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Intervention Preferences
Below is a list of procedures commonly done in a hospital during birth. As your doula it is important for me to know which ones you hope to
avoid and how strongly your belief is. How much would it bother you if you had:
Your full name
Induced Labor?
Not at all
A little
A lot
Extremely
Not at all
A little
A lot
Extremely
IV during labor and birth?
Artificial rupture of the membranes?
Not at all
A little
A lot
Extremely
Continuous fetal monitoring?
Not at all
A little
A lot
Extremely
Internal Monitoring?
Not at all
A little
A lot
Extremely
Not at all
A little
A lot
Extremely
Pitocin Augmentation?
Not at all
A little
A lot
Extremely
Vacuum Extractor/Forceps?
Not at all
A little
A lot
Extremely
Cesarean Birth?
Urinary Catheter?
Not at all
A little
A lot
Extremely
Not at all
A little
A lot
Extremely
Pushing on your back?
Not at all
A little
A lot
Extremely
Episiotomy?
Not at all
A little
A lot
Extremely
Perinial Tear?
Narcotic pain relief?
Not at all
A little
A lot
Extremely
Epidural for labor?
Not at all
A little
A lot
Extremely
Baby going to nursery?
Not at all
A little
A lot
Extremely