Here is a sample, offered by one of our clients to give other moms a good starting point.
Feel free to use wording from it, or even copy and paste. If you have questions about any of the preferences listed, please let me know and I will be glad to explain the family's intent as well as further resources regarding each item.
Remember, your birth plan should be 1 page long and include a categorized list of your wishes and preferences in each stage of your childbirth experience.
Birth Plan
Labor:
·
I would like my husband, Jason, and doula, Anne, to stay with me at all
times.
·
I request that pain medication NOT be offered to me; if I decide to use
pain medications, I will request them.
·
In the event of labor augmentation, I would like to try alternate
methods prior to use of Pitocin.
·
I prefer no IV fluids unless I am dehydrated such that juices, electrolyte
water, and other drinks do not properly hydrate me.
Pushing:
·
I request the freedom to choose various pushing and delivery positions;
to include squatting, hands & knees, or whatever may feel right at the
time.
·
I ask that no episiotomy be performed; I would like warm compresses and
perineal massage prior to delivery.
·
When it is time to push, I’d like to be allowed to progress free of
stringent time limits as long as my baby and I are doing fine.
Immediately Postpartum:
·
I request that the umbilical cord not be clamped, or even touched until
it is white and limp. I request to be allowed to naturally deliver the
placenta; I request to have the placenta stored safely and unaltered so that we
may take the placenta home for encapsulation.
·
I request that the immediate care of my baby be done on my abdomen or
chest with skin-to-skin contact for as long as possible.
·
I plan to exclusively breastfeed and request that no supplements or
pacifiers be given. If my baby needs to be fed by bottle or other means, I
would like to pump my breasts and provide breast milk throughout the hospital
stay.
Newborn:
·
I ask that all newborn care be done in my room.
·
If my baby requires special nursery care, I request access to him at
any time.
Special Circumstances:
·
If the above ideals must be altered for medical necessity, I ask that we be given as much time as safely possible to consider all our options before
procedures are done.
·
In the event of a cesarean delivery, I would like my partner and doula
with me.
·
If cesarean is necessary, I would like contact with my baby as soon as
possible and during recovery.
·
In the event of a stillbirth or death of my baby, I would like contact
with him as long as desired afterwards.
