ACTUAL BIRTH 

-- I want to breathe and push my baby out -- I don't want my baby pulled out in any way.

-- If absolutely necessary, I would prefer the use of vacuum extraction rather than forceps. 

CESAREAN
-- Unless absolutely necessary, I would like to avoid a Cesarean. 

-- If a Cesarean delivery is indicated, I would like to be fully informed and to participate in the decision-making process. We prefer that the anesthesia take effect before the catheter is inserted and that there are no "hot spots" (areas which are
not yet numb) before the surgery begins. 

--I would like my doula and husband present at all times if the baby requires a Cesarean delivery. 

-- Please explain the surgery to me as it happens. 

-- So I can view the birth, please ask me if I would like the screen lowered just before delivery of the baby. 

--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 the baby after the delivery. 

-- If possible, I would like to breastfeed the baby immediately after the birth. 

EPISIOTOMY 

-- I would prefer not to have an episiotomy unless absolutely required for the baby's safety. 

-- If possible, I would like to use perineal massage and hot compresses to help avoid the need for an episiotomy. I request manual perineal support during pushing contractions to reduce tearing.
 
-- I would rather tear than have an episiotomy. One possible exception to this is "buttonholing", where a cut would be performed to direct 3rd degree tearing away from the anus and rectum; or situations of severe fetal distress, where the baby needs to come out extremely quickly. I would like a local anesthetic to repair a tear or an episiotomy. 

DELIVERY 

--I would like to give birth in the water, and I would like to be able to deliver in any position in the water that I feel comfortable in. 

--
If for some reason I cannot give birth in the water, I would like to be allowed to choose the position in which I give birth, including squatting, a supported squat, a hands-and-knees position. 

--I prefer to push or not push according to my instincts and may prefer not to have guidance or coaching in this effort. 

-- I do not want to use stirrups while pushing. 

--I would like a mirror available so I can see the baby's head when it crowns. 

-- I would like the chance to touch the baby's head when it crowns. 

-- Even if I am fully dilated, and assuming the baby is not in distress, I may like to try to wait until I feel the urge to push before beginning the pushing phase. 

--I may want to have the room lights turned low for the actual delivery and we may want to light candles to put around the room. 

-- My husband would like to be the person who catches the baby at birth. 

-- I would appreciate having the room as quiet as possible when the baby is born. 

-- I would like to have the baby placed on my stomach/chest immediately after delivery, and the two of us wrapped up warmly together, if necessary, if we are out of the water.