like to hold our baby through delivery of the placenta and any repair procedures.
    · After our baby is breastfeed it is to be handed to DH (or my emergency support person).
    · Please wrap our baby before handing it to DH.
    · Please allow the umbilical cord to stop pulsating before it is cut.
    · Please administer local anaesthesia when repairing any episiotomy or tear(s).
    · I give my permission for an injection of Oxytocin to be administered to assist with the delivery of the placenta and the contraction of the uterus.

    Newborn Care
    · If possible, please evaluate our baby on my abdomen. Otherwise please evaluate our baby at my bedside.
    · We agree to all routine tests and examinations performed on our baby, including Vitamin K and Hep B injections, APGAR and newborn bloodspot screening, and have signed forms to this effect.
    · If our baby must go to the nursery for evaluation or medical treatment, DH will accompany our baby at all times and my emergency support person will stay with me.
    · Please do not give our baby a dummy.

    Postpartum Care

    · I would like to have our baby in the room with me at all times.
    · If our baby must go to the nursery for evaluation or medical treatment, DH will accompany our baby at all times and my emergency support person will stay with me.
    · We would like permission for access to my chart and our baby's chart.

    Breastfeeding
    · I plan to breastfeed and want to nurse immediately following the birth.
    · Please do not give our baby supplements (including formula, glucose, or plain water) without our consent, unless there is an urgent medical necessity.

  5. The Following 6 Users Say Thank You to zephani For This Useful Post:

    Cazza1981  (28-03-2011),Lottiemum  (31-01-2014),MGC Bertie  (01-01-2015),PeJu's Mum  (29-03-2012),Sunshinebell  (08-11-2013),thinkingaboutit  (24-01-2012)

  6. #5
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    Quote Originally Posted by zephani View Post
    Birth Plan for Zephani
    I just posted my birth plan. As you can see it is quite long and I'm still pregnant so I can't tell you how it went or anything, but my midwife has read it and said that it is very thorough and readable. Tell me what you think!

  7. #6
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    this was mine for an attempted VBAC, but i will prob have to have a section as things havent gone to plan
    ok see what u think and i can edit if needed. do u want me to print them an drop them round or will u print them. also if you decide to use a doula don't tell ur ob if he asks who will be there just say a 'friend' an partner they don't like doulas just a heads up if u decide to have one. hope all is well an it hasn't been to hot for you take care feet up an rest well try any way haha take care

    Tracy Burgess birth plan


    1st stage:
    birth partner(s):____________________

    *induction only if needed no less then 10 days over due.
    *free to move around during labor
    *free to eat an drink when wanted.
    *fhr monitoring only if medically needed, preferably portable monitoring.
    *vaginal examinations if needed
    *pain relief negotiable at the time no epidural
    * no drip

    2nd stage
    *free to birth in any positions
    *episiotemy if needed ask first
    *pushing when body feels ready
    *forceps and suction delivery only if needed and all other positions fail, ask first.


    3rd stage

    *assistance in 3rd stage only if needed ask first
    *skin to skin contact immediately after birth
    *partner cut cord
    *cord cut when mother feels needed
    *1st feed, breast when necessary

    postnatal care

    *vitamin k yes
    *hep b yes
    *baby left with mother as long as possible before drugs administered
    *if complications occur with baby partner is to be present with treatment were possible
    *rooming in at all times unless stated other wise at the time.
    REQUESTS IF SECTION NEEDED* screen to be lowered so can see baby born* skin to skin contact as long as nothing wrong with baby* breastfeed if possible while being stitched up * partner to remain with baby when not with me

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    Sunshinebell  (08-11-2013)

  9. #7
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    Wow - thanks for all the replies and support. I'm sure lots of women will find this information useful!

    Zephani - great detail in your BP - I hope it all goes well for you and look forward to hearing your outcome!

    Keep 'em coming ladies

  10. #8
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    Here is a birth plan I helped a "mum' with for her VBAC. Her VBAC was successful though it came at a very high cost.

    My Care providers
    I would prefer a midwife in attendance that I am already familiar with. This includes ****** or another midwife from the group practice. Also if a student midwife that I am familiar with is available he/she is welcome to attend and stay during the labour unless I ask them to leave for personal reasons that I cannot foresee at this present time. For medical reasons they may stay.

    People in attendance during my labor and Birth
    I would like my doula ******* to be present during my labour and birth. I would also like my mother ******, the baby’s father ***** and my best friend ******* to have access to enter the room when requested. I am aware of limitations on the amount of people allowed to attend during the labour and birth process however if it is at all possible for the attending midwife to ‘stretch’ the rules slightly to allow these people to be available I would be extremely grateful.

    Birth room attitudes
    After a traumatic birth of my first child, I would like the environment to be as relaxing and reassuring as possible. As I will be attempting a VBAC, I believe any stress I feel will further inhibit my plan of a vaginal delivery.
    I ask that midwives do not ask me directly if I would like pain relief. If it seems it is needed please speak to my doula or my mother as we have spoken about alternatives to pain medications and what to do if the situation of me needing pain relief arises.
    I would prefer to have information regarding my progress delivered to me a positive manner. Statements such as ''If this hasn't happened in 30 minutes, we will do this" I believe are unhelpful and in turn could result in me feeling as if I haven’t ‘performed’, which may also put unnecessary stress on myself and stop my body from performing the way it is intended.


    Location of Birth
    I have chosen to birth in the ******. I am aware that I am on a waiting list for a room in the *******. If a ******** room is available then I would prefer to birth in there as I believe the surroundings will enable me to relax and be more comfortable with my labour and delivery and hence make a VBAC likely. I also believe that the bath will be of great use to me for pain relief. If I have to give birth in the delivery suite I am happy to do so, but will ask if it is available that I am able to use Room *** as I understand it has a bath.

    Items I want to bring with me
    I would like to be able to listen to music while I am in labour as I believe this will help me relax. I would also like to bring in small items such as massage oils, soap bars and other items that I believe will benefit my labour process.

    Vaginal examinations
    I am happy to have as many vaginal examinations as medically required. If I request a vaginal examination for personal reasons I would like this request to be fulfilled if time and staff arrangements allow so. I believe this will give me something to focus on during my labour.

    Rupture of membranes
    I am happy for my membranes to be ruptured for medical reasons. But I am also aware that this may inhibit my chances of a successful VBAC so I ask that this be done only if there is no other alternative.

    Pain Relief
    I would like access to morphine and the nitrous oxide if needed. I do not want pethidine as it as it has previously caused me to hallucinate.
    I am open to using sterile water injections for back pain and also PCA Remifentanil.
    If I request pain relief I would like to wait at least three contractions before it is administered as this time will serve as a distraction and I may then be able to avoid using it.


    Foetal monitoring
    I would prefer to be active, upright, using the bath and other labour tools. I am happy to have intermittent monitoring every 15 minutes or so by the attending midwives.

    Positions during pushing
    I would prefer to kneel or squat while I am pushing. I would also like to be able to change my position if I feel it is necessary or if I am uncomfortable. My last resort of position will be laying transverse with my legs in stirrups. I believe this creates a smaller pelvic region and will inhibit my chances of a successful VBAC

    Talking to me and directing my pushing
    I am open to any and all suggestions for pushing from the midwifery staff, obstetrician and doula.

    Episiotomy
    I am open to an episiotomy for medical reasons and if it will be enhance my chances of a successful VBAC.

    Induction of Labour
    I would like to avoid the use of Syntocinon or any other medical induction unless medically required. I would like to avoid anything that may inhibit my chances of a VBAC.
    I am happy, however, to receive Syntocinon for the third stage of labour if it will reduce my chances of another post partum haemorrhage.

    My baby immediately following birth
    I request that the baby's father cut the cord unless he is unavailable. I would then like my mother to cut the umbilical cord.
    I would also like as much skin-to-skin contact after the baby is born and to be left to bond with my baby as soon as possible following the birth.


    Baby injections: Vitamin K and Hepatitis
    I would like my baby to receive all injections that are recommended.

    Separation of my baby from me
    It is important for me to not be separated from my baby at all if possible.

    My Flexibility
    My birth plan and outlook is quite flexible if there are medical reasons for any change. Also, if things are explained to either my doula or mother then I am happy for changes if needed.

    If I need a vacuum delivery
    I am happy for a ventouse delivery if it means the difference between a VBAC or a Caesarean.

    Forceps
    I am happy for a forceps delivery if medically necessary and to improve my chances of having a VBAC.

    If I need a Caesarean Delivery
    Ultimately I would like to have a VBAC. If for medical reasons I need a Caesarean then I would like my mother or ***** to attend with me.
    I would like to be awake for the procedure unless medical reasons prevent this.
    I would like still photographs to be taken of the baby being cleaned and weighed and of my first contact with the baby.
    I would like for my baby to remain in Theatre with me and for me to have skin to skin contact with my baby. I would also like my baby to come with me to recovery.
    I would like to breastfeed my baby as soon as possible after her birth.



    As you can see from my birth plan it is extremely important to me to have a VBAC. I would like to try everything possible to achieve this. I will have done plenty of preparation during my pregnancy, however I may still need the direction of my caregivers to help me achieve my desired birth.
    Thank you for taking the time to read my birth plan.


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  12. #9
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    This was mine for my homebirth earlier on this year. It's based on the proforma contained in the Mongan Method Hypnobirthing program. My midwives loved it, and it worked out exactly as I had planned.

    Our Birthing Preferences
    Dear A_____, J____, and any other midwives who might be attending the birth of our precious baby,

    P___ and I have chosen you, our private midwives, as the people we want to attend us when our baby is born. We have chosen the HypnoBirthing method of quiet, relaxed, natural birth.

    The information that follows is a copy of our Birth Preferences. P and I have given careful consideration to each specific request in the plan, and we feel that I represents our wishes at this time. We do realise that as labour ensues, we may choose to change our thinking and wish to feel free to do so. We understand that these choices presume a normal pregnancy and birth. Should a situation arise which constitutes a medical emergency – please know that you will have our full cooperation, after we have had an opportunity for an explanation of the medical need, and have had sufficient time to discuss the decision between ourselves. We wish to have clear and adequate explanations of all procedures, of the progress as labour as it is assessed, and of any special circumstances if they arise. In the absence of any such special circumstances, we ask that the following requests be honoured.

    Please attach this to your records.

    Please make this information known to the other midwives who might be attending the birth, should you not be attending us.





    Signed: ________________________________________


    Witnessed: ________________________________________

    During Thinning and Opening Phase of Labour

    We request:

    -The patience and understanding of midwives to refrain from any suggestion, practice, or procedure that could unnecessarily stand in the way of us having the most natural birth possible
    -That the staff honour the need for quiet
    -That the staff refrain from any reference to ‘pain’, ‘hurt’, ‘discomfort’, ‘hard labour’ or any suggestion of pain being experienced etc
    -That P not be asked to leave by the midwives at any time, for any reason.
    -Quiet room, dim lights, and background music/candles/ambiance as we desire
    -To be free of any monitoring equipment (ie Doppler, blood pressure cuff) between readings
    -No continuous EFM monitoring, unless medically necessary
    -No internal monitoring unless medically necessary
    -No suggestion of pain relief – unless requested by me
    -Freedom to walk around/move – or not – as I decide
    -To change positions and assume labour positions of my choice
    -No vaginal examinations, unless ABSOLUTELY necessary, and only after express permission is sought and received from me
    -No premature rupture of membranes
    -To allow labour to take its natural course without references to ‘moving things along’
    -To take fluids and light snacks as my instinct dictates
    -To use natural oxytocin stimulation in the event of a stalled or slow labour – ie nipple or clitoral stimulation – and to be accorded the uninterrupted privacy to be allowed to do so
    -No augmentation of labour via synthetic oxytocin, amniotomy, or stripping of membranes without discussion
    -To enjoy birthing pool, even after ROM, as my instinct dictates

    During Birth

    We request:

    -The patience and understanding of the attending midwives to refrain from any suggestion, practice, or procedure that could unnecessarily stand in the way of our having the most natural birth possible
    -To remain in the birthing pool for so long as my instinct dictates – up to and including the birth of our baby
    -To allow natural birthing instincts to facilitate the descent of the baby, as much as possible, with mother-directed breathing down until crowning takes place.
    -Use of HypnoBirthing techniques – NOT Lamaze Method.
    -To birth in an atmosphere of gentle encouragement during the final pushing stage without loud ‘coaching’ – Please – calm, low tones, free of loud ‘pushing’ prompts.

    If not in the birthing pool:

    -To assume a birthing position of choice that will least likely require any intervention
    -Use of a bed, bench, table (etc) for a leapfrog/squatting positions
    -Perineal massage with oil and hot compresses to avoid tearing
    -To allow for complete birthing before suctioning baby
    -Videotaping/photography of the birth as P and I desire
    -Use of mirror to allow me to see the crowning and birth
    -P to help ‘receive’ the baby

    After the birth

    -Please allow either P or myself to discover the sex of the baby
    -Immediate skin-to-skin contact, with the baby to be placed on my stomach/to the breast (if the cord length allows)
    -Delayed cutting of the cord for AT LEAST until it stops pulsating – and possibly until after placental expulsion
    -Allow as long as possible – ie at least 2 – 3 hours, if necessary – for the natural delivery of the placenta before any suggestion of medical intervention
    -No use of oxytocin for the delivery of placenta, unless this becomes medically necessary, and my express permission is sought and received
    -Immediate breast-feeding to assist in natural placental expulsion
    -Uterine massage every 15 minutes to assist placenta birth
    -Natural nipple stimulation to assist in placenta expulsion
    -Absolutely NO cord traction!
    -No synthetic oxytocin, or manual removal of the placenta unless there is an emergency.

    For Baby

    -To have bright lights removed during birth and at least until baby is moved to my chest, and for as long as possible afterwards
    -Allow vernix to be absorbed onto baby’s skin; delay ‘cleaning’ or ‘rubbing’ – use only a soft cloth when rubbing if appropriate
    -Allow baby to remain with me for as long as my instincts dictate – no weighing or measuring until I give my consent.
    -No vitamin K injection or oral preparation to be given
    -Please use a soft cloth between the scales and the baby

    We thank you in advance for you support and kind attention to our choices. We know you join us in looking forward to a beautiful home birth.

  13. #10
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    Not sure if I can post this, but I have been looking on a few american based websites and came across this 'checklist' type birth plan .. i think it simplifies things and sort of works as a checklist for the mamas who havent thought/won't be doing a birth plan

    (obviously some things aren't relevant to aussie births)


    [ ] Full name:

    [ ] Partner’s name:
    [ ] Today’s date:
    [ ] Due date: OR Induction date:
    [ ] Hospital name:

    Please note that I:
    [ ] Have group B strep
    [ ] Am Rh incompatibility with baby
    [ ] Have gestational diabetes
    My delivery is planned as:
    [ ] Vaginal
    [ ] C-section
    [ ] Water birth
    [ ] VBAC

    I’d like…:
    [ ] Partner:
    [ ] Parents:
    [ ] Other children:
    [ ] Doula:
    [ ] Other:
    …present before AND/OR during labor

    During labor, I’d like:
    [ ] Music played (I will provide)
    [ ] The lights dimmed
    [ ] The room as quiet as possible
    [ ] As few interruptions as possible
    [ ] As few vaginal exams as possible
    [ ] Hospital staff limited to my own doctor and nurses (no students, residents or interns present)
    [ ] To wear my own clothes
    [ ] To wear my contact lens the entire time
    [ ] My partner to film AND/OR take pictures
    [ ] My partner to be present the entire time
    [ ] To stay hydrated with clear liquids and ice chips
    [ ] To eat and drink as approved by my doctor
    I’d like to spend the first stage of labor:
    [ ] Standing up
    [ ] Lying down
    [ ] Walking around
    [ ] In the shower
    [ ] In the bathtub
    I'm not interested in
    [ ] An enema
    [ ] Shaving of my pubic area
    [ ] A urinary catheter
    [ ] An IV, unless I’m dehydrated (and a heparin or saline lock IS/IS NOT ok)
    I’d like fetal monitoring to be:
    [ ] Continuous
    [ ] Intermittent
    [ ] Internal
    [ ] External
    [ ] Performed only by Doppler
    [ ] Performed only if the baby is in distress
    I’d like labor augmentation:
    [ ] Performed only if baby is in distress
    [ ] First attempted by natural methods such as nipple stimulation
    [ ] Performed by membrane stripping
    [ ] Performed with prostaglandin gel
    [ ] Performed with Pitocin
    [ ] Performed by stripping of the membrane
    [ ] Never to include an artificial rupture of the membrane
    For pain relief, I’d like to use:
    [ ] Acupressure
    [ ] Acupuncture
    [ ] Breathing techniques
    [ ] Cold therapy
    [ ] Demerol
    [ ] Distraction
    [ ] Hot therapy
    [ ] Hypnosis
    [ ] Massage
    [ ] Meditation
    [ ] Reflexology
    [ ] Standard epidural
    [ ] TENS
    [ ] Walking epidural
    [ ] Nothing
    [ ] Only what I request at the time
    [ ] Whatever is suggested at the time
    During delivery, I would like to:
    [ ] Squat
    [ ] Semi-reline
    [ ] Lie on my side
    [ ] Be on my hands and knees
    [ ] Stand
    [ ] Lean on my partner
    [ ] Use people for leg support
    [ ] Use foot pedals for support
    [ ] Use a birth bar for support
    [ ] Use a birthing stool
    [ ] Be in a birthing tub
    [ ] Be in the shower
    I will bring a:
    [ ] Birthing stool
    [ ] Birthing chair
    [ ] Squatting bar
    [ ] Birthing tub
    As the baby is delivered, I would like to:
    [ ] Push spontaneously
    [ ] Push as directed
    [ ] Push without time limits, as long as the baby and I are not at risk
    [ ] Use a mirror to see the baby crown
    [ ] Touch the head as it crowns
    [ ] Let the epidural wear off while pushing
    [ ] Have a full dose of epidural
    [ ] Avoid forceps usage
    [ ] Avoid vacuum extraction
    [ ] Use whatever methods my doctor deems necessary
    [ ] Help catch the baby
    [ ] Let my partner catch the baby
    [ ] Let my partner suction the baby
    I would like an episiotomy:
    [ ] Used only after perineal massage, warm compresses and positioning
    [ ] Rather than risk a tear
    [ ] Not performed, even if it means risking a tear
    [ ] Performed only as a last resort
    [ ] Performed as my doctor deems necessary
    [ ] Performed with local anesthesia
    [ ] Performed by pressure, without local anesthesia
    [ ] Followed by local anesthesia for the repair
    Immediately after delivery, I would like:
    [ ] My partner to cut the umbilical cord
    [ ] The umbilical cord to be cut only after it stops pulsating
    [ ] To bank the cord blood
    [ ] To donate the cord blood
    [ ] To deliver the placenta spontaneously and without assistance
    [ ] To see the placenta before it is discarded
    [ ] Not to be given Pitocin/oxytocin
    If a C-section is necessary, I would like:
    [ ] A second opinion
    [ ] To make sure all other options have been exhausted
    [ ] To stay conscious
    [ ] My partner to remain with my the entire time
    [ ] The screen lowered so I can watch baby come out
    [ ] My hands left free so I can touch the baby
    [ ] The surgery explained as it happens
    [ ] An epidural for anesthesia
    [ ] My partner to hold the baby as soon as possible
    [ ] To breastfeed in the recovery room
    I would like to hold baby:
    [ ] Immediately after delivery
    [ ] After suctioning
    [ ] After weighing
    [ ] After being wiped clean and swaddled
    [ ] Before eye drops/ointment are given
    I would like to breastfeed:
    [ ] As soon as possible after delivery
    [ ] Before eye drops/ointment are given
    [ ] Later
    [ ] Never

    I’d like my family members(NAMES):
    [ ] To join me and baby immediately after delivery
    [ ] To join me and baby in the room later
    [ ] Only to see baby in the nursery
    [ ] To have unlimited visiting after birth
    I’d like baby’s medical exam and procedures:
    [ ] Given in my presence
    [ ] Given only after we’ve bonded
    [ ] Given in my partner’s presence
    [ ] To include a heel stick for screening tests beyond the PKU
    [ ] To include a hearing screening test
    [ ] To include a hepatitis B vaccine
    Please don’t give baby:
    [ ] Vitamin K
    [ ] Antibiotic eye treatment
    [ ] Sugar water
    [ ] Formula
    [ ] A pacifier
    I’d like baby’s first bath given:
    [ ] In my presence
    [ ] In my partner’s presence
    [ ] By me
    [ ] By my partner
    I’d like to feed baby:
    [ ] Only with breastmilk
    [ ] Only with formula
    [ ] On demand
    [ ] On schedule
    [ ] With the help of a lactation specialist
    I’d like baby to stay in my room:
    [ ] All the time
    [ ] During the day
    [ ] Only when I’m awake
    [ ] Only for feeding
    [ ] Only when I request
    I’d like my partner:
    [ ] To have unlimited visiting
    [ ] To sleep in my room
    If we have a boy, circumcision should:
    [ ] Be performed
    [ ] Not be performed
    [ ] Be performed later
    [ ] Be performed with anesthesia
    [ ] Be performed in the presence of me AND/OR my partner
    As needed post-delivery, please give me:
    [ ] Extra-strength acetaminophen
    [ ] Percoset
    [ ] Stool softener
    [ ] Laxative
    After birth, I’d like to stay in the hospital:
    [ ] As long as possible
    [ ] As briefly as possible
    If baby is not well, I’d like
    [ ] My partner and I to accompany it to the NICU or another facility
    [ ] To breastfeed or provide pumped breastmilk
    [ ] To hold him or her whenever possible
    Last edited by kel87; 20-03-2009 at 22:01. Reason: copy&paste didnt work!

  14. The Following 2 Users Say Thank You to kel87 For This Useful Post:

    DT75  (14-04-2015),MGC Bertie  (01-01-2015)


 

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