I really debated even posting it, but if it's at least a little help to a mom out there, then I'm glad that I posted. I should note that we also included (but did not post here) the names of our midwife, pediatrician, and places for them to sign. So here it is:
We are glad that you are part of this exciting birth of our
baby boy. We are first-time parents and have prepared ourselves through
exercise, nutrition, books, and Bradley Method classes. We hope that these
preparations will help us have a smooth labor and birth.
We desire to have a birth that is natural and free from
interventions. We do not want to be induced, have artificial rupture of the
membranes, or be offered pain relief such as an epidural, Pitocin to speed
labor, or a routine IV or catheter. We do not want any residents or nurses
in-training observing the labor and birth.
During First Stage Labor
·
Minimal
vaginal exams- one when first admitted, one when the mother feels ready to
push
·
Intermittent
fetal monitoring
·
Privacy
for the mother and father as much as possible
·
NO
Heparian lock IV
·
Freedom to walk and move into positions of
comfort, including use of the tub
·
Freedom to eat and drink
·
Low lights, aromatherapy, and music of our
choice
·
The mother would like to wear her own clothes
·
All guests need to be OK’ed by the coach (father)
·
Positive language used by all support persons in
regards to the mother’s progress
During Second Stage Labor
·
Freedom
to move to positions of comfort- tub, squatting, hands-and-knees, and so on
while pushing
·
No
episiotomy- the mother would rather tear; use perineal massage to avoid
·
Mirror available to see progress if desired
·
Father to
catch baby and cut cord when it stops pulsing
After the Birth of Our Baby Boy
·
Immediate
skin-to-skin contact with baby for holding and nursing; privacy of the
family at this time is desired
·
Delay
bath, testing, weighing, etc. until baby has had skin-to-skin time with
mother and father
·
First bath given by mother and father
·
We
decline eye drops and the Hepatitis B vaccine for our baby at birth
·
We accept
the hearing test, the vitamin K shot, and PKU test
·
We would like our baby circumcised
Complications
-Please
allow us time to privately discuss our options before any additional procedures
-If fetal distress requires a C-section, father
is to stay with mother continually; baby is to be given to mother as soon as
possible for nursing and skin-to-skin time
-If baby must be taken to NICU, please do not feed sugar water or introduce a
bottle or pacifier; mother will pump or nurse to feed the baby as soon as
possible
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