Plan, Sample 6
PLAN FOR _________________________
DUE DATE ______________
If all goes well and labor is progressing
the following are our preferences:
We prefer to walk around for as long as
possible and would rather have a Heparin Lock if there is a
possibility of an I.V.
We prefer to do our best with pain management
without medication and would rather not be offered medication;
______ will ask for it if needed.
We would like to have the freedom to choose
the most comfortable position to give birth in.
We would like to have the spontaneous
rupture of membranes.
We would like to have labor start and
progress on its own without the use of Pitocin in any way, unless
the baby's/mother's health is in danger.
We would prefer intermittent, rather than
continuous fetal monitoring.
We would request a quiet, dim environment
for delivery, if possible.
We would like to breastfeed upon delivery
rather than have Oxytocin.
We would like to have the baby placed
skin-to-skin on ______'s chest and the cord cut AFTER the placenta
We would like to avoid episiotomy.
_________ would like to be present during
washing and weighing of the baby.
We would like to waive eye care and Vitamin
K shot for newborn.
Would like to wait on the Hepatitis B
vaccine until the baby is older.
We would like to have 24 Hour rooming
in for mother and baby, rather than a stay in the nursery.