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Our Wishes for Childbirth Umbilical Cord

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					                                              Our Wishes for Childbirth

   Name: ______________ Partner: ____________ Midwife: ____________                            Doula: _________________

We have prepared this Birth Plan to help you understand our philosophy and the kind of care we hope to have for the birth of
our child. The pregnancy has gone very well thus far. We have been careful to eat well and stay fit, and have done everything
we can to prepare for a healthy and uncomplicated birth. We have chosen our midwife, Terry DiFelippo, because she shares
our desire for a low-intervention birth and respects our need for good communication. We have been studying the Bradley
Method and we wish for as natural a birth as possible, avoiding unnecessary procedures and medications. However, if
medications or procedures become necessary, we ask that you discuss them with us in advance so that we can participate in
the decision making. Thank you.



Before Labor Begins
- As long as the baby and I are healthy, I would like to go at least 10-14 days over my due date before we discuss inducing.
- I would like to discuss laboring at home as long as possible.
- If I go past my due date and the baby and I are fine, I prefer to go into labor naturally rather than be induced.
- I trust that my practitioner will seek out my opinion concerning all of the issues directly affecting my birth before deviating
from my plan.

Vaginal exams
- I prefer to have only 1 vaginal exam on or around my due date.
- Please obtain my permission before stripping my membranes during a vaginal exam.
- During a vaginal exam, I prefer at no time to have my membranes broken unless there is an emergency situation.
- I would like minimal vaginal exams, within reason, during my labor until I have an urge to push.

Hospital Admittance
- If I am less than four centimeters dilated, I would like to discuss with my healthcare provider the option of going home.

Induction
- As long as the baby and I are doing fine, I'd like to be allowed to progress free of stringent time limits.
- If my water breaks before I go into labor, I would like to wait 12 hours before we discuss being induced.
- If induction becomes necessary, I would like to try natural induction techniques first, like Breast Stimulation and Walking,
before pitocin or artificial rupture of membranes is attempted.
- If induction is necessary, I would like to attempt it with prostaglandin gel or another means before pitocin is administered.

First Stage of Labor
- I request the following people to be present during my labor/delivery: Jorge Granja, Doula, Magdalena Suarez, Cindy
Cooper.
- Please do not permit observers such as interns, students or unnecessary staff into the room without my permission.
- To preserve my privacy, I would prefer that everyone knock before entering.
- I would like to walk to the bathroom for as long as possible during labor and would like to avoid using a catheter.
- I would like to wear my glasses or contact lenses unless removal becomes medically necessary.
- I would like to have dimmed lights, people entering the room to speak softly, to play music, to wear my own clothes, to
wear headsets during my labor and delivery.
- I would like to stay hydrated by drinking clear fluids instead of having an IV.
- I prefer to have a heparin lock instead of an IV.
- I would like to walk and move around as I choose.

Pain Management
- I have prepared for this birth with: Bradley techniques and our goal is a natural, spontaneous, unmedicated birth.
- We realize that many pain medications exist, please do not offer them, we will ask for them if we need them.
- I am prepared to try to handle pain with these natural and alternative methods: Breathing techniques, Distraction
techniques, Hypnotherapy, Massage, Guided Relaxation, Shower, Labor Pool
- I wish to labor freely in the labor pool or shower.
Monitoring
- I prefer the baby to be intermittently monitored to allow for as much mobility as possible.

Second Stage Labor
- I prefer to have the lights dimmed for delivery.
- It's important to me to push instinctively. I do not want to be told how or when to push. Even if I am fully dilated, and
assuming the baby is not in distress. No "directed" (yelling and bossing) coaching.
- As long as the baby and I are healthy, I prefer to have no time limits on pushing.
- I would like the freedom to push and deliver in any position I like.
- To help prevent tearing, please apply: Hot compresses, Oil, Perineal massage, Encourage me to breathe properly for slower
crowning. I would like to avoid an episiotomy at all costs, even if it means I were to tear.
- I would like to take pictures and/or film during labor and delivery.
- I would like to deliver without the use of forceps or vacuum extraction. Please discuss this with us beforehand.

After Baby is Born
- As long as my baby is healthy, I would like my baby placed immediately on my abdomen with a warm blanket over us during
the first hours to help regulate baby's body temperature.
- I would like to breastfeed the baby immediately.
- Please delay all essential routine procedures on my baby until after the bonding and breastfeeding period.


Third Stage Labor
- Please wait for the umbilical cord to stop pulsating before it is clamped.
- Please allow my partner to cut the umbilical cord if he wishes.
- I would prefer for the placenta to be born spontaneously without the use of pitocin, and without the use of controlled
traction on the umbilical cord.
- Please remove my IV/Heparin lock as soon as possible after delivery.


Newborn Procedures
- I would like the baby to room with me at all times and to never be separated, unless my baby is sick.
- I would like to have routine newborn procedures delayed until bonding and breastfeeding have occurred.
- If the baby has any problems, I would like my partner to be present with the baby at all times, if possible.
- Please do not administer eye drops/vitamin K to my baby, I am willing to sign a formal waiver if need be.
- We decline routine PKU testing at the hospital and have made other arrangements for this procedure at a later date this
week.
- I prefer any immunizations be postponed to a later time
- Please do not bathe my baby at all, instead we prefer to rub in the vernix.
- We would like our baby is to be exclusively breastfed.
- Please do not offer my baby the following without my consent: Formula, Pacifiers, Any artificial nipples, Sugar water


Cesarean Section Delivery
-I feel very strongly that I would like to avoid a cesarean delivery
- If a cesarean is necessary, I expect to be fully informed of all procedures and actively participate in decision-making.
- I would like my husband, Jorge Granja, to be present during the surgery.
- If possible, please do not strap my arms to the table during the procedure.
- If possible, I would like to breastfeed the baby immediately after the birth.
- If conditions permit, I would like to be the first to hold the baby after the delivery.


Patient ___________________________ Coach __________________________ Physician ________________________

				
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Description: Our Wishes for Childbirth Umbilical Cord