Birth Preferences

Sarah C EDD Mar 20 2026 VHC Arlington
3 Things to Know First
  1. Unmedicated plan — please do not routinely offer epidural. Patient will request if desired.
  2. Delayed cord clamping — prefer waiting until cord turns white (when feasible and safe). Prioritize uninterrupted golden hour when stable.
  3. Limit interventions — avoid episiotomy, cesarean, and frequent cervical checks unless medically indicated.
Physiologic vaginal birth
Do not offer epidural
Avoid episiotomy
Baby stays with parents
OB: Dr Jessica Sommer, DO, FACOG
Doula: Eliza Williams
👥

Support People / Room

  • In room: Father of baby + doula only.
  • Low-stimulation environment — dim lighting; patient will provide twinkle/birthing lights.
  • Music — patient will provide playlist and Bluetooth speaker.
📡

Monitoring / Mobility / IV

  • Intermittent fetal monitoring preferred if clinically appropriate.
  • If continuous monitoring needed → wireless preferred (stay mobile).
  • Saline lock / portable IV preferred for ambulation.
  • Freedom to move, hydrate, and change positions during labor.
💛

Pain Management

Unmedicated
  • Plan: unmedicated.
  • Do NOT routinely offer epidural — patient understands she may request it at any time.
  • Non-pharmacologic comfort measures encouraged (movement, positioning, doula support).
🩺

Cervical Exams

≤ q4h
  • Limit to those necessary for clinical decisions — no more often than every 4 hours when feasible.
  • Minimize repeat exams by multiple staff — same provider preferred (OB).
  • If recommended, briefly state how the exam will change management.
⚕️

Labor Interventions

  • Vaginal delivery preferred — avoid cesarean if safely possible.
  • Avoid episiotomy unless emergent/necessary.
  • AROM, augmentation, or operative vaginal delivery only if indicated and discussed.
  • When assessing progress, please note if baby's head is well applied to cervix.
💧

Induction / Augmentation

If needed
We understand induction method depends on cervix, fetal status, and clinical context.
  • If indicated → start with cervical ripening (prostaglandin per provider judgment) before oxytocin. Prefer to avoid balloon if possible.
  • If Pitocin needed → low-dose protocol: lowest rate, titrate slowly (ideally ≤ q45min), assess contraction pattern + fetal response, avoid tachysystole.
  • If tachysystole or fetal intolerance → prompt dose reduction/stop and reassess.
🤱

Second Stage / Perineal Protection

  • Patient-directed pushing preferred when feasible.
  • Comfortable with perineal massage and other perineal protective measures.
  • Open to warm compresses and position changes to reduce tearing risk.
🔗

Cord Management

Delayed clamp
  • Delayed cord clamping — at least 60 seconds; prefer waiting until cord turns white when feasible and safe.
  • Father cuts cord (when feasible and per policy).
Some teams use time-based guidance (30–60+ sec); some use cord pulsation/appearance as a practical cue.
🌿

Placenta Delivery (Third Stage)

  • Prefer physiologic placental delivery when safe.
  • Avoid cord traction/tugging unless clinically indicated.
  • If active management recommended for bleeding risk → explain indication and options.
✨

Golden Hour / Skin-to-Skin

Priority
  • Immediate skin-to-skin if mother/baby stable.
  • Uninterrupted golden hour — delay routine measurements and non-urgent procedures.
👶

Newborn / Rooming-In

  • Baby remains with parents as much as medically appropriate.
  • If separation required → explain reason and allow parent accompaniment when feasible.
🛁

Bathing

Delay ~24h
  • Delay first bath ~24 hours (WHO guidance) when feasible.
  • If meconium present → sponge bath is okay.
  • Otherwise → prefer submerged bath over sponge bath if clinically appropriate.
💉

Labs / Injections / Vaccinations

  • One parent present and holding baby during all blood tests, injections, or vaccinations (unless medically contraindicated).
  • Explain what is being done before proceeding.
🏥

If Cesarean Becomes Necessary

Contingency
We understand cesarean may be the safest option in some situations. If needed, we request family-centered practices when feasible.
  • Father and doula in OR per policy.
  • Skin-to-skin ASAP (in OR or PACU) when mother and baby are stable.
  • Delayed cord clamping if feasible in surgical context.
  • Minimize separation — baby with parents when possible.
  • Father holds baby for labs/injections; inform parents before any procedures.
This document states preferences and does not replace clinical judgment or emergent management.
Last updated: [03/03/2026]  |  Contact during admission: [703-850-9025]