Labor Augmentation/Induction
I would like to avoid induction unless it is medically necessary.
As long as My Child and I are healthy, I do not want to discuss induction prior to 42 weeks.
If my pregnancy progresses past 40 weeks, I would prefer to base the decision to induce on the results of My Child's biophysical profiles, not on my own personal discomfort or impatience.
I would like to try alternative means of labor augmentation, like walking or nipple stimulation, before pitocin or artificial rupture of membranes is attempted.
If induction is attempted, but fails, I would like to come back at another time rather than pursue further intervention (assuming my membranes are intact and that waiting presents no danger to My Child or myself).
Please do not rupture my membranes artificially unless medically indicated.

Anesthesia/Pain Medication
Please do not offer anesthesia/analgesia unless I ask for it.
If I ask for pain relief, please feel free to offer nonmedical choices for coping and/or remind me how close I am to the birth.
I would like to avoid all narcotics, if possible.

Cesarean Section Delivery
I feel very strongly that I would like to avoid a cesarean delivery
If a cesarean is necessary, I expect to be fully informed of all procedures and actively participate in decision-making.
I would like Colleen Nichol, Dallace Bedard to be present during the surgery.
Please explain the surgery to me as it happens.
I would prefer epidural anesthesia, if possible, in order to remain conscious through the delivery.
I would like to have a respectful atmosphere without chatter during any part of the surgical procedure.
If possible, please do not strap my arms to the table during the procedure.
If conditions permit, I would like to be the first to hold My Child after the delivery.
If possible, I would like to breastfeed My Child immediately after the birth.
I would like our plans outlined here for after the birth to be followed as closely as possible.
Please lower the screen just before delivery so I may see the birth of the baby.

Perineal Care
I prefer not to have an episiotomy unless it is medically indicated.
To avoid episiotomy or tearing, Colleen Nichol, Dallace Bedard or my labor assistant will perform perineal massage with oil and apply hot compresses.
To help my perineum stretch, please help guide my pushing efforts by letting me know when to push and when to stop.
Please administer local anesthesia when repairing any episiotomy or tear(s).

Delivery
Even if I am fully dilated, and assuming My Child is not in distress, I would like to wait until I feel the urge to push before beginning the pushing phase.
I prefer to push or not push according to my instincts and would prefer not to have guidance or coaching in this effort.
I would like the freedom to push and deliver in any position I like.
I would appreciate help from Colleen Nichol, Dallace Bedard and staff supporting my legs as I push.
I would like to have a mirror available and adjusted so I can see My Child's head crowning.
I would like the opportunity to touch My Child's head as it crowns.
I would like a soothing environment during the actual birth, with dim lights and quiet voices.
I would like Colleen Nichol, Dallace Bedard to help catch My Child.
I would like to have the birth recorded with photographs, video tape and/or tape recording.

Immediately after the birth
Please place My Child on my stomach/chest immediately after delivery.
I would like to breastfeed My Child immediately.
Colleen Nichol, Dallace Bedard would like the option to cut the cord.
(other) would like the option to cut the cord.
I prefer to wait for spontaneous delivery of the placenta and do not want a routine injection of pitocin.

Newborn Care
I would like to hold My Child skin-to-skin during the first hours to help regulate baby's body temperature.
I would like to hold My Child through delivery of the placenta and any repair procedures.
Please evaluate and bathe My Child at my bedside.
If My Child must go to the nursery for evaluation or medical treatment, Colleen Nichol, Dallace Bedard, or someone I designate, will accompany My Child at all times.
I would prefer to bathe My Child myself, at my discretion.
Please delay eye medication for My Child until we are well past the initial bonding period (a couple hours after the birth).
If available, would prefer erythromycin eye treatment or other antibiotic eye drops instead of silver nitrate.
I would prefer to have Vitamin K administered orally.

Postpartum Care
I would prefer not to be catheterized until I've had some private time to attempt urination on my own.
If available, I would prefer a private room.
I would like to have My Child room-in with me at all times.
I would like my Colleen Nichol, Dallace Bedard to room-in with me.
I would like (other) to room-in with me.
I would like my other children to have free visitation access.
Assuming I feel up to it and My Child is healthy, I would like to be released from the hospital as soon as possible following the birth.
I would like permission for access to my chart and My Child's chart.

Breastfeeding
I plan to breastfeed and want to nurse immediately following the birth.
Please do not give My Child supplements (including formula, glucose, or plain water) without my consent, unless there is an urgent medical necessity.
Unless I am unable to give my consent, please do not give My Child any supplements without first informing me of the reason(s) and seeking my consent.
I would like to know more about breastfeeding.
I would like to meet with the staff lactation consultant.

Additional notes
I would like to take still photographs during labor and the birth.
I would like to make a videorecording of labor and/or the birth.
I am not planning to have My Child circumcised.