Birth Preferences

Download Form

While birth can sometimes be unpredictable, working through your birth preferences can help decrease anxiety and improve your overall birth experience. Please print this form, complete and bring to a visit with you during your third trimester.

Before Labor Begins

  • I would like to wait as long as possible for natural labor (41 weeks and 5 days for mothers without a medical indication for induction)
  • I would like to be induced at 41 weeks
  • I would like an elective induction between 39 and 41 weeks if my cervical exam qualifies me for such
  • I would like my membranes stripped when possible (after 39 weeks)
  • I would like to use natural cervical ripening methods like nipple stimulation, Evening Primrose oil and raspberry leaf tea after 36 weeks

Hospital Clothing

  • Hospital gown
  • My own clothing

Baby Monitoring

  • Continuous
  • Wireless
  • Intermittent
  • Internal

Pain Relief Measures

  • Epidural
  • Offer it to me
  • Only if I ask for it
  • IV pain medication
  • Offer it to me
  • Only if I ask for it

Relaxation Techniques

  • Vocalization
  • Relaxation
  • Breathing
  • Imagery/Visualization
  • Focal Point
  • Massage

Comfort Measures

  • Hot/cold packs
  • Massage
  • Aromatherapy
  • Low lighting
  • Doula support
  • Shower/tub (where available)
  • Music

Hydration

  • Drink clear fluids
  • IV fluids

Food

  • Eat lightly at home
  • Water/juice/jello/popsicles
  • Nothing to eat

Positions

  • Walking
  • Sitting
  • Lying down
  • Rocking
  • Standing
  • Hands and knees
  • Squatting
  • Lunging
  • Birth ball

Augmenting Labor

  • Patience/nothing
  • Nipple Stimulation
  • Position changes
  • Releasing of water
  • Pitocin

Pushing

  • Spontaneous
  • Directed/coached
  • Varying positions
  • Mirror present

Perineal Care

  • Perineal massage
  • Warm compress
  • Slow delivery of head
  • Episiotomy (not standard)

Delivery Position

  • Semi-sitting
  • Side lying
  • Hand and knees
  • Squatting

Cutting Cord

  • Partner or mother
  • Doctor/midwife
  • Wait until cord stops pulsating (delayed cord clamping)
  • Cut as soon as possible
  • Cord blood banking planned

After Delivery

  • Baby skin to skin with mother
  • Baby to be taking directly to the warmer
  • Clean baby before holding
  • Delay baby’s bath for at least 24 hours
  • Baby stays in the room

Placenta

  • Per hospital protocol
  • Encapsulation planned

Newborn Medications

  • Antibiotic eye ointment
  • Hepatitis B vaccine
  • Vitamin K injection (required for circumcision; oral is not a reasonable substitution)

Circumcision

  • Yes
  • Give Tylenol
  • Give Sweet-Ease
  • Use Lidocaine or Marcaine
  • No

Feeding

  • Breastfeeding only
  • Formula feeding
  • No pacifiers
  • Pacifiers OK
  • Breast pump if needed
  • Lactation consultation

Twin Vaginal

  • Partner present
  • Doula present
  • Dimmed lights
  • Epidural
  • Skin to skin between deliveries

Belly Birth

  • Partner present
  • Doula present
  • Dimmed lights
  • Clear drape at delivery
  • Mom’s music playlist
  • Take pictures
  • Skin to skin as soon as possible