Dear Midwife and the staff of my Hospital
This birth plan is intended to express
the preference and desires we have for the
birth of our baby. It is not intended to be
a script. We fully realize that situations
may arise such that our plan cannot and should
not be followed. However, we hope that
barring any extenuating circumstances, you
will be able to keep us informed and aware of
our options. Thank you.
- I would like to be free to walk around during labor.
- I wish to be able to move around and change position at will throughout labor.
- I would like to be able to have fluids by mouth throughout the first stage of labor.
- I do not want an IV unless I become dehydrated.
- I do not wish to have continuous fetal monitoring unless it is required by the condition of the baby.
- I do not want an internal monitor unless the baby has shown some sign of distress.
- I do not wish to have the amniotic membrane ruptured artificially unless signs of fetal distress require internal monitoring.
- If labor is not progressing, I would like to have the amniotic membrane ruptured before other methods are used to augment labor.
- I would prefer to be allowed to try changing position and other natural methods (walking, nipple stimulation) before pitocin is administered.
I’d like labor augmentation performed with prostaglandin gel if needed.
- I realize that many pain medications exist I’ll ask for them if I need them.
- Unless absolutely necessary, I would like to avoid a Cesarean.
- If my primary care provider determines that a Cesarean delivery is indicated, I would like to obtain a second opinion from another physician if time allows.
- I would like (coach) present at all times if the baby requires a Cesarean delivery.
Please perform a low transverse incision in the uterus.
I would prefer a double-layer stitch for the repair of the uterus.
- I would prefer not to have an episiotomy unless absolutely required for the baby’s safety.
- I would appreciate guidance in when to push and when to stop pushing so the perineum can stretch.
- If possible, I would like to use perineal massage to help avoid the need for an episiotomy.
- I would like a local anesthetic to repair a tear or an episiotomy.
- I would like to be allowed to choose the position in which I give birth, including squatting.
- I would like (partner) and/or nurses to support me and my legs as necessary during the pushing stage.
- I would like a mirror available so I can see the baby’s head when it crowns.
- I would like to have the baby placed on my stomach/chest immediately after delivery.
IMMEDIATELY AFTER DELIVERY
- I would like to have (coach) cut the cord.
- I would prefer that the umbilical cord stop pulsating before it is cut.
- I would like to have the baby evaluated and bathed in my presence.
- If the baby must be taken from me to receive medical treatment, (coach) or some other person I designate will accompany the baby at all times.
- I would like to donate the umbilical cord blood if possible.
- I would like to see the placenta after it is delivered.
- I would like the baby with me during the day but in the nursery at night, but brought to me for breastfeeding. (Note: be sure to check the breastfeeding preferences below.)
- I plan to breastfeed the baby and would like to begin nursing very shortly after birth.
- Unless medically necessary, I do not wish to have any bottles given to the baby (including glucose water or plain water).
- I would like more information about breastfeeding.
- I would like to meet with a Lactation Consultant.
- I would like the baby to be circumcised before we check out of the hospital.
- I would like to take still photographs during labor and the birth.
- My support people are (support people) and I would like them to be present during labor and/or delivery.