Wishes for Childbirth for Karlee Dawn Bloom
Due Date: June 1st, 2009
Patient of: San Joaquin Hospital
Please Note
My bloodtype is Rh- (Rhesus Negative)
Labor
I would like to have an enema upon admission to the hospital.
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 wear my own clothes, rather than a hospital gown.
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 adminstered instead of an IV.
Please do not administer an IV or heparin lock unless there is a clear medical indication that such is necessary.
I would like a quiet, soothing environment during labor, with dim lights and minimal interruptions.
Please limit the number of vaginal exams.
As long as my son is doing well, I prefer that fetal heart tones be monitored intermittently with an external monitor or doppler, even if the membranes have ruptured.
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.
To preserve my privacy and dignity, I would prefer that everyone knock before entering.
Labor Augmentation/Induction
I would like to avoid induction unless it is medically necessary.
As long as my son and I are healthy, I do not want to discuss induction prior to 42 weeks.
If my pregnancy progresses past 40 weeks, I would prefer to base the decision to induce on the results of my son's biophysical profiles, not on my own personal discomfort or impatience.
If induction is attempted, but fails, I would like to come back at another time rather than pursue further intervention (assuming my membranes are intact and that waiting presents no danger to my son or myself).
Please do not rupture my membranes artificially unless medically indicated.
Anesthesia/Pain Medication
Please do not offer anesthesia/analgesia unless I ask for it.
If I ask for pain relief, please feel free to offer nonmedical 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 My moms, Angela Granheim and Tricia Bloom to be present during the surgery.
Please explain the surgery to me as it happens.
I would prefer epidural anesthesia, if possible, in order to remain conscious through the delivery.
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 son after the delivery.
I would like our plans outlined here for after the birth to be followed as closely as possible.
Perineal Care
I prefer not to have an episiotomy unless it is medically indicated.
I would rather have an episiotomy than risk a tear.
Please administer local anesthesia when repairing any episiotomy or tear(s).
Please suture tears only if necessary.
Delivery
Even if I am fully dilated, and assuming my son is not in distress, I would like to wait until I feel the urge to push before beginning the pushing phase.
I prefer to push or not push according to my instincts and would prefer not to have guidance or coaching in this effort.
I would like the freedom to push and deliver in any position I like.
I would appreciate help from My moms, Angela Granheim and Tricia Bloom supporting my legs as I push.
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 son on my stomach/chest immediately after delivery.
Please allow the umbilical cord to stop pulsating before it is cut.
I prefer to wait for spontaneous delivery of the placenta and do not want a routine injection of pitocin.
Please remove my IV/Heparin lock/catheter as soon as possible after delivery.
Newborn Care
I would like to hold my son skin-to-skin during the first hours to help regulate baby's body temperature.
I would like to hold my son through delivery of the placenta and any repair procedures.
Please evaluate and bathe my son at my bedside.
If possible, please evaluate my son on my abdomen.
Postpartum Care
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.
Once I've had time to recover, I would like my son to room-in with me.
I would like my son to room-in with me.
I would like permission for access to my chart and my son's chart.
Breastfeeding
Please do not give my son supplements (including formula, glucose, or plain water) without my consent, unless there is an urgent medical necessity.
Unless I am unable to give my consent, please do not give my son any supplements without first informing me of the reason(s) and seeking my consent.
Please do not give my son a pacifier.
Additional notes
I would like to take still photographs during labor and the birth.
I am planning for my son to be circumcised before we check out of the hospital. (Note: Do not waive Vitamin K shot in this event)
Due Date: June 1st, 2009
Patient of: San Joaquin Hospital
Please Note
My bloodtype is Rh- (Rhesus Negative)
Labor
I would like to have an enema upon admission to the hospital.
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 wear my own clothes, rather than a hospital gown.
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 adminstered instead of an IV.
Please do not administer an IV or heparin lock unless there is a clear medical indication that such is necessary.
I would like a quiet, soothing environment during labor, with dim lights and minimal interruptions.
Please limit the number of vaginal exams.
As long as my son is doing well, I prefer that fetal heart tones be monitored intermittently with an external monitor or doppler, even if the membranes have ruptured.
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.
To preserve my privacy and dignity, I would prefer that everyone knock before entering.
Labor Augmentation/Induction
I would like to avoid induction unless it is medically necessary.
As long as my son and I are healthy, I do not want to discuss induction prior to 42 weeks.
If my pregnancy progresses past 40 weeks, I would prefer to base the decision to induce on the results of my son's biophysical profiles, not on my own personal discomfort or impatience.
If induction is attempted, but fails, I would like to come back at another time rather than pursue further intervention (assuming my membranes are intact and that waiting presents no danger to my son or myself).
Please do not rupture my membranes artificially unless medically indicated.
Anesthesia/Pain Medication
Please do not offer anesthesia/analgesia unless I ask for it.
If I ask for pain relief, please feel free to offer nonmedical 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 My moms, Angela Granheim and Tricia Bloom to be present during the surgery.
Please explain the surgery to me as it happens.
I would prefer epidural anesthesia, if possible, in order to remain conscious through the delivery.
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 son after the delivery.
I would like our plans outlined here for after the birth to be followed as closely as possible.
Perineal Care
I prefer not to have an episiotomy unless it is medically indicated.
I would rather have an episiotomy than risk a tear.
Please administer local anesthesia when repairing any episiotomy or tear(s).
Please suture tears only if necessary.
Delivery
Even if I am fully dilated, and assuming my son is not in distress, I would like to wait until I feel the urge to push before beginning the pushing phase.
I prefer to push or not push according to my instincts and would prefer not to have guidance or coaching in this effort.
I would like the freedom to push and deliver in any position I like.
I would appreciate help from My moms, Angela Granheim and Tricia Bloom supporting my legs as I push.
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 son on my stomach/chest immediately after delivery.
Please allow the umbilical cord to stop pulsating before it is cut.
I prefer to wait for spontaneous delivery of the placenta and do not want a routine injection of pitocin.
Please remove my IV/Heparin lock/catheter as soon as possible after delivery.
Newborn Care
I would like to hold my son skin-to-skin during the first hours to help regulate baby's body temperature.
I would like to hold my son through delivery of the placenta and any repair procedures.
Please evaluate and bathe my son at my bedside.
If possible, please evaluate my son on my abdomen.
Postpartum Care
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.
Once I've had time to recover, I would like my son to room-in with me.
I would like my son to room-in with me.
I would like permission for access to my chart and my son's chart.
Breastfeeding
Please do not give my son supplements (including formula, glucose, or plain water) without my consent, unless there is an urgent medical necessity.
Unless I am unable to give my consent, please do not give my son any supplements without first informing me of the reason(s) and seeking my consent.
Please do not give my son a pacifier.
Additional notes
I would like to take still photographs during labor and the birth.
I am planning for my son to be circumcised before we check out of the hospital. (Note: Do not waive Vitamin K shot in this event)
