Birth Plan

A good birth plan is important for a couple of reasons; one, it makes your intentions and desires know to the delivery team prior – especially when you are not able to “think clearly”. Second, it makes you and your partner think through these issues prior to going to the hospital. This is important because you both have time to think through your preferences and make informed choices. Keep in mind that these are only preferences and the delivery team will do what needs to be done to protect you and the baby. And remember to keep your birth plan to one page and be as clear and specific as possible.

There’s also a good Birth Plan Creator on which covers more items.

Birth Plan for (mother’s name)
Due Date: ________
Patient of Dr. _________
Scheduled to deliver at ________ Medical Center

Dear Dr. __________ and the Medical Center Staff:

I look forward to sharing my upcoming birth with you. I have created the following birth plan to help you understanding my preferences for my upcoming labor and delivery. I fully understand that in certain circumstances these guidelines may not be followed, but it is my hope that you will assist me in making this the experience I hope for. If you have any questions or suggestions let me know.

(mother’s name)

? I would prefer to avoid an enema and/or shaving of pubic hair
? I wish to be able to walk, 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 would prefer to keep the number of vaginal exams to a minimum
? I do not wish to have continuous fetal monitoring unless it is required or an IV put in my arm “just in case”
Labor Augmentation/Induction
? I do not wish for my amniotic membranes ruptured artificially unless signs of fetal distress require internal monitoring
? I would prefer to be allowed to try positions before pitocin is administered
Pain Medications
? I do not want any kind of medication/anesthesia offered to me during labor, though I would like it available if I specifically request it. I will ask if I need any pain medications, including an epidural
? I would like my husband present at all times if my son requires a Cesarean delivery
? I wish to have an epidural for anesthesia
? If my son is not in distress, I would like my son shown to my husband and I immediately after birth
? I would prefer not to have an episiotomy unless absolutely required for the baby?s safety. I realize that mean I may tear naturally.
? I would like my husband &/or mother to support my legs as necessary during the pushing stage
? I would like to have my son placed on my stomach/chest immediately after delivery
After Delivery
? I would like my husband to cut the cord
? I would prefer my son be examined and bathed in my presence
? If my son must be taken from me to receive medical treatment, my husband will accompany him at all times
? I would like a private room if available
? I plan to breastfeed and I do not want any bottles given to my son (including glucose water or plain water). I do not want my son given a pacifier.
? I would like to make a video recording of labor, not necessarily the birth
? My husband, ______, will be with me throughout the birth as well as my mother, _______.

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