B I RT H P L A N

NAME:

Due Date: Dr.s Name: Allergies: My Delivery Is Planned As: Id Like To Be With Me: Pain Medication:

DURING LABOR

F I R S T S TAG E L A B O R

F E TA L M O N I T O R I N G

L A B O R AU G M E N TAT I O N

PAIN RELIEF: PLEASE DO NOT OFFER

D U R I N G D E L I V E RY

A S B A B Y I S D E L I V E R E D, I W O U L D L I K E T O :

A S B A B Y I S D E L I V E R E D, I W O U L D N O T L I K E T O :

I F C - S E C T I O N I S N E C E S S A RY, I W O U L D L I K E :

Emergency Contact:

B I RT H P L A N

I F C - S E C T I O N I S N E C E S S A RY, I W O U L D L I K E :

A F T E R D E L I V E RY

I D L I K E B A B I E S M E D I C A L E X A M A N D P RO C E D U R E S :

P L E A S E D O N O T G I V E B A B Y:

I D L I K E T O F E E D B A B Y:

I D L I K E B A B Y T O S T AY I N M Y R O O M :

ID LIKE MY HUSBAND

IF BABY IS NOT WELL, ID LIKE

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Emergency Contact:

B I RT H P L A N

ASPEN BALLARD

Due Date: July 28, 2013 Dr.s Name: Dr. Chang Allergies: Penicillin My Delivery Is Planned As: Vaginal Id Like: My Husband and Mother in the room.
My daughter is also welcome before
intense contractions Pain Medication: Please do not offer

DURING LABOR Music Played (I will provide) Dimmed Lights Wear my own clothes My husband present

F I R S T S TAG E L A B O R I would like to stay laying down or walking L A B O R AU G M E N TAT I O N As doctor recommends

F E TA L M O N I T O R I N G Continuous

Pitocin

Membrane Stripping

PAIN RELIEF: PLEASE DO NOT OFFER Breathing Techniques D U R I N G D E L I V E RY Semi Recline Use my mother and husband for leg support Massage Hot Therapy What I Request

A S F O S T E R I S D E L I V E R E D, I W O U L D L I K E T O : Push as directed My husband to cut the cord Use whatever method my doctor recommends Push without time limits as long as were not at risk My placenta saved and put over ice An episiotomy to prevent tearing, with anesthesia

A S F O S T E R I S D E L I V E R E D, I W O U L D N O T L I K E T O : Use a mirror to see him as he crowns Touch his head as he crowns

I F C - S E C T I O N I S N E C E S S A RY, I W O U L D L I K E : To make sure all options have been exhausted

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To stay conscious

Emergency Contact:

B I RT H P L A N

I F C - S E C T I O N I S N E C E S S A RY, I W O U L D L I K E : My husband to remain with me while he can My hands left free so I can touch and hold Foster My husband to hold Foster as soon as possible A F T E R D E L I V E RY I would like to hold Foster after cleaned and test are run Breastfeed immediately after delivery My husband, daughter and myself left alone with him After Bryson, Logan and I have bonded, family and friends can come in as they like and as many as allowed The screen lowered My surgery explained To breastfeed in the recovery room

I D L I K E F O S T E R S M E D I C A L E X A M A N D P RO C E D U R E S : Given in my presence or my husbands PLEASE DO NOT GIVE FOSTER: Sugar Water ID LIKE TO FEED FOSTER With only breast milk (pumped or naturally) On demand I D L I K E F O S T E R T O S T AY I N M Y R O O M : At all times (circumcision excluded) ID LIKE MY HUSBAND To have unlimited visiting IF FOSTER IS NOT WELL, ID LIKE My husband and I to accompany him to NICU To hold him whenever possible To breastfeed or provide pumped breast milk To sleep in my room With the help of a lactation consultant Formula To include circumcision

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Emergency Contact: