I thought to publish mine here :) I'll post after tomorrow's appointment as to what was given the kabash and what wasn't. I'm sure some is really out of my hands because they are "hospital policy" - but I'm still going to fight for it.
"This is our first baby, and though we admittedly have only a little idea of what we’re in store for, we appreciate your positive support in regards to our preferences for our labor and birth. We would like to try to have a drug-free labor and birth, and have prepared the best we can by practicing the Bradley Method. We understand that there may be circumstances that are out of our hands, but we hope that the information provided below will help in communicating our wishes for an “ideal” labor & birth situation. Thank You!
• My bloodtype is Rh- (Rhesus Negative)
• I would like to wear contact lenses or glasses at all times when conscious.
• Please perform no routine prepatory tasks (shaving, enema, etc.), unless requested.
• I expect that doctors and hospital staff will discuss all procedures with me before they are performed.
• I would like to be free to walk, change positions and use the bathroom as needed or desired.
• I prefer to eat and drink throughout labor, as desired.
• I will remain hydrated by drinking moderate amounts of fluids (water, juice, ice chips).
• So I can stay as mobile as possible, I would prefer to have a heparin lock administered instead of an IV.
• I would like a quiet, soothing environment during labor, with dim lights and minimal interruptions.
• I would like to play my own music.
• Please limit the number of vaginal exams.
• As long as my daughter is doing well, I prefer that fetal heart tones be monitored intermittently with an external monitor or doppler, even if the membranes have ruptured.
• I feel very strongly that I would like to avoid internal fetal monitoring.
• Please allow me to vocalize as desired during labor and birth without comment or criticism.
• I do not mind observation by students, interns or staff.
• Though I do not mind observation, I would prefer if talking was kept to a minimum.
• I would like to avoid induction unless it is medically necessary.
• As long as my daughter and I are healthy, I do not want to discuss induction prior to 42 weeks.
• I would like to try alternative means of labor augmentation, like walking or nipple stimulation, before pitocin or artificial rupture of membranes is attempted.
• Please do not rupture my membranes artificially unless medically indicated.
• Please do not offer anesthesia/analgesia unless I ask for it.
• If I ask for pain relief, please feel free to offer non-medical choices for coping and/or remind me how close I am to the birth.
• I would like to avoid all narcotics, if possible.
Cesarean Section Delivery
• I feel very strongly that I would like to avoid a cesarean delivery
• If a cesarean is necessary, I expect to be fully informed of all procedures and actively participate in decision-making.
• I would like Paul (Husband) to be present during the surgery.
• I would prefer epidural anesthesia, if possible, in order to remain conscious through the delivery.
• I would like to have a respectful atmosphere without chatter during any part of the surgical procedure.
• If possible, please do not strap my arms to the table during the procedure.
• If conditions permit, I would like to be the first to hold my daughter after the delivery.
• If possible, I would like to breastfeed my daughter immediately after the birth.
• If conditions permit, my daughter should be given to Paul (Husband) immediately after the birth.
• I would like our plans outlined here for after the birth to be followed as closely as possible.
• I prefer not to have an episiotomy unless it is medically indicated.
• To help my perineum stretch, please help guide my pushing efforts by letting me know when to push and when to stop.
• I would rather tear than have an episiotomy.
• Please suture tears only if necessary.
• Even if I am fully dilated, and assuming my daughter is not in distress, I would like to wait until I feel the urge to push before beginning the pushing phase.
• I would like the freedom to push and deliver in any position I like.
• I would like a soothing environment during the actual birth, with dim lights and quiet voices.
• I would like to have the birth recorded with photographs, video tape and/or tape recording.
Immediately after the birth
• Please place my daughter on my stomach/chest immediately after delivery.
• I would like to breastfeed my daughter immediately.
• I prefer to wait for spontaneous delivery of the placenta and do not want a routine injection of pitocin.
• I would like to wait 10-15 minutes before the umbilical cord is cut.
• Please remove my IV/Heparin lock/catheter as soon as possible after delivery.
• I would like to hold my daughter skin-to-skin during the first hours to help regulate baby's body temperature.
• Please evaluate and bathe my daughter at my bedside. If possible, please evaluate my daughter on my abdomen.
• If my daughter must go to the nursery for evaluation or medical treatment, Paul (Husband) or Rebekah (Sister) will accompany my daughter at all times.
• Please delay eye medication for my daughter until we are well past the initial bonding period (a couple hours after the birth).
• If available, would prefer erythromycin eye treatment or other antibiotic eye drops instead of silver nitrate.
• I would like to waive the administration of routine Vitamin K, unless medically indicated.
• I would prefer not to be catheterized until I've had some private time to attempt urination on my own.
• If available, I would prefer a private room.
• I would like to have my daughter room-in with me at all times.
• If available, I would like my Paul (Husband) to room-in with me.
• I plan to breastfeed and want to nurse immediately following the birth.
• Unless I am unable to give my consent, please do not give my daughter any supplements without first informing me of the reason(s) and seeking my consent.
• Please do not give my daughter a pacifier.
• I would like to take still photographs during labor and the birth.
• I would like to make a video recording of labor and/or the birth."