A birth plan is a document that tells your medical team your preferences for such things as how to manage labor pain. Of course, you can't control every aspect of labor and delivery, and you'll need to stay flexible in case something comes up that requires your birth team to depart from your plan. But a printed document gives you a place to make your wishes clear when you have a choice.
A written birth plan also helps refresh your provider's memory when you're in labor. And it informs new members of your medical team — such as your labor-and-delivery nurse — about your preferences when you're in active labor.
I supply all my clients with a mock birth plan template so that we can easily talk about all the things you can expect at birth. Often times (especially for new moms) we have no idea what to expect in birth until we're there, in the moment. And though we can talk with our physician or mid-wife what to expect, its often impossible to talk through all the scenarios and choices there are in birth without having done it yet. There are so many variables that contribute to the birth experience and having a birth plan helps us prepare psychologically for birth. A birth plan can really empower a woman to have a voice during birth. I recommend giving everyone a copy of your birth plan that is expected to be in the room during your labor (doctor, hospital staff, doula, friend or relative, etc.) This is because you want those who plan to be there with you know how to best support you. It simply is not best to only inform your doctor/mid-wife what you desire in labor and birth. Every support person you choose to be in the room with you during labor and birth will effect your experience - it's important every person present are on the same page - and thats it's all about the mother who is laboring.
A birth plan also helps us talk about the possibilities and alternatives to things not going according to The Plan. So much of birth prep is mental, that evaluating all your options and alternatives can prepare you for processing your birth experience in a healthy way if things don't go according to plan.
Here is my template I use, with options listed so moms have a good understanding of what is available to them. This plan has worked really well with both home, birth centers, and hospital births.
www.sacred-birth.blogspot.com
Birth Plan Worksheet
Basic Information
Name: __________________________________________
Partner’s Name: ___________________________________
Doctor/Midwife’s Name(s): __________________________
Other Birth Attendants (doula, friends, etc.):
_________________________________________________________________________________
Children and Helpers, if attending: _________________________________________________________________________________
Baby’s pediatrician, if known: _________________________________
Delivery location: ______________________________________
Estimated Due Date: ___________________________________
Pre‐Birth Preferences
Do have any religious practices that will be contributing to your birth environment/experience?
_________________________________________________________________________________
Do have any religious practices that will be contributing to your birth environment/experience?
_________________________________________________________________________________
Induction:
___ I prefer to be induced on _____________ (date)
___ I will discuss induction after _____________ (date)
___ I prefer not to be induced unless it becomes medically necessary
___I am having a scheduled c‐section on _____________ (date)
Arriving at the Birth Location
___ I will be birthing at home
___ I prefer to arrive as soon as contractions begin or my water breaks
___ I prefer to arrive once my labor is well established
___ I prefer to arrive only once I am advanced in labor; I want to labor at home as long as possible
Paperwork
___ We will pre‐register
___ We will do the paperwork at our earliest convenience; please do not separate me from my support
person
___ We will do the paperwork immediately; please make an y separation as brief as possible
Comfort Measures
I would like to use the following comfort measures:
___Pain medication (see below)
___Massage
___Birthing ball
___Birthing tub
___Music
___Essential oils
___Other: _____________________________
Pain Medication
___Please don’t offer it; I will ask if I want it
___Please offer me pain medication immediately upon arrival (explain my options)
___Please offer me pain medication only if I seem to need it
IV
___I do not want an IV or Hep lock at all
___I am okay with a Hep lock, but do not want an IV
___I would like an IV
Water
___I would like my water broken upon arriving at the hospital, to speed things along
___I would like my water broken only if my labor is slow and I am exhausted
___I would like my water broken only if my baby’s arrival is imminent and it hasn’t broken on its own
___I would not like my water broken under any circumstances
Food/Drink
___Please offer me ice chips or popsicles and nothing else
___Please offer me drinks but not food
___Please offer me food and drink as I need it
___Please do not offer me anything; I will ask or have an IV
Labor Augmentation
___If it becomes necessary, I would like to try natural methods first, including:
___Nipple stimulation
___Nipple stimulation
___Walking
___Herbs
___Other
___Please offer me Pitocin
___I would like to try to avoid augmentation if at all possible; my baby will come when s/he is ready
Fetal Monitoring
___I prefer an external continuous monitor
___I prefer a continuous internal monitor
___Please use an external monitor for a few minutes per hour to check on my baby
___Please use a Doppler to check on my baby occasionally
___Please do not use any devices to monitor my baby; use a fetoscope or palpations only
Labor Positions
I would like to labor:
___While walking
___Lying down
___Sitting on a birthing ball
___In the tub/shower
___Let me decide at the time
Environment
___Please keep the lights dimmed
___Please keep noise levels low
___Please play music. I would like a particular collection: _________________
___Please do this: _______________________________________
Internal Exams
___Please examine me as soon as I arrive and hourly after to check my progress
___Please examine me only if I ask
___Please keep examinations to a minimum
Pushing Preferences
___I would like to push on my back
___I would like to push on my hands and knees
___I would like to push on my side
___I would like to push on a birthing stool
___I would like to push _____________________
___Let me the decide at the time
Episiotomy
___Please cut an episiotomy if my baby is large and having difficulty
___Please do not cut an episiotomy; I would rather risk a tear
___Please allow me to try different pushing positions to avoid a tear
___Please use perineal support, massage and hot compresses to help avoid a tear
Vacuum/Forceps
If I need an assisted delivery, I would prefer:
___Vacuum
___Forceps
___I trust my doctor to decide what’s best
C‐section
___Please help me to avoid a c‐section unless an emergency arises
___Please offer me a c‐section in my labor is not progressing after ___ hours
___I would prefer a c‐section
___Other: ___________________________
Emergency Procedures
___Please explain to me what my options are so I can choose
___Please use your own discretion and choose what is best for me
Moment of Birth
___Please place my baby immediately onto my chest and leave him/her there
___Please allow me to hold my baby briefly before taking him/her to be cleaned and weighed
___Please take my baby to be cleaned/weighed immediately
___ Placenta saving (see how to get your placenta home after hospital birth)
Please explain:
_______________________________________________________________________________
Cord Cutting
___Please cut my baby’s cord immediately
___Please allow my husband/partner to cut the cord
___Please have a doctor cut the cord
___Please wait until the cord stops pulsing before cutting
___Please wait at least an hour to cut my baby’s cord
___Please do not cut my baby’s cord (lotus birth)
Initial Bonding
___Please leave us alone for an hour after birth to bond
___Please clean and dress my baby, complete our medical exams, and then allow us bonding time
___Please do this: _______________________________________________
Newborn procedures:
We give consent for:
___Eye ointment
___Hep B vaccine
___Vitamin K shot
___PKU test
___Hearing test
We do NOT give consent for (please bring us any waivers we need to sign):
___Eye ointment
___Hep B vaccine
___Vitamin K shot
___PKU test
___Hearing test
Feeding
___My baby is exclusively breastfed, please do not offer:
___Formula
___Sugar water
___Pacifiers
___My baby is formula fed, please help us choose a formula
Rooming In
___I wish for my baby to remain in my room 24/7
___Please take my baby to the nursery only at my request
___Please take my baby to the nursery at night so I can sleep (bringing him/her for feedings)
___Please take my baby to the nursery except when s/he needs fed
Visitors:
___I am open to any visitors during visiting hours
___Please allow only the following people: __________________________________________
___Please do NOT allow the following people: _______________________________________
___Please, no visitors during these times: ___________________________________________
Medications Post‐Birth
___Please offer me OTC‐strength medications to cope with pain (acetaminophen, ibuprofen)
___Please offer me stronger medications to cope with pain (as prescribed)
___Please offer me arnica or another natural pain reliever
___Please do not offer me pain medication
___Please offer me a stool softener
___Please do NOT offer me a stool softener
Baby’s Exam
___Please perform my baby’s exam in my room
___Please perform my baby’s exam in the nursery with myself or my partner present
___Please perform my baby’s exam in the nursery, we do not need to be present
Hospital/Birthing Center Stay:
___We prefer to leave 6 hours after birth
___We prefer to leave 24 hours after birth
___We prefer to stay 48 hours after birth
___Please give your recommendation on our length of stay
Complications
___If my baby requires a hospital transfer, please allow my partner to accompany him/her
___If my baby requires a hospital transfer, please allow us to go together once I am released
___Please allow another family member to accompany my baby: ________________________
Other:
_________________________________________________________________________________
_________________________________________________________________________________
www.sacred-birth.blogspot.com
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