Risks of Program/Procedure:

natural birthing

There are several possible complications and risks arising from childbirth and from participation in the Program/Procedure described in this agreement and consent. Some of these complications are listed below. This information is not meant to produce fear or anxiety, but to properly advise patients of the risks involved. The following does not include every possible injury or complication..

  • Fetal distress, which is the lack of oxygen for the baby before birth.
  • Neonatal asphyxia, which is the lack of oxygen for the baby after birth.
  • Maternal hemorrhage, which is excessive blood loss from the mother.
  • Pre-eclampsia, which includes high blood pressure and possible convulsions/seizures.
  • Placenta previa, which is when the placenta is placed on or near the cervix.
  • Placenta abruption, which is premature separation of the placenta prior to the delivery from the uterus.
  • Retained placental tissue, which can cause maternal hemorrhage and infection to the mother.
  • Cephalopelvic disproportion, which is where the baby is too large to pass through the pelvis.
  • Shoulder dystocia,which is a condition where the shoulders of the baby become lodged in the pelvis after the babies head has emerged
  • Prolapse of the umbilical cord, which can result in the deprivation of oxygen and nutrients to the baby.
  • Malpresentation of the baby during birth, which is where the baby is not descending into the birth canal in an optimal position.
  • Stillbirth/Fetal Demise.
  • Maladaptation to life outside the womb

All of these complications could happen during labor & birth anywhere and could result in permanent injury and/or death to the baby and/or mother.

Agreement of Patient:

Before participating in the Holistic Birthing Center/Program, I understand and agree to the following:

  1. I will abide by the terms and conditions contained in the document entitled "HBC Responsibilities," which is attached to this document;
  2. I agree that in order to participate in Holistic Birthing Center/Program, I must participate in all education and orientation provided throughout the program, including, but not limited to, education regarding philosophy of The Holistic Birthing Center/Program, education regarding labor and birth, and education regarding care of my newborn after birth;
  3. I agree that I must attend prenatal office visits and comply with testing to be deemed low risk in order to participate in the Holistic Birthing Center/Program;
  4. I acknowledge and agree that the gestational age of my baby must be at least 37 weeks or greater, and no greater than 42 weeks in order to participate in Holistic Birthing Center/Program, and that no other high risk factors may be present; I agree to inform my practitioner if any risk factor in my pregnancy occurs;
  5. I agree to arrange for a physical of my baby prior to discharge from the Holistic Birthing Center/Program and to schedule a follow-up with the pediatrician or family practitioner for examination of the baby following discharge;
  6. I agree to abide by any other policies of Holistic Birthing Center/Program;
  7. I agree to have my medical record reviewed by the Holistic Birthing Center/Program Quality Assurance Committee.

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