I desire that no family or guests attend the birth. If anyone shows up at the hospital they should be told to return home and wait for communication from my husband or myself.
All parties should note that we want silence during contractions and the delivery because of our religious beliefs.
Do not offer pain medication. I know my own pain threshold, and I will request it if I feel it is necessary.
When the baby is born, I would prefer that the room stay silent and calm. It is especially important do not want any comments about the sex or the state of health of the baby announced.
If there is a vaginal birth, please do not cut the cord until it has stopped pulsing.
I desire to keep the placenta. Please do not send it off as medical waste.
Under no circumstances do I want any drug administered to my baby or I without my express permission. Permission should be asked before EACH drug is administered.
I do not wish to have any drug in the benzodiazepine class even in a life saving emergency.
Please do not administer a Vitamin K injection to the baby.
Please do not administer eye prophylaxis to my baby after birth.
We would like to do the newborn screening tests as two tests, the first occurring before we leave the hospital.
A male baby will not be circumcised.
I desire a labor and delivery that is as free from medication and other interventions as possible. Please discuss any suggested interventions or procedures with me and obtain my consent for proceeding.
If there are strong indications of fetal distress or infection, I would like this fully examined before there is a decision to cut.
If the baby is found to be a surprise breech, I do not consider this to be an indication for caesarean.
In the event of a C-Section I do not want to be put to sleep, I want the surgery to be done with an epidural if possible.
I would like my husband to be in the room at all times during the surgery. If it is an emergency, I respect that the surgeons will need their space, but I still prefer that my husband be allowed at least to stay in the room, even if only in a corner that is out of the way.
I would like my wishes regarding silence (including music) to be respected during surgery. I know that some coordination is necessary between the surgeons, but this should be as succinct as possible.
When the baby is born, I would like it to be handed to my husband for care.
I would like to breastfeed the baby in the recovery room if possible.
Please do not admit my baby to special care simply for observation, but only if there is an emergent medical concern.
Please do not give my baby supplements of glucose water or formula milk without my permission.
Please do not give my baby a pacifier for any reason.
If I have trouble breastfeeding, I would greatly appreciate the help of a midwife who is fully supportive of breastfeeding, and would not like other interventions or solutions until it is clear that breastfeeding will be impossible.
I would like to go home as soon after the birth or surgery as possible, unless I, or my baby, have health problems that require hospital treatment.