Mother's Name *
Mother's Name
Phone *
Phone
Father/Partner's Name
Father/Partner's Name
Phone
Phone
Address
Address
Music Lighting, visitors Essential Oils
Artificial induction (suppositories, foley balloon, pitocin) Artificial augmentation (pitocin) Membrane Sweep Natural methods
Food/drink Mobility Entonox (gas) Pethidine (opiate) Morphine (nervous system) Epidural Desire to be in water? Open to massage, hot/cold packs?
Vaginal exams Doppler or internal
Communication techniques Triggers or needs in discomfort Position for delivery Touch crown of head/mirror to see Photography Religious/Spiritual practices
Forceps Vacuum Episiotomy Perennial massage, hot compress
Postpartum
Immediately after delivery