First Name *
Last Name *
Hospital * Select Antelope Valley Hospital,1600 W. Ave. J,Lancaster CA 93534 Bellflower Medical Center,9542 E. Artesia Blvd.,Bellflower CA 90706 Beverly Hospital,309 W. Beverly Blvd.,Montebello CA 90640 California Hospital Medical Center,1401 S. Grand Ave.,Los Angeles CA 90015 Cedars Sinai Medical Center,8700 Beverly Blvd,Los Angeles CA 90048 Centinela Freeman Regional Medical Center,555 E. Hardy St.,Inglewood CA 90301 CHA - Hollywood Presbyterian Medical Center,1300 N. Vermont Ave.,Los Angeles CA 90027 Citrus Valley Medical Center - Queen of the Valley Campus,1115 S. Sunset Blvd.,West Covina CA 91790 Downey Regional Medical Center,11500 Brookshire Ave.,Downey CA 90241 East Los Angeles Doctor's Hospital,4060 Whittier Blvd.,East Los Angeles CA 90023 East Valley Hospital Medical Center,150 W. Route 66,Glendora CA 91740 Encino/Tarzana Regional Medical Center,18321 Clark Street,Tarzana CA 91356 Foothill Presbyterian Hospital,250 S. Grand Ave.,Glendora CA 91741 Garfield Medical Center,525 N. Garfield Avenue,Monterey Park CA 91754 Glendale Adventist Medical Center,1509 Wilson Terrace,Glendale CA 91206 Glendale Memorial Medical Center,1420 S. Central Avenue,Glendale CA 91204 Good Samaritan Hospital,1225 Wilshire Blvd.,Los Angeles CA 90017 Greater El Monte Medical Center,1701 Santa Anita Ave.,South El Monte CA 91733 Henry Mayo Newhall Memorial Hospital,23845 W. McBean Parkway,Valencia CA 91355 Huntington Memorial Hospital; 100 W California Blvd.; Pasadena CA 91105 Kaiser - Baldwin Park,1011 Baldwin Park Blvd.,Baldwin Park CA 91706 Kaiser - Bellflower,9400 E. Rosecrans Ave.,Bellflower CA 90706 Kaiser - Los Angeles,4867 Sunset Blvd,Los Angeles CA 90027 Kaiser - Panorama City,13652 Cantara St.,Panorama City CA 91402 Kaiser - South Bay,25825 S. Vermont Ave.,Harbor City CA 90706 Kaiser - West Los Angeles,6041 Cadillac Ave.,Los Angeles CA 90024 Kaiser - Woodland Hills,5601 De Soto Ave.,Woodland Hills CA 91367 L.A. Metropolitan Medical Center,2231 S. Western Ave.,Los Angeles CA 90018 LAC Harbor/UCLA Medical Center,1000 W. Carson Street,Torrance CA 90509 LAC Olive View Medical Center,"14445 Olive View Drive, 4th Fl.",Sylmar CA 91342 LAC USC Medical Center,1200 N. State Street,Los Angeles CA 90033 Lakewood Regional Medical Center,3700 S. Street,Lakewood CA 90712 Little Company of Mary - San Pedro Hospital,1300 W. 7th Street,San Pedro CA 90732 Little Company of Mary Hospital,4101 Torrance Blvd.,Torrance CA 90503 Los Angeles Community Hospital,4081 E. Olympic Blvd.,Los Angeles CA 90023 "Martin Luther King, Jr. - Harbor Hospital",12021 S. Wilmington Ave.,Los Angeles CA 90059 Memorial Hospital of Gardena,1145 Redondo Beach Blvd.,Gardena CA 90247 Methodist Hospital of Southern California,300 W. Huntington Drive,Arcadia CA 91006 Mission Hospital,3111 E. Florence Ave.,Huntington Park CA 90255 Monterey Park Hospital,900 S. Atlantic Blvd.,Monterey Park CA 91754 Northridge Hospital Medical Center,18300 Roscoe Blvd.,Northridge CA 91328 Pacific Alliance Medical Center,531 W. College Street,Los Angeles CA 90012 Pacifica of the Valley Hospital Medical Center,9449 San Fernando Road,Sun Valley CA 91352 Pomona Valley Hospital Medical Center,1798 N. Garey Ave.,Pomona CA 91767 Presbyterian InterCommunity Hospital,12401 E. Washington Blvd.,Whittier CA 90602 Providence Holy Cross Medical Center,15031 Rinaldi Street,Mission Hills CA 91345 Providence St. Joseph Medical Center,501 S. Buena Vista Street,Burbank CA 91505 San Dimas Community Hospital,1350 W. Covina Blvd.,San Dimas CA 91773 San Gabriel Valley Medical Center,438 West Las Tunas Drive,San Gabriel CA 91778 Santa Monica/UCLA Medical Center,1250 16th Street,Santa Monica CA 90404 St. Francis Medical Center,3630 E. Imperial Highway,Lynwood CA 90262 St. John's Hospital Health Center,1328 22nd Street,Santa Monica CA 90404 Torrance Memorial Medical Center,3330 Lomita Blvd.,Torrance CA 90505 UCLA Ronald Reagan Medical Center,757 Westwood Plaza,Los Angeles CA 90095 Valley Presbyterian Hospital,15107 Vanowen Street,Van Nuys CA 91405 Verdugo Hills Hospital,1812 Verdugo Blvd.,Glendale CA 91208 West Hills Hospital & Medical Center,7300 Medical Center Drive,West Hills CA 91307 White Memorial Medical Center,1720 E.Cesar Chavez Ave.,Los Angeles CA 90033 Whittier Hospital Medical Center,15151 Janine Drive,Whittier CA 90605 Other
Expected Delivery Date * In the next year In the next two years In the future
I expect to wear my own clothes instead of a hospital gown during labor and birth Select Yes No
I will prepare a list of preferences (birth plan) for my birth Select Yes No
I would like to be allowed to eat during labor if I am hungry Select Yes No
I plan to use movement and gravity to promote and encourage adequate labor contractions and help the baby descend Select Yes No
I plan to labor in the shower Select Yes No
I hope to be able to labor in a tub at the hospital. Select Yes No
I hope to be able to give birth in a tub at the hospital Select Yes No
I hope to have the services of a midwife at my hospital birth Select Yes No
I'm planning on having an unmedicated birth Select Yes No
I want to have photos taken of my birth by a family member, doula or professional photographer Select Yes No
I'd like the opportunity to initiate laid-back or baby-led newborn feeding techniques on my own, as long as the baby and I are able to do so. Select Yes No
I hope to have skin-to-skin contact with my baby immediately following the birth Select Yes No
I expect to be allowed full rooming in with my baby Select Yes No
