Starting birth plan

Birth Plan Worksheet

ATTENDANTS AND AMENITIES

I'd also like:

To dim the lights

LABOR

I'd like the option of returning home if I'm not in active labor.

Once I'm admitted, I'd like:
My partner to be allowed to stay with me at all times
Only my practitioner, nurse, and guests present (i.e., no residents, medical students, or other hospital personnel)
To wear my contact lenses, as long as I don't need a c-section
To eat if I wish to
To stay hydrated by drinking clear fluids instead of having an IV
To walk and move around as I choose

As long as the baby and I are doing fine, I'd like:
To have intermittent rather than continuous electronic fetal monitoring
To be allowed to progress free of stringent time limits

If they're available, I'd like to try:
A birthing stool
A birthing pool/tub


When it's time to push, I'd like to:
Do so instinctively

I'd like to try the following positions for pushing (and birth):

Whatever feels right at the time

As long as my baby and I are doing fine, I'd like the pushing stage to be allowed to progress free of stringent time limits


PAIN RELIEF

I'd like to try the following pain-management techniques:
Breathing techniques/distraction
Massage
Medication
Please don't offer me pain medication. I'll request it if I need it.


VAGINAL BIRTH

I'd like:
The room to be as quiet as possible
To risk a tear rather than have an episiotomy

After birth, I'd like:
To hold my baby right away, putting off any procedures that aren't urgent
To breastfeed as soon as possible
My partner to cut the umbilical cord

C-SECTION

If I have a c-section, I'd like:
My partner present at all times during the operation
The baby given to my partner as soon as he's dried (as long as he's in good health)
To breastfeed my baby in the recovery room


POSTPARTUM

After delivery, I'd like:
All newborn procedures to take place in my presence
My partner to stay with the baby at all times if I can't be there
To stay in a private room
To have a cot provided for my partner

I plan to:
Breastfeed exclusively

The following can be offered to my baby:

Please don't offer anything to my baby at any point

I'd like my baby fed:
On demand

I'd like:
24-hour rooming-in with my baby

If my baby's a boy:
I'd like him circumcised at the hospital.

I'd like my other child(ren) brought in to see me and meet the new baby as soon as possible after the birth.