We have known for months that our unborn baby has been diagnosed with Bilateral Renal Agenesis, also known as Potter’s Syndrome. We have made an informed decision to carry this baby to term and keep our baby as long as possible. It is our priority to have our baby born alive. Please honor our request to preserve the dignity of our baby’s life. Please respect our following decisions:

1. We would like staff to be informed and aware of the situation.

2. Donna would like an epidural during labor. If complications arise for the baby during labor, in order to maximize the chances for a live birth, then we would like the option of having a C-section. We would want to properly medicate Donna so she does not have any pain during the procedure, but at the same time, we want to ensure that Donna is alert throughout it and that Walter is by her side. We want Donna to have as best physical outcome as possible, but our primary goal is to ensure that our baby has every chance to meet us and that he/ she is protected from unnecessary pain and suffering.

3. We request that a liaison (i.e. nurse, social worker, chaplain) periodically give updates to waiting family members.

4. If the baby is a girl, we would like her referred to as Victoria. If the baby is a boy, we would like him to be referred to as Jonathan.

5. We would like the doctor to cut the cord.

6. We would like for mechanical assistance (bagging only, no intubation) to be used only temporarily to try to initiate the baby’s breathing, if necessary, immediately after birth. We do not want any extraordinary measures taken to maintain breathing or initiate a heartbeat. After this is performed and after wiping and wrapping the baby, we request that our baby be handed to Mom/Dad and that weighing the baby, labs and confirmation of the diagnosis be postponed until later.

7. Our baby will be baptized as soon as possible after cutting the cord. This will be performed by Walter. We ask that the grandparents and our three children be present at this time if possible.

8. We would like our baby to stay with us at all times.

9. Our baby should be offered comfort care: feeding, bathing, swaddling and holding by his/her parents and family.

10. We wish to be with our baby and hold our baby at the time of death.

11. When our baby dies, we want some time to be together as a family alone.

12. We would like to be alone, away from other newborns before and after our baby’s birth.

13. We do not wish an autopsy to be performed.

We would like to keep the following items as keepsakes:

To the staff of Labor/Delivery and Neonatal Units,

We have tried our best to prepare for this short time with our beloved baby. Thank you so much for helping us and supporting us through this celebration of our baby’s short but precious and meaningful life.