Sample Birth Plan

Look into your options...
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.