Here’s an easy to print version or please feel free to copy and paste to amend to your own desires. This of course is my personal guideline and can be a quick resource or please tailor to your own needs.
Mother’s registered name: [Enter Your Name]
The following are the guidelines by which we would like to follow during our labor, delivery and stay.
1) No Assisted delivery techniques unless life saving for mom or child. These include the use of Forceps, Vacuum or Suction, C-section or Episiotomy.
2) No unnecessary medical personnel in Birthing Room for delivery. We would like to have a controlled and intimate environment.
3) Father & Baby. Should there be any need to remove the child from the immediate surroundings of the mother, the father is to accompany the baby. For the entire stay at the hospital regardless of security devices.
4) Drugs. We have chosen to leave our options open to an epidural. However, we do not want any narcotics administered at any time, unless consented by mother or father in case of emergency procedure.
5) IV & Electronic Monitoring – We fully understand the benefits of the IV and would like a moveable stand. However, nothing other than hydrating fluids should be administered without the parent’s prior consent. We would like to be able to move around in support of the labor process. We would like to be able to remove the monitors when possible to move around.
