Limit cervical checks to those necessary for clinical decision-making.
Prefer fewer exams and spacing them out when possible; minimize repeat exams by multiple staff.
If an exam is recommended, please briefly state how it will change management.
Labor Interventions (General)
Vaginal delivery preferred; avoid cesarean if safely possible.
Avoid episiotomy unless emergent/necessary.
Artificial rupture of membranes, augmentation, or operative vaginal delivery only if indicated and discussed.
Induction / Augmentation Preferences (If Needed)
We understand induction method depends on cervix, fetal status, and clinical context.
If induction is indicated, preference is to start with cervical ripening approaches (mechanical balloon and/or prostaglandin cervical ripening per provider judgment) rather than proceeding directly to oxytocin when appropriate.
If oxytocin (Pitocin) is needed, request a low-dose protocol: start at the lowest feasible rate and titrate slowly in small increments, with close assessment of contraction pattern and fetal response, aiming to avoid tachysystole.
If tachysystole or fetal intolerance occurs, prefer prompt dose reduction/stop and reassessment.
Second Stage / Perineal Protection
Patient-directed pushing preferred when feasible.
Patient is comfortable with perineal massage and other perineal protective measures as clinically appropriate.
Open to warm compresses and position changes to reduce tearing risk.
Cord Management
Delayed cord clamping preferred when mother and baby are stable.
Request: delay clamping at least 60 seconds, and longer if feasible without compromising safety.
Note: some teams use time-based guidance (e.g., 30–60+ seconds); some use cord pulsation/appearance as a practical cue.
Placenta Delivery (Third Stage)
Prefer physiologic placental delivery when safe.
Please avoid traction/tugging on the umbilical cord to deliver the placenta unless clinically indicated.
If active management is recommended due to bleeding risk, please explain the indication and options.
Golden Hour / Skin-to-Skin
Immediate skin-to-skin requested if mother/baby stable.
Uninterrupted golden hour requested when clinically appropriate; delay routine measurements and non-urgent procedures.
Newborn Location / Rooming-In
Baby to remain with parents as much as medically appropriate.
If separation is required, request explanation and parent accompaniment when feasible.
Bathing
Delay first bath until after golden hour is complete (unless medically necessary).
When bath occurs, prefer submerged bath over sponge bath if clinically appropriate.
Labs, Injections, Vaccinations
For blood tests, injections, or vaccinations: request one parent present and holding baby unless medically contraindicated.
Please explain what is being done before proceeding.
If Cesarean Becomes Necessary
We understand cesarean may be the safest option in some situations. If needed, we request family-centered practices when feasible.
Father present in the OR per policy.
Skin-to-skin as soon as mother and baby are stable (in OR or PACU).
Delayed cord clamping if feasible and safe in the surgical context.
Minimize separation; baby with parents when possible.
For labs/injections: father holds baby when feasible; inform parents before any procedures.
Sharing Notes (For Staff)
This page is designed to be skimmed quickly by OB, RN, anesthesia, and doula.
Patient preference: collaboration and shared decision-making; flexibility if clinical status changes.
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