[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-352012-105":53,"doc-detail-352012-en":126},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":119,"head_meta":121,"extra_data":123,"updated_unix":125},105,"en","cleveland-clinic-birth-preferences-worksheet-form","Cleveland Clinic Birth Preferences Worksheet - Form","","Cleveland Clinic Birth Preferences Worksheet helps patients document personal values and specific choices for labor, delivery, and postpartum care. The form prompts patients to identify preferred name and pronouns, note discussions with an OB provider, and share preferences for labor support, pain management, comfort items, monitoring, and procedures. It also collects information about baby’s sex/name announcement, who should be present, preferred birthing positions, c-section options, cord blood banking, and postpartum preferences for care team review.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/cleveland-clinic-birth-preferences-worksheet-form/352012/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/cleveland-clinic-birth-preferences-worksheet-form/352012.png","ImageObject",442,249,{"name":88,"@type":89},"Aldword","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-11","2026-09-22",true,{"@type":98,"interactionType":99,"userInteractionCount":76},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What is the purpose of the Birth Preferences Worksheet?","Question",{"text":108,"@type":109},"It helps a patient record labor, delivery, and postpartum values and preferences to review with the OB provider and care team during prenatal care and as labor progresses.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"When should labor and delivery decisions be made?",{"text":113,"@type":109},"The worksheet states decisions are best made by the patient with the OB provider during prenatal visits, well before the time of birth.",{"name":115,"@type":106,"acceptedAnswer":116},"Does the form allow preferences to change if medical needs arise?",{"text":117,"@type":109},"Yes. It notes preferences and wishes may not be followed exactly as written and may need to change to ensure a safe, healthy birth for the patient and baby.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},352012,1791356533,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":135,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":76,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":9},2336478940917,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","Cleveland Clinic Birth Preferences Worksheet  \nMy preferred name:    \nMy preferred pronouns are:    \nDecisions about labor and delivery preferences are best made by you, with your OB provider, during prenatal visits, well before the time of birth. While some people will need very little intervention during labor and delivery, people with certain medical conditions may need procedures, such as continuous monitoring for baby or induction of labor, to improve safety and ensure a healthy delivery.  \nYour OB provider can tell you about the benefits, risks, and alternatives of the decisions you may face during labor and birth. This is your opportunity to share your values and preferences and make informed decisions together, based on your needs. This form should go with you to the hospital to be shared with your care team and reviewed as labor progresses.  \nMy OB provider is:   I have talked about and shared my labor and birth preferences with my OB provider during prenatal care visits. I recognize that my preferences and wishes may not be followed just as written and may need to change if medical needs arise in order to ensure a safe and healthy birth for my baby and me.  \nI would like my care team to know this about me and/or my history:    \n__________________________________________________________________________________________  \n__________________________________________________________________________________________  \nI am having a:  \n[ ] Girl [ ] Boy  \n[ ] Surprise – I would like   to announce  \nMy baby’s name is:   I’d like the following people to be present during labor and/or birth:  \nPartner:  \n__________________________________________________________________________________  \nFriend/s:  \n_________________________________________________________________________________  \nRelative/s:   Other:    \nDoula:    \nCleveland Clinic | Birth Preferences Worksheet 23-WHI-4492458  \nComfort items:  \nI’d like to (check all that apply):  \n[ ] Bring music/a sound machine [ ] Dim the lights  \n[ ] Bring an aromatherapy diffuser/essential oils  \n[ ] Wear my own gown/robe during labor and delivery  \n[ ] Bring a pillow/blanket from home [ ] Bring my own slippers/socks  \nHospital admission & procedures  \nOnce I’m admitted, as long as the baby and I are doing fine, I’d like to (check all that apply):  \n[ ] Use a low intervention birthing suite  \n[ ] Have an IV in place but drink clear fluids to stay hydrated rather than have an IV infusion  \n[ ] To have movement in labor: Walk / Sit on a birthing ball / Use a rocking chair  \n[ ] Have intermittent rather than continuous fetal monitoring  \n[ ] Use portable monitoring for baby if available if  \nI would like to move and need monitoring [ ] Be allowed to progress free of strict time limits [ ] Have my labor augmented only if necessary  \n(membrane sweeping, pitocin, breaking water)[ ] Limit vaginal exams  \n[ ] Have all procedures and interventions discussed with me first  \n[ ] Take pictures and/or video during labor and after delivery (institutional policy prohibits filming/ photos of delivery & during emergencies, you should have opportunities to take photos before & after delivery)  \nLabor support:  \nIf available and safe for me and baby, I’d like to try a (check all that apply) :  \n[ ] Squatting bar  \n[ ] Birthing pool/tub  \n[ ] Shower  \n[ ] Peanut ball  \n[ ] Birthing ball  \n[ ] Other labor props as available on the unit (i.e. , birthing stool)  \nPain relief  \nI’d like to try the following pain-management techniques (check all that apply):  \n[ ] Acupressure  \n[ ] Bath/shower  \n[ ] Breathing techniques  \n[ ] Distraction (tablet, watch TV, read, etc.)[ ] Hot/cold therapy  \n[ ] Self-hypnosis  \n[ ] Massage  \n[ ] Medication  \nOther:    \nPain relief:  \nIf I decide I want medicinal pain relief, I’d prefer (check all that apply):  \n[ ] An epidural [ ] IV pain medication [ ] Nitrous oxide  \nPushing:  \nWhen it’s time to push, as long as my baby and I are doing fine, I’d like to (check all that apply):  \n[","cbCaikqF7AIMVxVe","https://ap.wps.com/l/cbCaikqF7AIMVxVe","pdf",172564,6,"English","# Birth Preferences Worksheet\n## Personal Preferences and Care Team Notes\n## Labor, Comfort Items, and Admission Decisions\n## Labor Support, Pain Relief, and Pushing\n## Positions, Delivery, and Post-Birth Care\n## C-Section Options\n## Cord Blood Banking\n## Postpartum Preferences","[{\"question\":\"What is the purpose of the Birth Preferences Worksheet?\",\"answer\":\"It helps a patient record labor, delivery, and postpartum values and preferences to review with the OB provider and care team during prenatal care and as labor progresses.\"},{\"question\":\"When should labor and delivery decisions be made?\",\"answer\":\"The worksheet states decisions are best made by the patient with the OB provider during prenatal visits, well before the time of birth.\"},{\"question\":\"Does the form allow preferences to change if medical needs arise?\",\"answer\":\"Yes. It notes preferences and wishes may not be followed exactly as written and may need to change to ensure a safe, healthy birth for the patient and baby.\"}]","Cleveland Clinic Birth Preferences Worksheet - Form | PDF",1790097119]