Birth Wish List for [your name]

[hospital name] Hospital. Our due date is [edd].

Desire: Have a safe, gentle, natural (no drug) and joyful birth using Active Birth Method

Labor
  • I want to stay home and labor as long as possible.

  • Request nurses that support natural child birth.

  • Intermittent fetal monitoring.

  • I want to drink fluids (clear liquid), fruit juices, throughout the first stage of labor.

  • I do not want I.V. fluids. If necessary, please use Heplock.

  • I want to labor in any position I feel comfortable.

  • I want my husband and my doula to stay with me at all times and not be excluded.

  • I want to use alternative methods such as different positions before pitocin is used.

  • I want to be able to walk around even after my water has broken.

  • I would like minimum number of vaginal exams.

  • I want the use the shower, Jacuzzi and have my husband and my doula with me.

  • I want my amniotic membranes intact and to not be ruptured artificially only if medically necessary.

Pain medication
  • No pain medication and analgesics administered unless I request them.

  • Not intending to have epidural.

Caesarean
  • No Caesarean unless my Doctor, my husband and myself determine it medically necessary. I would like my husband and doula to remain with me.

  • My husband to accompany our baby after birth unless in distress.

Episiotomy
  • Do not want episiotomy. Please assist with counter pressure and warm compresses.

During delivery
  • I would like to follow my body instincts and be coached on how and when to push.

  • I would like our son to be placed on my chest immediately after delivery.

After delivery
  • My husband would like to cut the cord.

  • Prefer having at least1 hour bonding time with our son after birth. Please delay newborn procedures.

  • Please do newborn screening tests in the room while I nurse.

  • For normal delivery, time for placenta to expel on its own.

  • I would like only the Vitamin K shot for our baby. No HEP B and no antibiotics in his eyes.

  • No circumcision for baby.

  • Please give us a copy of discharge summary for our pediatrician.

Breastfeeding
  • I would like to breastfeed. My doula and will help baby latch on.

  • No bottle or pacifier given to baby unless medically necessary.

  • I would like to get assistance from the lactation specialist during my stay at the hospital.

Photos/Video
  • My doula will take still pictures or video at birth.