Name ________________________________ Signature ______________________________________________
Care Provider__________________ Attending Birth: ______________________________________________
1. Labor to begin spontaneously, up to 42 weeks. |
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I am bringing extra pillows or items to help with labor relaxation. |
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2. Ability to move around during labor. |
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3.. Non-clinical pain relief during labor. Massage of hands, feet, back. Optimal Fetal Positioning. |
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Hydrotherapy- tub, shower, water birth, |
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Medication for pain. |
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4. Spontaneous rupture of membranes if warranted |
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5. Minimum amount of fetal monitoring possible. |
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6. Ability to eat and drink during labor. Plans for nourishment. |
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7. Choose position for pushing:
Semi-sitting, squatting, supported stand, birth stool, side-lying. |
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8. Perineal hot compresses & olive oil for management of perineum during 2nd stage. |
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9. Touch baby’s head when crowning. |
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10. I would like to lift baby out after head and shoulders are born. |
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11. Cord stopped pulsing before clamping. |
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12. Natural descent of placenta, if possible. |
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13. Baby stays with me at all times. Any procedures done at my bedside, if possible. |
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