Birth Preference Checklist

 

Birth Preferences Checklist.png

Check off as many items as you would and discuss with your partner, birth team, and setting, so ideally your preferences are honored and you are all on the same page.

I call these my preferences as I am aware that my labor may not proceed as planned, I may change my mind, and I acknowledge the importance of flexibility.

Eating and drinking in labor:

  • I would like to eat and drink freely in labor
  • I have no strong feelings about eating and drinking in labor and will do what my provider recommends

Being mobile or confined to the bed:

  • I would like to move around as I desire during labor
  • I would like to move around as much as possible or be helped into different positions in the event of an epidural
  • I have no strong feelings about being mobile in labor and will do what my provider recommends

Wearing a hospital gown or your own clothes:

  • I will wear my own clothes during labor
  • I will wear a hospital gown during labor
  • I will decide at the time what I want to wear during labor; I may wear nothing
  • I have no strong feelings about what I wear in labor

Freedom to vocalize and be uninhibited:

  • I want the freedom to make any sound
  • I need to in labor and it is important to me to feel uninhibited when all is going well; please do not tell me to try not to make noise
  • I have no strong feelings about vocalization during labor

Noise and lighting preferences:

  • I want to have the lights dim or off during labor
  • I prefer to have the windows and curtains open to allow natural light in during labor
  • I prefer to have the curtains drawn for darkness and privacy during labor
  • I would like to light candles or electric candles in my birth setting
  • I don’t mind the bright hospital lights

Your support team:

My support team will include the following:

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Routine IVs and saline locks:

  • I do not want a routine IV or saline lock placed in labor
  • I would like a routine saline lock placed when in labor
  • I want an IV or saline lock placed only if medically necessary
  • I have no strong feelings about routine IVs and saline locks and will do what my provider recommends

Labor Assessment and Induction

  • I would like my labor to be allowed to start and progress on its own, unless it is medically necessary to induce or augment it
  • In the event a medical induction is necessary, I want to be given options for induction method, and to discuss the pros and cons of each option (these can include artificial rupture of membranes, foley bulb, medication to soften the cervix, and synthetic oxytocin)
  • I would like my labor progress to be assessed, allowing for wide variation and ebbs and flows, as long as I, and my baby, are not in danger; I do not want my labor progress assessed according to the rigid Friedman Curve as commonly used in many modern hospitals
  • I consent to being induced, augmented and my labor progress assessed as recommended by my provider

Method of fetal monitoring:

  • I prefer intermittent fetal monitoring using a fetoscope unless a portable Doppler is necessary
  • I prefer intermittent fetal monitoring using a fetoscope or portable fetal Doppler only
  • I prefer intermittent fetal monitoring and periodic continuous fetal monitoring per hospital or provider routine protocol
  • I consent to continuous fetal monitoring only in the event it becomes medically necessary
  • I would like continuous fetal monitoring while in labor

 Vaginal exams and their frequency:

  • I do not want any vaginal exams during labor
  • I prefer minimal vaginal exams, such as on initial assessment and at onset of pushing, unless another is requested by me or medically necessary
  • I will decide whether or not I want a vaginal exam when the time comes; I reserve the right to decline vaginal exams
  • I will consent to however many vaginal exams the provider recommends

Artificial rupture of membranes (“breaking the bag of water”):

  • I would like to allow my membranes to break spontaneously, unless as a last resort to help labor progress or to induce labor
  • I only want my membranes broken artificially if medically necessary or I request them to be broken while in labor
  • I will consent to artificial rupture of membranes if the provider recommends it

Medications for pain relief and sleep:

  • I do not want any pain or sleep medication at any time during labor and prefer to deal with pain and need for sleep naturally — unless medically necessary
  • I do not want to be offered any pain medication; if I want some I will request it directly
  • I am open to medication for pain relief and sleep as recommended by my provider

Antibiotics:

  • I do not want routine IV antibiotics to prevent infection when all is well and there is no infection; I consent to IV antibiotics only if medically necessary
  • I consent to routine IV antibiotics to prevent or treat infection as recommended by my provider

 Episiotomy:

  • I do not want an episiotomy cut; I want perineal support, and methods to prevent tearing, but to be allowed to tear naturally and be repaired if medically necessary
  • If an episiotomy is being considered I want to be asked for my express consent
  • I am fine with an episiotomy being cut if my care provider says it is necessary

Directed versus instinctual pushing:

  • I do not want to be directed in how to push; I want to push instinctually
  • I want to push in the position of my choosing, but would like some direction in pushing effectively if needed
  • I want to be directed in when and how to push

Allowing for the resting phase between being fully dilated and urge to push:

  • In the event that I am fully dilated but don’t have the urge to push, I want to wait until I feel the urge; I do not want to be directed to push without the urge
  • I want to be directed to push when I reach 10 centimeters dilated, regardless if I have the urge to push or not, or per my provider’s recommendation

Forceps or vacuum assisted birth:

  • I do not want forceps or a vacuum used during my birth unless there is an emergency
  • I consent to forceps or a vacuum assist only if absolutely medically indicated as a last resort before cesarean, and I want to discuss it with my support team first if time allows
  • I want my care provider to talk to me about the difference between forceps and the vacuum before either one is used
  • I consent to whatever my provider recommends

Cesarean section:

  • I do not want a cesarean section unless there is a medical emergency in which my life or the baby’s life is in danger
  • If there is a situation where a cesarean section is being considered and it is not a time-sensitive emergency, I want to be informed of the risk and benefits of doing it or not, and I want private time to discuss it with my support team and care providers before I make my decision to consent or decline it at that time
  • I reserve the right to request a cesarean section, but understand my provider may or may not perform the surgery if not deemed medically necessary
  • I consent to any intervention, including a cesarean section, that my provider recommends

Who will catch your baby:

  • I want my care provider to catch my baby
  • I want my partner to catch or help catch our baby, in the event of normal childbirth, but I may change my mind at the time
  • I want to watch my baby being born with a mirror and to assist in catching my own baby, when all is well, but I may change my mind at the time

Who will discover the gender:

  • I want my care provider or attending staff to call out the gender
  • I want my partner to call out the gender
  • I want to discover the gender myself
  • My partner and I want to discover the gender together

Immediate skin-to-skin:

  • I want the baby brought to my belly or chest immediately for skin-to- skin
  • I want the baby to be placed down in front of me, and I will pick my baby up and hold skin-to-skin when I am ready; I do not want this instinctual process of mother-led discovery to be disturbed unless medically necessary
  • If the baby must be taken for medical care, I want him/her placed on my chest for skin-to-skin as soon as possible
  • In the event of a cesarean section, I want to do partner-assisted skin-to- skin in the operating room
  • If I am physically unable to do skin-to-skin right away, I want my partner to do skin-to-skin with the baby

Keeping baby with you at all times, without separation when all is normal, versus baby exams and procedures done in the nursery:

  • I want the baby kept with me at all times, even during exams and procedures
  • I am OK with the baby being given exams and procedures separately from me, but in the same room
  • I am OK with the baby being taken to the nursery for exams and procedures, but want the baby brought back to me when they are finished
  • I am OK with whatever the hospital routine protocol is regarding this

Safeguarding the sacred first hour

  • I want no disturbances of any kind during the first hour after birth unless medically necessary (this not only includes interventions, but also unnecessary talking, pictures, phone calls, texting, sharing on social media, etc.)
  • I want no disturbances of any kind during the first hour after birth unless medically necessary (this includes interventions, but I am fine with the following activities).
  • I am OK with whatever the hospital/provider protocols and they can do whatever they usually do during this time

Immediate versus delayed cord clamping:

  • I want to delay cord clamping for at least 1 1/2 to 2 minutes
  • I want to delay cord clamping until the cord has stopped pulsing
  • I want to delay cord clamping until my placenta is born, unless medically necessary or I request cord clamping at the time
  • In the event that the baby needs medical attention directly after birth, I want the cord to pulse as long as possible before clamping
  • I want to delay cord clamping even if I have a cesarean section
  • I want my care provider to cut the cord
  • I want my partner to cut the cord
  • I want my———–  to cut the cord (daughter, son, mother, father, sister, brother, friend, etc.)
  • I want to cut the cord myself
  • We will be having a lotus birth and keeping the cord attached until it naturally falls off

Keeping the placenta for ceremonial burial:

  • I want to keep my placenta and take it home with me
  • I do not wish to keep my placenta

Early breastfeeding without supplementation, and breastfeeding support:

(Conscious Creation promotes and recommends exclusive breastfeeding for 6 months as per WHO recommendations)

  • I plan to breastfeed exclusively and to begin within the first hour after giving birth
  • Do not offer my baby formula, sugar water, or anything other than my breast milk; especially do not give my baby any of these things without my express consent.
  • I will breastfeed on demand, per the baby’s schedule
  • I request a visit from the hospital or birth center’s lactation consultant on staff each day until discharge, or until breastfeeding is established and going well
  • I will arrange for a lactation consultant to visit me at home after my home birth or after my hospital discharge
  • I request referral help arranging to have a reputable lactation consultant assist me at home
  • I will not be breastfeeding and will feed my baby formula; my formula preference is  —————— (specify brand, type, dairy free, soy free, organic, etc.)
  • I am fine with the staff feeding my baby whatever formula they recommend or have on hand

Newborn exams and procedures:

  • I plan to make an informed decision to decline the following exams/procedures:
  • I plan to allow the following exams/procedures:

Other requests or things important to you:

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(This can be things about the birth setting and environment that are important to you, like wanting the windows open for fresh air or wanting to get outside in labor; dietary preferences or restrictions; religious observances and considerations; specific labor coping techniques you do or do not want; affirmative language used/refrain of language that undermines your confidence or creates tension; and any other instructions or requests from staff about how you wish to be treated.)