Name: Dana Cluff
Husband’s name: John Cluff
Baby Norah’s due date: May 7, 2013
Midwife’s name: Sherry Oldfield
My delivery is planned as:
~ Natural Home Birth, perhaps water birth
My Birth Team - I request the following people to be present during labor and delivery:
- John Cluff
- Kim Carr
- Sherry / Assistant
As long as the baby and I are healthy, I would like to have no time restrictions on the length of my pregnancy. If I go past my due date and the baby and I are fine, I prefer to go into labor naturally rather than be induced. If induction becomes medically necessary, I would like to try natural induction techniques first (with the guidance of my midwife), such as:
~ Nipple stimulation
~ Walking
~ Herbs
~ Castor oil
~ Acupuncture
~ Sexual intercourse
During labor, I’d like:
~ Music (and Hypnobirthing tracks) played
~ The lights dimmed
~ The room as quiet as possible
~ As few interruptions as possible
~ As few vaginal exams as possible
~ To wear my own clothes
~ My partner to film and take pictures
~ My partner to be present the entire time
~ To eat and drink as I please
~ Music (and Hypnobirthing tracks) played
~ The lights dimmed
~ The room as quiet as possible
~ As few interruptions as possible
~ As few vaginal exams as possible
~ To wear my own clothes
~ My partner to film and take pictures
~ My partner to be present the entire time
~ To eat and drink as I please
I’d like to spend the first stage of labor:
~ Standing up
~ Walking around
~ In the shower
~ In the bathtub
~ Standing up
~ Walking around
~ In the shower
~ In the bathtub
I'd like fetal monitoring to be:
~ Performed only by Doppler
~ Performed only by Doppler
For pain relief, I’d like to use:
~ Acupressure
~ Breathing techniques
~ Cryotherapy (cold)
~ Distraction techniques
~ Thermotherapy (heat)
~ Hypnotherapy
~ Massage
~ Meditation
~ Acupressure
~ Breathing techniques
~ Cryotherapy (cold)
~ Distraction techniques
~ Thermotherapy (heat)
~ Hypnotherapy
~ Massage
~ Meditation
During delivery, I would like to try these positions:
~ Squat
~ Lie on my side
~ Be on my hands and knees
~ Stand
~ Lean on my partner
~ Use people for leg support
~ Use a birthing ball
~ Be in the bath tub
~ Be in the shower
~ Squat
~ Lie on my side
~ Be on my hands and knees
~ Stand
~ Lean on my partner
~ Use people for leg support
~ Use a birthing ball
~ Be in the bath tub
~ Be in the shower
As the baby is delivered, I would like to:
~ Visualize “breathing the baby down”, and be encouraged to go slowly
~ Use a mirror to see the baby crown
~ Touch the head as it crowns
~ Not have an episiotomy (and risk a tear)
~ Place the baby on my chest as soon as possible
~ Visualize “breathing the baby down”, and be encouraged to go slowly
~ Use a mirror to see the baby crown
~ Touch the head as it crowns
~ Not have an episiotomy (and risk a tear)
~ Place the baby on my chest as soon as possible
Immediately after delivery, I would like:
~ To deliver the placenta spontaneously and without assistance, leaving it attached to the baby as long as possible (at least 20 minutes after birth)
~ The umbilical cord to be clamped only when we are ready to separate the placenta
~ To deliver the placenta spontaneously and without assistance, leaving it attached to the baby as long as possible (at least 20 minutes after birth)
~ The umbilical cord to be clamped only when we are ready to separate the placenta
If a C-section is necessary, I would like:
~ To make sure it is a true emergency
~ To make sure all other options have been exhausted
~ To stay conscious
~ My partner to remain with me the entire time
~ The placenta to REMAIN attached to the baby for AS LONG as possible, and for the cord to not be cut until we are ready to do so!
~ To make sure it is a true emergency
~ To make sure all other options have been exhausted
~ To stay conscious
~ My partner to remain with me the entire time
~ The placenta to REMAIN attached to the baby for AS LONG as possible, and for the cord to not be cut until we are ready to do so!
~ The screen lowered so I can watch baby and the placenta come out
~ My hands left free so I can touch the baby
~ My partner to hold the baby as soon as possible
~ To breastfeed in the recovery room
~ My hands left free so I can touch the baby
~ My partner to hold the baby as soon as possible
~ To breastfeed in the recovery room
I would like to hold baby:
~ Immediately after delivery
~ Immediately after delivery
I would like to breastfeed:
~ As soon as possible after delivery
~ As soon as possible after delivery
We’d like our family members:
~ To join us and baby in our room later (perhaps after baby is measured and weighed), and for the atmosphere to stay as quiet as possible during this time
I’d like baby’s medical exam and procedures:
~ Given in my presence
~ Given only after we’ve bonded
~ Given in my partner’s presence
~ Given in my presence
~ Given only after we’ve bonded
~ Given in my partner’s presence
Don’t give baby:
~ Vitamin K
~ Antibiotic eye treatment
~ Sugar water
~ Formula
~ A pacifier
~ Vitamin K
~ Antibiotic eye treatment
~ Sugar water
~ Formula
~ A pacifier
I’d like baby’s first bath given:
~ By me and my partner
~ By me and my partner
I’d like to feed baby:
~ Only with my breastmilk
~ On my baby’s schedule
~ With the help of a lactation specialist (Sherry)
~ Only with my breastmilk
~ On my baby’s schedule
~ With the help of a lactation specialist (Sherry)
I’d like baby to stay in my room:
~ All the time
~ All the time
If in the hospital, I’d like my partner:
~ To have unlimited visiting
~ To sleep in my room
~ To have unlimited visiting
~ To sleep in my room
After birth, I’d like to stay in the hospital:
~ As briefly as possible
~ As briefly as possible
If baby is not well, I’d like:
~ My partner and I to accompany it to the NICU or another facility
~ To ONLY breastfeed or provide pumped breastmilk
~ To hold baby whenever possible, for us to give baby neonatal massages, and kangaroo care (skin to skin contact)
~ My partner and I to accompany it to the NICU or another facility
~ To ONLY breastfeed or provide pumped breastmilk
~ To hold baby whenever possible, for us to give baby neonatal massages, and kangaroo care (skin to skin contact)
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