Hospital Preferences

Name

First Last

During my labor, I would prefer that the following people be in the room with me:

My Family/Friends
Adopting Mother(s)
Adopting Father(s)
Hudson Hearts Counselor

At the time of my delivery, I would prefer that the following people be in the room with me:

My Family/Friends
Adopting Mother(s)
Adopting Father(s)
Hudson Hearts Counselor

When the baby is born, I would like to:

Hold the baby first by myself
Request that the doctor give the baby to the adopting parent(s) to hold immediately
Prefer not to see the baby at all

During the postpartum, I prefer that the adopting parent(s):

Stay in my room with me and the baby
Stay in another room or in the nursery with the baby
Spend time in my room with the baby and some time in the nursery

I would like to be off the nursery floor following delivery prior to discharge:

Yes
No

I would like to spend time alone with the baby prior to discharge:

Yes
No

I understand that I will meet with the hospital Social Worker to complete the hospital discharge paperwork. I also understand that he/she will confirm that I am comfortable with my adoption plan:

Yes
No

I have been advised that I will complete the birth certificate form:

Yes
No

I prefer to:

Have an outfit and dress my baby upon discharge
Have the adopting parent(s) bring an outfit and dress the baby upon discharge

At the time of discharge, I prefer to:

Leave the hospital before the baby and adopting parent(s)
Leave the hospital after the baby and adopting parent(s)
Leave the hospital together with the baby and adopting parent(s)

HOSPITAL STAY PREFERENCE