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Birth Preferences
Sample III
Bullet Point
Format
This type of Birth Preferences sheet also works well when printed
on a colored index card. A Bullet point list works best in an
uncompromising place of birth. It's a down-and-dirty,
non-negotiable list of your most important preferences.
As alway, get it signed.
Same reasons still apply.
BIRTH PREFERENCES
We have prepared these Birth Preferences to help you understand our
philosophy
and the kind of care we hope to have for the birth of our
child. We expect, and trust, that our practitioner
will seek our opinion on all issues that may affect our birth
experience or that deviate from these preferences. We fully realize
that
emergencies can happen, and that in the case of an emergency, the Birth
Team will take the best steps for our family.
- Provide Informed Consent Before All Procedures
- Full Mobility with Intermittent Fetal Monitoring
- Self-Directed Pushing
- Avoid all Labor Augmentation
- Delayed Cord Clamping
- Prefer Tear vs Episiotomy
- Delay All Newborn Procedures
- No Circumcision
- We Refuse All Newborn Vaccinations
- Breastmilk Only - No Supplementation of Any Kind
- If Baby is Sick, Father will Accompany at All Times
We thank you for taking the time to go over these Birth Preferences,
and
appreciate your cooperation in getting our new family off to great
start!
Physician
Date
Mother
Date
Father
Date
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