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Sample Birth Plan When I was pregnant, a friend provided me with a copy of her birth plan. I think it is a good plan for anyone who is considering natural childbirth and breastfeeding. Feel free to copy the plan and edit it to meet your needs: Scheduled to deliver at: Partner: Support Person: To everyone involved in my labor and delivery: I look forward to sharing my upcoming birth with you. I have created the following birth plan to help you understand my preferences for my upcoming labor and delivery. It is not intended to be a script. I fully realize that situations may arise such that my plan cannot and should 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, please let me know. Thank you. Sincerely,
Labor - Maintain mobility (walking, rocking, up to the bathroom, etc.) - Positioning as desired throughout labor. - Water (if allowed) and ice chips by mouth throughout the first stage of labor. - I do not want an IV unless I become dehydrated. - I will be bringing my own music to play during labor. - Peace and quiet - Dim lights - Would prefer to keep the number of vaginal exams to a minimum.
Monitoring - I do not wish to have continuous fetal monitoring unless it is required by the condition of my son. - I do not want an internal monitor unless my son has shown some sign of distress. - I would prefer to have intermittent monitoring (ACOG Standards) with a Doppler if possible.
Labor Augmentation/Induction - I would prefer to use natural methods (positioning, walking, nipple stimulation) to start labor and would like to avoid the use of pitocin if at all possible. - I do not wish to have the amniotic membrane ruptured artificially unless signs of fetal distress require internal monitoring.
Anesthesia/Pain Medication - Please do not offer me pain medications, I will ask for them if I need them. - I plan to use relaxation techniques, positioning, massage, acupressure, aromatherapy, hydrotherapy and heat/cold packs to cope with pain.
Cesarean - Unless absolutely necessary, I would like to avoid a Cesarean, however if it is required, I would like to be fully informed and to participate in the decision making process. - I would like my partner present at all times in the event of a Cesarean delivery. - I wish to have an epidural for anesthesia. - If my son is not in distress, he should be given to my husband immediately after birth. - My husband would like to cut the cord. - I would like to breastfeed as soon as possible after delivery.
Episiotomy - I would prefer to avoid an episiotomy unless absolutely required for the baby's safety. - If possible, I would like to use warm compresses, perineal massage and positioning to avoid the need for an episiotomy. - I would appreciate guidance in when to push and when to stop pushing so the perineum can stretch. - I would like a local anesthetic to repair a tear or an episiotomy.
Delivery - Choice of position, including squatting, using my husband or a squatting bar for support. On all fours or whatever feels comfortable to me at the time. - I would like my husband and/or nurses to support me and/or my legs during pushing. - Even if I am fully dilated, and assuming my son is not in distress, I would like to wait until I feel the urge to push before beginning the pushing phase. - Prolonged length, if progress is being made, to avoid a forceps or Cesarean delivery. - I would like to have a mirror available so I can see my son’s head when it crowns. - I would appreciate having the room as quiet as possible when my son is born. - I would like to have my son placed on my stomach/chest immediately after delivery.
Immediately After Delivery - I would prefer that the umbilical cord stop pulsating before it is cut. - My husband would like to cut the cord. - I would like to hold and, if possible, breastfeed my son while I deliver the placenta and any tissue repairs are made. - I would like to hold my son for at least 15 minutes before he is photographed, examined, etc. - I would appreciate if my son remained near me following the birth during evaluation and bathing, however, if he must be taken from me for medical treatment, my husband should accompany him at all times. - I would prefer to hold my son rather than have him placed under heat lamps. - I do not want an injection of pitocin after the delivery to aid in expelling the placenta. - I would like to delay the eye medication for my son until a couple of hours after birth. - I would like an opportunity to see the placenta after it is delivered.
Postpartum - I would like to have my son room in and be with me at all times, if possible.
Breastfeeding - I plan to breastfeed my son and would like to begin nursing very shortly after birth. - I would like to meet with a Lactation Consultant, if available. - Unless medically necessary, I do not wish to have any bottles given to my son, including glucose water or plain water. - I do not want my son to be given a pacifier.
Circumcision - I do not want my son to be circumcised.
Other - My other support person, besides my husband, is ( ) and I would like her to be present during labor and delivery. - I would prefer that no students, interns, residents, or non-essential personnel be present during my labor or the birth. - I would like the option of taking still photographs and/or making a video-recording during labor and birth.
In the event of a sick baby - I would like to breastfeed, if possible, as soon as possible. - Unlimited visitation for parents. - Handling of the baby (Kangaroo care, holding, care of, etc.) - If my son is transported to another facility, please move us as soon as possible.
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