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Midwife Consent for Waterbirth Mobile App

Though warm water immersion in labor and birth has existed for a long time and in many cultures and has been studied and found to be safe, it is still considered an “alternative” practice by the field of obstetrics. For this reason patients are required to sign the Midwife Consent for Waterbirth mobile app listing the potential benefits and risks of water birth.. The app lists the criteria for waterbirth deliveries.

GoCanvas has a collection of apps developed for Midwives and Doulas. They are all Free with your GoCanvas Subscription. Check them out in our Application Store!

  • Lendlease
  • The Cooperative
  • PG&E
  • Red Bull
  • Mirvac

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Take a peek inside the Midwife Consent for Waterbirth Mobile App

Included Features

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Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico statictext

    Consent for Warm Water Immersion for Labor and Birth

  • Ico textbox

    I/We

  • Ico statictext

    have chosen to consider a water birth with the midwives with <Insert Name> Midwifery Services.

  • Ico statictext

    The following criteria must be met for the option of water birth:

  • Ico checkbox

    Uncomplicated pregnancy of at least 37 weeks gestation

  • Ico checkbox

    An established labor pattern with strong, regular contractions

  • Ico checkbox

    Reassuring fetal heart rate

  • Ico checkbox

    No heavy vaginal bleeding

  • Ico checkbox

    Lack of significant meconium staining

  • Ico checkbox

    Lack of maternal infection or unknown skin condition

  • Ico checkbox

    Agreement of the midwife attending your labor and birth

  • Ico statictext

    * The midwives reserve the right to request any mother to leave the birth tub for any reason.

  • Ico statictext

    I/We understand that the potential benefits of water immersion in labor and birth include:

  • Ico checkbox

    Relaxation and pain management in labor

  • Ico checkbox

    Facilitation of mobility / movement in labor

  • Ico checkbox

    A gentle transition for the newborn

  • Ico checkbox

    Being highly rated by mothers as a more positive labor and birth experience

  • Ico statictext

    I/We understand that potential risks of warm water immersion may include:

  • Ico checkbox

    Maternal or newborn infection

  • Ico checkbox

    Fetal tachycardia (increased heart rate) secondary to water temperature being too hot or prolonge...

  • Ico checkbox

    The slowing or cessation of contractions

  • Ico checkbox

    Potential aspiration of fluid resulting in drowning, pneumonia or death

  • Ico statictext

    I/We have been informed of the alternatives to warm water immersion for labor and birth, includin...

  • Ico statictext

    Having been so informed, I/we have chosen warm water immersion for labor and birth with <Insert N...

  • Ico signature

    Mother’s Signature

  • Ico date

    Date

  • Ico signature

    Partner’s Signature

  • Ico date

    Date

  • ...and More!

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