Step 1: Preliminary Information
Fields marked * are required.
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 I had a doula at my labor and birth * Select Yes No Not important to me I expect to wear my own clothes instead of a hospital gown during labor and birth Select Yes No Not important to me I will prepare a list of preferences (birth plan) for my birth Select Yes No Not important to me I would like to be allowed to eat during labor if I am hungry. Select Yes No Not important to me I plan to use movement and gravity to promote and encourage adequate labor contractions and help the baby descend. Select Yes No Not important to me I plan to labor in the shower Select Yes No Not important to me I hope to be able to labor in a tub at the hospital. Select Yes No Not important to me I hope to be able to give birth in a tub at the hospital Select Yes No Not important to me Do you want to use a midwife at your hospital birth?: Select Before Both before & after Not allowed Are you planning an unmedicated birth? Select Yes No Not important to me Step 3: Labor & Birth : Continued
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Do you want photos taken of your birth by a family member, doula or professional photographer? Select Yes No Not important to me If you are planning on breastfeeding, would you like the opportunity to initiate laid-back or baby-led breastfeeding techniques on your own as the first attempt? Select Yes No Not important to me I hope to have skin-to-skin contact with my baby immediately following the birth Select Yes No Not important to me I expect to be allowed full rooming in with my baby Select Yes No Not important to me Step 4: Add your own Text (Optional)
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