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Genesis Women’s Health & Midwifery Birth Center is Now Open -Accepting New Patients !!!!

Guía del plan de parto de Genesis Birth Concepts

Pregnant Woman in Underwear

14 de marzo de 1984

Personal Photo

First name*

Last name*

Email*

Phone*

Address

Birthday

Día

Mes

Año

Expected Due Date*

Día

Mes

Año

Name of Primary Support Person*

Relationship of Support Person

Name of Physician/ Certified Nurse Midwife*

My Delivery Is Planned As:*

Natural Childbirth

Water Birth

I Would Like To Wear;

Hospital Gown

My Own Clothes

For Comfort Measures During Labor, I Would Like To:

Walk In The Room/Hall

Use The Birthing Ball

Use Heat/ Cold Massage

Use Water Therapy

Use My Own Pillows

Have Clear Liquids (Water, Juice, Jello)

Use Shower

Use Squat Bar

Sit In Rocker

For Pain Control

During The Pushing Phase of Labor, I Would Like To:

Use Foot Pedals

Use The Stirrups

Use The Squat Bar

Use Whatever Method Is Comfortable At That Time

For Intravenous Access I Would Prefer:

That upon admission, routine lab work will be drawn and at that time, tubing will remain in place and a saline lock created.

If an IV must be connected, I do not want any pain medications administered through the IV without permission from me or my significant other.

To be kept informed at all times regarding IV fluids I am receiving, medications, and their purpose.

During Birth:

I want to see the baby's head (in a mirror) as it crowns

I want to touch the baby's head as it crowns.

I want my partner to help catch the baby (if appropriate).

Immediately After The Deliver, I Would Like To:

Place baby skin-to-skin

Wrap baby in blanket before holding.

Breastfeed my baby within the first hour

Have my significant other cut the cord

Have my baby's first bath in my room.

Feeding:

I plan to breastfeed

Please assist me with nursing as soon as possible after the birth.

Please no supplemental formula to my baby without my permission.

I plan to bottle feed my baby

If I Have A Boy, I Would Like For Him To Be Circumcised

Yes

No

I Plan to Attend, or Have Already Attended, These Classes During This Pregnancy

Early Pregnancy

Baby Basics

Basic Training For New Dads

Breastfeeding Basics

Childbirth Preparation

What is the best and/or worst thing about your previous labor and birth? Or other comments:

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info@genesisbirthconcepts.com
2788 Bayard Street
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East Point, Georgia 30344

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