Tuesday, March 28, 2023

My Birth Preferences

My Birth Preferences

At West Valley Medical Center, we’re dedicated to providing you and your family with focused attention and compassionate care as you go through the journey of delivering a healthy baby. We created this tool to help you outline some of your preferences for the childbirth process. Situations may arise during which – for the safety of you or your baby – your first preference is not possible. If those situations arise, you will be kept informed of your choices and allowed the chance to give informed consent whenever possible. We’ll partner with you to reach your labor and delivery goals together in a safe, nurturing environment. Please save this document for your own records, bring it to your free Childbirth Preparation Class, share it with your provider, and tuck a copy in your “go bag” for the big day!

General Information

Birth Philosophy

During Labor

Anesthesia/Pain Medication


2nd Stage of Labor


Cesarean Section Delivery

3rd Stage of Labor


Infant Feeding


My Hospital Stay

Additional Notes

Save My Birth Preferences

By selecting the Save button, your information will remain available for two days. If this is a public computer, we don't recommend saving this form.

You may also print out your birth preferences to have on hand during your pregnancy. Please consider the environment before printing.

By selecting the Reset button, your information will be cleared from all the above fields.

Next Steps

Once you complete your birth plan, we recommend the following next steps:

  1. Contact us to find out about tour options and maternity classes
  2. Print and discuss the birth plan with your doctor
  3. Bring a printed copy of the birth plan with you when you come to deliver at the hospital

General Internet communication is inherently not secure. DO NOT send data considered confidential or private in nature on this form. (e.g., Social Security Numbers, Diagnosis Information, Credit Card Numbers, etc.)