Regarding labor and birth - Mary Doe

Due Date: 03/19/2009
Patient of Dr. McDermott
Scheduled to deliver at Seattle Grace

03/17/2009
Dear Dr. McDermott

I'm having a baby and these are my wishes for before, during and post delivery. Please direct any questions to Claire or Ginger. Thank you.

Sincerely,
Mary Doe

Labor

• I wish to be able to move around and change position at will throughout labor.
• I would like to be able to have fluids by mouth throughout the first stage of labor.
• I would prefer to keep the number of vaginal exams to a minimum.

Monitoring

• I do not wish to have continuous fetal monitoring unless it is required by the condition of my daughter.

Labor Augmentation/Induction

• I do not wish to have the amniotic membrane ruptured artificially unless signs of fetal distress require internal monitoring.
• I would prefer to be allowed to try changing position and nipple stimulation before Pitocin is administered.

Anesthesia

• I do not want any kind of anesthesia offered to me during labor, though I would like it available if I specifically request it.
• Custom note regarding use of an epidural.

Cesarean

• If my primary care provider determines that a Cesarean delivery is indicated, I would like to obtain a second opinion from another physician if time allows.
• I would like my husband present at all times if my daughter requires a Cesarean delivery.
• I wish to have an epidural for anesthesia.
• If my daughter is not in distress, my daughter should be given to (blank) immediately after birth.

Episiotomy

• I would prefer not to have an episiotomy unless absolutely required for the baby's safety.

Delivery

• I would like my husband and/or nurses to support me and my legs as necessary during the pushing stage.
• I would like a mirror available so I can see my daughter's head when it crowns.
• Even if I am fully dilated, and assuming my daughter is not in distress, I would like to try to wait until I feel the urge to push before beginning the pushing phase.
• I would like to have my daughter placed on my stomach/chest immediately after delivery.

After Delivery

• I would like to cut the cord myself.
• I would like to have my daughter examined and bathed in my presence.
• If my daughter must be taken from me to receive medical treatment, my husband or some other person I designate will accompany my daughter at all times.
• I would like a private room if available.
• After the birth, I would prefer to be given a few moments of privacy to urinate on my own before being catheterized.
• I would like to donate the umbilical cord blood.

Breastfeeding

• Unless medically necessary, I do not wish to have any bottles given to my daughter (including glucose water or plain water).
I do not want my daughter to be given a pacifier.

Photos

• I would like to make a videorecording of labor and/or the birth.

Other

• My support people are my doula and (blank) I would like them to be present during labor and/or delivery.