Primary Medical Care Givers
This is who you would prefer to “look after you”, medically speaking. You may have full confidence in midwifery care and wish for no involvement by a doctor – except in circum-stances beyond the midwife’s expertise – or, in the event of requiring a doctor to be called, you would list your preferred GP or Ob / Gyno. See also “Birthing Assistance and Support”, page 272 for expanded information on this topic.
Other Supporters / Assistants
Write in names and roles of those you’ll be inviting or bringing along to provide non-medical support – e.g. partners, advocates, doulas, etc. See pages 275 - 278.
Your desire to allow or disallow the presence or involvement of non-involved people such as resident doctors, medical students, uninvited personnel or visitors.
Indicate your wishes to move around, both within the room and outside of it if feasible; to use the shower, bath, rails, cushions, furniture, positions, etc. Where there exists a choice of rooms, express your desire to be allocated the most suitable room. For example, in some rural areas, where Birth Centres don’t exist, there may be small pokey labour rooms and larger family birthing rooms. In some wards, showers are not ensuite and might be down the hall. Pre-visit your hospital to find out what is and what isn’t available. See also pages 301 - 309.
Dim lights, candles, aromatherapy oils, incense, peace and quiet, music may be your scene. Mention any important things you’d like staff to be aware of. See also pages 296 - 297.
Express your wishes about how you will want to manage hunger and food during labour. You may be bringing it, or buying it from in or nearby the hospital. You may like the midwife to give guidance about the use of food, for example in maintaining energy level or avoiding nausea. See also “Food During Labour”, page 297.
Monitoring and Examination
Express your preferences for the different monitoring and examination options. For the baby there can be foetal heart rate (internal scalp, external belt, Foetoscope or the old fashioned Pinard
horn).For the mother there can be: vaginal examinations, heart and blood pressure monitoring, contraction monitoring, urine tests. State how often you would tolerate any of these. You can also insist that there is no continuous monitoring. You can ask that monitoring not be done inconveniently, or request that examinations are done in whatever position you are in, rather than having to get up on the bed. Decide who is to be informed of your “progress”. See also pages 282 - 285.
Labour Induction and Progress of 1st Stage
Consider your attitude to the routine medical time limits for 1st Stage labour and how you wish these guidelines to be managed in your labour. Would you consider having your labour artificially induced in the first instance, or sped up at any later time? If so, by what method – intravenous drip or vagina gel? See also pages 280 - 282.
Would you wish this done: if deemed neces-sary, only upon request, or under no circum-stances? See also pages 287 - 288.
Management of Pain
Consider your most likely response to pain and outline your preferences for management. Pethidine, epidural (standard / walking), pudendal block? Water methods, massage, comfort, activity? Only if requested by the mother, upon the suggestion of others? See also “Medicinal Pain Relief” page 285, and “Natural Pain Management” page 299.
2nd Stage Management
Consider your attitude to the routine medical methodologies for 2nd Stage labour and how you would like this stage managed. Write your preference for free choice of birthing place and position, pushing urges, use of mirror, help in touching the baby’s head, use of forceps, vacuum extraction, use of perineal massage, episiotomy or natural tear, stitches, etc. See also pages 288 - 290.
Who would you like to first know this and announce it?
Indicate your choice for a natural or acceler-ated delivery, your wishes to inspect it and discuss its condition, any desires to take it home.See also “Placental Induction” page 290, and “Natural Placental Delivery” page 323.