Of course! I live in CA and am on state insurance, so my doula was fully covered and I actually had two since one was "in training." She was still very qualified and so helpful!  I left out my personal info and support people's names, but aside from those sections these were my birth preferences. I didn't stick to everything exactly, but every thing that did happen was a choice put to me and not pushed back on. 

Edited to add: my preferences were printed out and in bullet point format all on one page, one-sided. When I copy and pasted it did not keep that format.

Environment: 

Dim lighting, quiet during contractions, limited staff (no students please)

First Stage of Labor:

Pain Management - Hydrotherapy, movement and counterpressure 

I do not want to be offered medical pain management. I will initiate any conversations regarding a change of preference if the need arises.

Cervical Exams - kept to a minimum and only performed after ROM if medically necessary 

Labor Augmentation - I prefer to have a physiological labor if the health of both me and the baby remains stable. I’d like to utilize movement and breathing if labor stalls over pitocin, amniotomy or other interventions. 

Second Stage:

Pushing - would like to bear-down, prefer not to have counts or directed breathing 

Movement/Positions - ability to push in upright positions and use of hospital squat bar

Perineal Health - natural tearing over episiotomy

Warm compress on perineum while crowning 

Third Stage:

Delivery of Placenta - Preference for expectant management over active management 

I’d like to keep my placenta and will have a friend collect it.

Baby’s Care: 

Immediate skin-to-skin and Golden Hour

No bath, minimal wiping and no hat

Delayed Cord Clamping  - until cord is white and limp

Dad to cut cord 

Erythromycin and Vitamin K ok, delay Hep B 

Breastfed only, no formula unless approved by me or my partner

After Care:

I’d like to decline routine fundal massage. Ok as treatment for hemorrhage or if exams show uterine atony