Birth Vision - For the Birth Partner
This form should be filled out by the birth partner, while not in the presence of the mother! Please take your time to fill this out thoughtfully. I will bring a copy of both the mothers, and the partners answers to our prenatal appointment. I will be reading these answers out loud. This exercise will allow us to see if the mother and partner have similar or dissimilar visions of the birth and allows me a more complete view of the birth team!
Name
First Name
Last Name
When you think about birth, what top three words come to your mind?
Describe your ideal birth. What would the environment be like? How do you want to feel and be treated? How would your birth team serve you?
Given that the mother and baby are healthy and doing well, what are your top three priorities or goals for this labor and birth? (ex: respect, choices, calm environment, minimal interventions, etc.)
What is your biggest fear about labor and birth?
When the mother is in pain, what types of physical comforts does she like to use? (Ex: a quiet room, heat, cold, words spoken, etc.)
Where does the mother hold tension in her body?
What role do you want to take in the birth of your child? Do you have any needs or desires that you want to fufill?
What do you anticipate you will need help with?
What would your "dream doula" experience be like? What role would you like your doula to fulfill?
What do you anticipate the mothers needs to be for labor and delivery?
What do you anticipate your families needs to be for postpartum? (both immediately postpartum and long term)
Is there any other information you would like me to be aware of so that I may serve you better?
Submit
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