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Birth Plan

Ultimate Birth Plan

Birth Plan

Creating Your Birth Plan

Let's begin the process of creating your birth plan with one simple fact: you cannot plan for everything. Unless you have a magical crystal ball that allows you to see into the future, you cannot make plans for every contingency. This is exactly why a very detailrich and comprehensively written birth plan is a great thing to create. Just consider the simplest benefit of making the plan: you don't have to think, remember, recall or even answer questions during labor, birth and afterwards. The plan contains the answers to almost every possible query or dilemma, and that means you focus on the once in a lifetime experience of birthing your child. Naturally, it may initially seem as if it is a simple thing to list your wants or wishes, but it can get very involved. This is why we use clear "headings" to distinguish the different periods of time in which a birth plan may be very useful and handy. They are: General Information - this includes your name as well as that of your partner, physician (doula or midwife), your due date and all of your basic medical details; Labor Preferences - this includes many different factors that range from your wishes in terms of the type of delivery (c-section, vaginal, etc.), the names of those allowed in the birthing room, and any environmental and comfort requirements. This might range from music and aromatherapy to the types of pain relief you will accept; Delivery Preferences - this is information about the positions you want to use while delivering the baby, if you have special delivery requests such as catching the baby, allowing the partner to physical perform some processes, etc. it is included here; Post-Delivery Wishes - do you want your partner to cut the cord? Do you wish to see the placenta? How do you want to receive the baby once delivery is completed? These are important factors that are best written down and made clear to everyone working in the delivery room; Baby's Medical Care - many parents have no idea that they can ask to watch the medical procedures done to the baby immediately after birth, even fewer know that (as long as there are no immediate problems) they can delay an exam until they have bonded with the child. Parents may ask to clean the baby immediately after delivery and more. This area of the plan allows parents to specify the life

Birth Plan

experiences that they do not want to miss because of the blur and rush of delivery; During the Hospital Stay - here is the area for your feeding preferences for the new born, where you want the baby to stay, if a partner is to stay with you, and more; and In the Event of Trouble - this is the proverbial "gray area" that most parents dread. This is the spot to indicate your preferences for any of those "what if" scenarios.

Now that you understand the basic order of things, we can get started in making the specific choices and writing them down in the plan. Remember to be sure to give copies of this to your medical provider, your partner, and to ensure that everyone involved in the birthing process has reviewed your wishes as stated in the document.

General Information
Full Name: Partner's Name: Due Date/Date of Induction: Doctor's Name: Hospital Name: Name of Alternative Care Provider (i.e. Doula, Midwife, etc.): Primary Language: Religious Customs to be observed:

Medical Details
Note that I have: Group B Strep Rh Incompatibility with my Baby Gestational Diabetes

Birth Plan Special Dietary Requirements:

Allergies: Blood Type: Rh Factor:

Type of Delivery Planned

C-Section Vaginal VBAC Water Birth

Support Before and/or During Labor

Partner: Parents: Other Children: Other:

Labor Preferences
During labor I would like: My partner with me the entire time Hydration with clear liquid The option to eat and drink if approved by my physician Minimal vaginal exams Limited interruptions Staff limited only to my doctor and the nurses on duty (No students, interns, residents, etc.)

Birth Plan My own clothing My contact lenses to remain in place

Camera or video device used by my partner/support Music (I will bring from home) Dim Lights Quiet Room conditions

Stage 1 Labor Preferences

During the first stages of labor I prefer: To be standing To be lying down To be able to walk around To have access to a shower To be in a water tub/bathtub I DO NOT want: An enema Shaving of pubic area Catheterization of the urinary tract IV unless medically necessary

Fetal Monitoring
I want: External Internal Continuous Intermittent Audible Inaudible

Birth Plan Performed by Doppler Performed only if signs of distress

I will agree to labor augmentation only if: Baby is in distress Natural methods fail to generate results Membrane stripping is used Prostaglandin gel is used Pitocin is used Rupturing of membrane is used Rupturing or stripping of membranes is NOT used

Pain Management
I would prefer to use: Acupressure Acupuncture Breathing Cold/Hot Therapies Demerol Epidural Hypnosis Massage Meditation Reflexology TENS Nothing What I might request at the time

Birth Plan

What a physician or alternative provider recommends at the time

Delivery Preferences
Stage 2 Labor - Pushing and Positions
The position I would prefer to deliver is: Semi-Reclined Lying on my side Lying on my back Squatting Hands and knees Standing With leg support With stirrups With a birth bar With a birth stool In a birthing tub In the shower

I will supply the:

Birth stool Birth chair Squatting bar Birthing tub

Birth Plan

During the delivery process I want to: Push as directed Push when I feel the need Push without a fixed time limit (unless baby is at risk) See the crowning with a mirror Touch the head as I crown Allow the epidural to wear off at the end of delivery Use the entire dose of epidural Have no forceps used Have no vacuum extraction Help to catch my baby Have my partner catch the baby Let my partner suction the baby's airways Use whatever methods are necessary

If at risk: Prefer not to perform (even if tearing is possible) Only as last resort Only if doctor deems necessary With anesthesia Without anesthesia

Birth Plan

Post-Delivery Wishes
Immediately after delivery
I want: My partner to cut the cord The cord to be cut after pulsating stops The cord blood to be harvested for a bank (List bank: The cord blood to be donated (List organization: To pass the placenta without augmentation To see the placenta ) )

If a C-Section is Recommended
I would like: To exhaust my other options Get a second opinion Remain awake To have my partner with me throughout No screening in order to see delivery To have the surgeon explain each process as it occurs To have an epidural For my partner to catch the baby

Holding the Baby

I want to: Hold the baby immediately upon birth After suctioning has occurred After weighing and exam After being cleaned Before eye care is done

Birth Plan

I want to: Feed immediately after delivery Before eye care is done Later Not at all

Support Options
I want my family to: Be with me after delivery To meet me in my room To see baby only in nursery To have unlimited visitation

Baby's Post Delivery Care

Medical Procedures
Given only in my presence Only after I have properly bonded with the baby (and as long as no risks exist) In my partner's presence To include the heel stick (beyond PKU) To include a hearing test To include the Hepatitis B vaccine Immunizations according to normal procedures

To exclude:
Antibiotic eye ointment Exclude immunizations until a later date Formula

Birth Plan Pacifier Sugar water Vitamin K

First Bath
I want to bathe my baby I want my partner to bathe the baby I want it done in my presence I want it done in my partner's presence

Only with my breast milk Only with formula When required On a schedule With support of lactation expert

During the Hospital Stay

Baby will stay:
In my room all of the time In my room during the day With me when I am awake Only with me for feeding Only when I request

I want my partner to: Have unlimited visitation

Birth Plan To sleep in my room

I prefer: No circumcision Circumcision To be performed later With anesthesia To be done only in my presence or my partner's

My Comfort
Please give me: Acetaminophen as needed Percoset as needed Stool softener is required Laxative if required I would like to stay as long as possible I would like to go home as soon as possible

In the Event of Trouble

If my baby experiences medical difficulty after delivery, I want: My partner or I to accompany the baby to another facility or the NICU (whichever applies) To drink only my breast milk if possible To be able to hold and visit the baby whenever possible