Memorandum of Understanding for Labor and Delivery
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This memorandum outlines the patient’s rights, expectations, and consent preferences for her labor and delivery process. The patient thanks all parties involved in her care and requests that this document be included in her medical records. It has also been provided to her labor support person, attorney, and a maternal advocacy organization.
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The patient acknowledges her understanding of her rights to informed consent and refusal, as outlined by the American College of Obstetricians and Gynecologists (ACOG), and expects these rights to be upheld barring a true medical emergency. She specifies that the following interventions require her explicit written or verbal consent before being performed:
 
Cesarean section
Labor induction or augmentation (e.g., Pitocin)
Operative vaginal delivery
Vaginal exams
Episiotomy
 
The patient emphasizes that any intervention performed without her consent will be considered a violation of her rights to informed consent and bodily autonomy. She acknowledges the expertise and care provided by healthcare professionals but requests her wishes for a natural birth be respected unless medically necessary and expressly consented to.