Thank you for being part of our team for this amazing, transformative experience. We are so grateful for your knowledge and support.

My primary wish is a physiologic birth at home. Should there be reason to discuss other possibilities, we will address them with our care team and choose how to proceed.

I will keep my waters intact until they rupture naturally {in order to facilitate the most efficient dilation of my cervix, and provide my baby with a bacteriostatic environment for as long as possible.}

Vaginal exams as per my request only. {Please keep your hands off my vagina unless I ask, in order for the least disruption to my neocortex and my body’s intuitive responses to labour.}

I request an unmanaged, physiologic pushing phase {to protect my baby and my pelvic floor. I understand the difference between 10 cm dilated and complete dilation.} and will wait until my body begins pushing spontaneously. Please refrain from mentioning pushing unless I initiate the conversation.

I plan employ water organically throughout my labour and birth. Thank you for keeping an eye on the water temperature for me. {I may want to birth in water, or not. I may want to stay in the water to birth my placenta or I may want to get out once my baby is born.} Please wait until I initiate a move before making a suggestion. I prefer not to be disturbed.

Either myself or my partner will catch our child, unless we specifically request your help. {We prefer our child’s microbiome to be colonized by us.}

Thank you for facilitating a physiologic 3rd stage for our family. Please do not manipulate my fundus/uterus, or attempt cord traction for at least 30 minutes after the birth. Please don’t try to move me unless I ask you to. I do not consent to Pitocin during or after the birth. If you have reason to believe there is excessive bleeding (more than 1 litre/4 cups), we will address it in the moment and decide how to proceed.

We will cut/burn our son’s cord {or not} once it has stopped pulsing. We will keep our placenta in the bowl provided. Thank you for making sure that it gets safely into the fridge/on ice.

I would like the hour after birth unfold organically, with the least disruption possible. {I understand this to be a sacred time whereby my baby and I will be creating our deepest bond, facilitated by a complex cocktail of hormones unique to this moment and easily disrupted.} If you have questions at this time, please speak directly with my partner or my doula.

{I understand my baby will receive a bolus of highly oxygenated and glucose-rich blood from his/her placenta, and} does not need to nurse immediately.} Please allow my baby and I to initiate breastfeeding organically in our own time. It is ok if he/she doesn’t nurse in the first hour. I will ask for help if I want it.

Assuming all is well, I ask that the well-baby exam be done the following day, with baby skin-to-skin. I do/do not consent to Vitamin K and/or eye ointment. We can discuss the heel poke in our follow-up the next day.

Should the need to transfer arrive, I would like to continue to implement as many aspects of a physiologic birth as possible in hospital.