My name is:
My baby is due (date and chosen location of birth):
My midwife/doctor is:
My birthing partner is:
Would you like to be with you all the time?
Who would you like to be present during labour?
Who would you like to be present during delivery?
Who would you like to be present once the baby is born?
Is there anyone you would not like to be present?
(Example of this section, for me: My name is Amy Harrison, I am planning to give birth with the help of my midwife Hayley Mutch and my husband/birthing partner, Calvin Harrison, on due date August 8, 2011 at Victoria Hospital. I would like them to be present when they are able, and I would like my mother, mother-in-law, and 2 sisters to be free to visit during labour. During delivery I ask that only Hayley and Calvin are present. I would like 15 minutes after birth to establish breastfeeding and spend time as a family before visitors enter. I would like to leave the hospital shortly after.)
THE LABOUR SECTION
Where would you like to spend the majority of your labour?
What things would you like to do to ease the discomfort?
- E.g. I would like to remain mobile to ease discomfort. I would like to practice deep breathing and change of position to ease discomfort.
- Clearly state “I would not like medical pain relief offered to me” if you mean it.
How do you feel about the following things:
- IVs (You can opt to take fluids by mouth instead of IV, if you aren’t being prepped for surgery.)
- Shave preps
- Electronic fetal monitoring (consider continuous vs. intermittent)
- Induction (and which method?)
- Birthing stool, birthing tub, birthing ball, birthing bar
THE DELIVERY SECTION
How do you feel about:
- Episiotomy (vs. a natural tear)
- Assisted delivery (If the baby seems to have trouble being born they may offer vacuum suction or forceps.)
AFTER THE BIRTH
Who should cut the cord, and when?
Where should the baby be placed? (On your tummy?)
- I recommend making a note that you would like to try breastfeeding as soon as possible. This is a great choice!
How would you like the third stage (delivering the placenta) to do? (Unassisted, injection to speed it up, save the placenta, see the placenta, etc.)
Who can enter the room to see the new baby/parents?
How long would you like to stay in the room?
Then print your birth wishlist (make copies) and sign.