Публикую по просьбе :). Может кому-то пригодится. С собой в госпитале желательно иметь 3 копии такого документа. Сюда же можно вставить фото, ну и конечно каждый может скорректировать под себя. :)
Birth Preferences for ... and ... and our baby (girl/boy)(Due: ...)
Patient of ..., ... Hospital
I am ..., and my husband is .... Our birth assistant, ..., will accompany us. I fully understand that in certain circumstances these guidelines may not be followed, but it is my hope that you will assist me in making this the experience I hope for. We welcome your suggestions at any point. We plan to be flexible and hope that you will too. We are both detailed oriented people, so we like to be informed about details, we also realize that we will be inundated with lots of information during this time. We hope that by learning about laborahead of time that we can make the best decisions for us.
My primary concerns are to avoid induction and a C-section if at all possible. I would also like to have freedom of movement to deal with pain naturally for as long as I can, please do not bring up pain medication, if I want it I will ask for it using my code word PINEAPPLE.
First Stage
I would like to spend my early labor at home. If you think that I have arrived at the hospital in early labor, I would like to return home.
I would like the lights dim and to be able to listen to my own music.
I would like to eat and drink during early labor if can. Please remind me to drink if I forget. I prefer this to IV fluids, if I do need an IV I would like a Heparin Lock.
My primary plan to cope with pain is to use movement and water. I hope to be able to walk, stand, and use the shower or bath or exercise balls, etc.
To help me with freedom of movement, I would like the baby monitored intermittently, if the baby has to be continuously monitored please do it with wireless devices.
... and ... may help with relaxation techniques, including massage and positioning.
I would like to use natural techniques to stimulate labor if necessary, such as nipple stimulation, before considering medications.
Please do not bring up pain medication, if I want it I will bring it up.
Second Stage
I would like to follow my own urges to push in whatever position I find comfortable.
Please make suggestions if you think I could do something more effectively.
I prefer to tear naturally and not have an episiotomy.
After the birth (our wishes for our baby):
After the baby is born, ... would like to cut the cord.
We would like our baby to be with us at all times unless it is medically necessary for her/him to be taken away, if that is the case we want ... to stay with her at all times.
We have decided not to do the antibiotic eye ointment.
We don’t want to have the Hepatitis B shot given at the hospital. We have discussed this with our pediatrician.
I plan to breastfeed her on demand without bottles, and I appreciate lactation coaching/assistance if available. I’d like to wait several weeks before I try a pacifier. Please do not offer the baby any glucose water, pacifiers or formula.
Thank you so much for taking the time to read our wishes; we greatly appreciate your help in making this a wonderful experience for our growing family.
Birth Preferences for ... and ... and our baby (girl/boy)(Due: ...)
Patient of ..., ... Hospital
I am ..., and my husband is .... Our birth assistant, ..., will accompany us. I fully understand that in certain circumstances these guidelines may not be followed, but it is my hope that you will assist me in making this the experience I hope for. We welcome your suggestions at any point. We plan to be flexible and hope that you will too. We are both detailed oriented people, so we like to be informed about details, we also realize that we will be inundated with lots of information during this time. We hope that by learning about laborahead of time that we can make the best decisions for us.
My primary concerns are to avoid induction and a C-section if at all possible. I would also like to have freedom of movement to deal with pain naturally for as long as I can, please do not bring up pain medication, if I want it I will ask for it using my code word PINEAPPLE.
First Stage
I would like to spend my early labor at home. If you think that I have arrived at the hospital in early labor, I would like to return home.
I would like the lights dim and to be able to listen to my own music.
I would like to eat and drink during early labor if can. Please remind me to drink if I forget. I prefer this to IV fluids, if I do need an IV I would like a Heparin Lock.
My primary plan to cope with pain is to use movement and water. I hope to be able to walk, stand, and use the shower or bath or exercise balls, etc.
To help me with freedom of movement, I would like the baby monitored intermittently, if the baby has to be continuously monitored please do it with wireless devices.
... and ... may help with relaxation techniques, including massage and positioning.
I would like to use natural techniques to stimulate labor if necessary, such as nipple stimulation, before considering medications.
Please do not bring up pain medication, if I want it I will bring it up.
Second Stage
I would like to follow my own urges to push in whatever position I find comfortable.
Please make suggestions if you think I could do something more effectively.
I prefer to tear naturally and not have an episiotomy.
After the birth (our wishes for our baby):
After the baby is born, ... would like to cut the cord.
We would like our baby to be with us at all times unless it is medically necessary for her/him to be taken away, if that is the case we want ... to stay with her at all times.
We have decided not to do the antibiotic eye ointment.
We don’t want to have the Hepatitis B shot given at the hospital. We have discussed this with our pediatrician.
I plan to breastfeed her on demand without bottles, and I appreciate lactation coaching/assistance if available. I’d like to wait several weeks before I try a pacifier. Please do not offer the baby any glucose water, pacifiers or formula.
Thank you so much for taking the time to read our wishes; we greatly appreciate your help in making this a wonderful experience for our growing family.
