1st Stage
I do not consent to oxygen, IV medication, or a saline lock ‘just in case’
Please do not offer pain relief. If I wish to have some myself or my husband will ask for it.
I do not consent to continuous monitoring unless intermittent monitoring shows something that needs closer attention.
I do not wish for my water to be artificially broken unless I request it
2nd Stage
no pulling/maneuvering baby's head before shoulders are born
in case of shoulder dystocia - help me change to hands/knees position, absolutely no pulling
Would like to have Michael help catch the baby and announce the sex
I wish to push on instinct and with freedom of position. Please do not count.
3rd Stage
I do not consent to suctioning the baby
I do not consent to a pitocin shot after birth unless I am hemorrhaging.
I do not consent to traction, gentle or otherwise, on the cord. I will deliver the placenta once it has detached on it’s own
I do not consent for the cord to be cut until it has stopped pulsating and preferably until placenta is delivered unless lifesaving measures are needed.
We would like to take the placenta home.
4th Stage
I do not consent to uterine massage unless uterus is not contracting on its own
Newborn exams will be delayed for at least one hour after birth
I do not consent to the vitamin K shot, Hepatitis B, or erythromyacin, and baby will not have blood drawn without prior consent
I do not consent to the vitamin K shot, Hepatitis B, or erythromyacin, and baby will not have blood drawn without prior consent
We will not be circumcising if the baby is a boy.
We would like to return home as soon as possible and would appreciate help in doing so