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Birth Preferences: _________(name)
Due Date: ___________ ? _________
Spouse: ______________ ? Doula: _____________
Pain Medication/ Pain
Delivery / Postpartum
Birth plan for _________ and ________
Our desire is to have a natural, non-medicated and intervention free birth. We fully appreciate your support in our decision.
Thank you for understanding; we know that you will do everything possible to make our stay in the hospital a pleasant one!
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