This article is from the Birth Planning FAQ, by wnymph@FensEnde.com (Sabrina Cuddy) with numerous contributions by others.
BIRTH PLAN FOR _____ AND _______
We have prepared this Birth Plan to help you understand our philosophy
and the kind of care we hope to have for the birth of our child. The
pregnancy has gon e very well thus far. We have been careful to eat
well and stay fit, and have done everything we can to prepare for a
healthy and uncomplicated birth. We have chosen our obstetrician, Dr.
____, because she shares our desire for a low-intervention birth and
respects our need for good communication. We wish for as natural a
birth as possible, avoiding unnecessary procedures and medications.
However, if medications or procedures become necessary, we ask that you
discuss them with us in advance so that we can participate in the
It is important to us that we remain together at all times during the
labor and delivery (vaginal or cesarean). We would like to have our
labor coach, ____, stay with us throughout, as well.
We hope to avoid routine procedures (e.g., prep, enema), to delay
introduction of an IV feed unless needed, and to keep the number of
vaginal examinations to a minimum. If procedures or medications are
proposed, we ask that you discuss them with us and suggest alternative
therapies or comfort measures so that we can make well-informed
We would like to have the option of sucking on ice chips, and may also
want to try walking, different labor positions, and perhaps a hot
shower for pain relief in labor.
As long as things are progressing well, we prefer intermittent
monitoring with an external fetal monitor. We very much want to avoid
internal fetal monitorin g unless it is specifically medically
Because we want labor to progress at a natural pace, we hope to avoid
artificia l induction or augmentation of labor (e.g., amniotomy,
stripping of membranes, pitocin). We would also like to avoid an
episiotomy and try perineal support o r hot compresses instead.
We would like to have a mirror placed so that mother can watch the
birth, and, if things are progressing well, mother would like to be
allowed to touch the baby's head as it begins to crown.
It is very important to us to hold and nurse our baby immediately after
birth, and to have the weighing and bathing done in our room so that we
can watch. If this is not possible, we would like to have father stay
with the baby at all times. Also, we ask that you discuss any routine
neonatal procedures with us before they are performed.
We plan to exclusively breastfeed our baby, and therefore request that
s/he not be given bottles, water, or a pacifier without our prior
approval. We also would like to have a private maternity room with 24
hour rooming in, and a cot or comfortable chair for father.
We thank you for taking the time to go over this Birth Plan, and
appreciate your cooperation in getting our new family off to great
Patient ________________________ _________
Coach ________________________ _________
Physician ________________________ _________