1. Labor to begin spontaneously, up to 42 weeks.

2.  Ability to move around during labor.

3..  Non-clinical pain relief during labor. Massage of hands, feet, back.  Optimal Fetal Positioning.

   Hydrotherapy- tub, shower, water birth,

4. Spontaneous Rupture of Membranes if warranted

5.  Minimum amount of fetal monitoring possible.

6.  Ability to eat and drink during labor.  Plans for nourishment.

7. Choose position for pushing:

 Semi-sitting, squatting, supported stand, birth stool, side-lying.

8.  Perineal massage/hot compresses & olive oil for management of perineum during 2^nd stage.

9. Touch baby’s head when crowning.

10. Lift baby out after head & shoulders are born.

11. Cord to stop pulsing before clamping.

12. Natural descent of placenta

1.  In the room for the entire labor.

2.  Will need to leave at some point.

3.  Want to be an active part of coaching.

4.  Would like all procedures, tests, and other interventions explained.

5.  Am able to stand the sight of blood.

6.  Would like coaching help from Midwife or Doula.

7.  Would like to play an active role in the delivery of the baby’s body.

8.  Special needs or concerns for partner.

9.  Would like to give baby Leboyer bath

10. Other questions or comments

1.  Immediate skin-to-skin contact

2.  Warm blanket for mom & baby

3. Dim lights in room

4. Baby to remain with mother for at least one hour.

5.  Any necessary procedures done on mom’s abdomen if possible.

6.  Breastfeeding as soon as the baby desires

7.  Baby sleeps with mom or in crib next to bed.

8.  CPR, infant care information

9.  PKU to be done while baby is nursing

10.  Circumcision info.?

11. Leboyer Bath

12. Special diet for mother

14. Nursing help desired