3rd Trimester

Birth plan template

Does anyone have a link to a good birth plan template?  I can't find the one I used with DD but wanted to make sure I get how I want my birthing process to go down in writing for the hospital staff.  TIA!

Re: Birth plan template

  • Thebump has one, under pregnancy tools.
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  • I picked and chose from multiple birth plan templates to create a one page birth plan that addresses all my most important issues...i found that not one of them was 100% good enough
  • Normal 0 false false false MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} Here is my birth plan...i pasted it from word.

     

    Birth Preferences:       _________(name)
    Due Date: ___________ ? _________ OB/GYN ?

    Spouse: ______________ ? Doula: _____________

     

    Labor

    • I would appreciate being assigned a nurse who enjoys natural births
    • I wish to be able to change position at will throughout labor.
    • I would like to be able to eat and drink as I desire.
    • I would like the lights in the room to be kept low during my labor.
    • I would appreciate a minimum of vaginal exams and only to be done by nurses or doctors. Please allow 3-4 hours between each centimeter dilation before declaring "stalled progress".
    • Please no IV or Saline-Lock unless absolutely necessary.

     

    Monitoring

    • I would prefer intermittent fetal monitoring as opposed to continuous fetal monitoring; as required by the condition of baby.
    • I wish to avoid an internal monitor unless absolutely necessary.

     

    Labor Augmentation/Induction

    • I do not wish to have the amniotic membrane ruptured artificially.
    • I would prefer to be allowed to try changing position and other natural methods (walking, nipple stimulation) before artificial induction is suggested or insisted upon.

     

    Pain Medication/ Pain Relief

    • I realize that many pain medications exist. I'll ask for them if I need them. I do not wish to have these offered to me.
    • I'd like to manage my pain naturally through the bath and showers; and would appreciate coaching as needed for using the birthing ball, spousal massage, and ice/heat packs as required.
    • Please refrain from any medical interventions not previously agreed upon. I am happy to discuss any measures which may be deemed medically necessary prior to their implementations

     

    Cesarean

    • I would like to avoid a Cesarean unless absolutely necessary and would prefer to try alternatives to cesarean without pressure.
    • If a Cesarean delivery becomes necessary, I would like to be fully informed and to participate in the decision-making process with my spouse present at all times.

     

    Episiotomy

    • I do not want an episiotomy and wish to protect the perineum, I would prefer a natural tear...but I am willing to discuss this should the need arise.
    • I am practicing ahead of time by squatting, doing Kegel exercises and perineal massage. I would appreciate guidance in when to push and when to stop pushing to allow the perineum to stretch.

     

    Delivery

    • I would like to be allowed to choose the position in which I give birth, including squatting, on hands and knees etc.
    • Even if I am fully dilated, and assuming baby is not in distress, I would like to try to wait until I feel the urge to push before beginning the pushing phase.
    • I would appreciate the room lights turned low for the delivery.
    • I would like to have baby placed on my stomach/chest immediately after delivery as long as baby is okay.

     

    Immediately After Delivery / Postpartum

    • Please allow the umbilical cord to stop pulsating before it is cut. I would like my spouse to be offered the option to cut the cord.
    • I would like to hold baby while I deliver the placenta and any tissue repairs are made.
    • I would like to have baby evaluated and bathed in my presence or my spouse's presence.
    • If baby must be taken from me to receive medical treatment, my spouse will accompany baby at all times.
    • I appreciate your patience in waiting for the placenta to detach naturally...I do not want a routine injection of Pitocin after the delivery to aid in expelling the placenta, unless absolutely necessary (as long as there is no heavy bleeding).
    • I'd like to delay baby's eye medication for a few hours after birth.
    • I do not wish to have the baby injected with Hepatitis B vaccine.
    • Unless required for health reasons, I do not wish to be separated from my baby.

     

    Breastfeeding

    • I plan to breastfeed baby and would like to begin nursing very shortly after birth.
    • I would like to meet with the staff Lactation Consultant as soon as possible following birth to assess breastfeeding progress.
    • I do not wish to have any bottles (including glucose water or plain water) or pacifiers given to baby.
  • I used birthplan.com, then copied and pasted into a word document, took out the headings, and shortened a lot of the sentences.  My birthing instructor recommended that it not be longer than one typed page and not too small of a font or most medical staff won't take the time to read it.
  • It didn't copy perfectly...but i have it bulleted and set up in two columns on one page in word...i felt it was best to keep it all on one side of a page! =)
  • Birth plan for _________ and ________

    Care provider:

     

    Our desire is to have a natural, non-medicated and intervention free birth. We fully appreciate your support in our decision.

     

    Labor

    • Would like to be able to move around often
    • Intermittent fetal monitoring
    • Would like to be able to eat and drink
    • Do not want an I.V.
    • Would like the option to labor in any position I feel comfortable (i.e. birth ball, shower/tub, all fours, etc...)
    • Would like to keep vaginal exams to a minimum
    • Please do not offer me any pain medication

     

    Birth

    • Please assist with counter pressure, positioning, warm compresses, and KY jelly
    • Would like a quiet and peaceful room, with dim lights
    • Do not want an episiotomy
    • Please encourage me to stay off my back?prefer to be on all fours or squatting
    • Do not want forceps or a vacuum to be used
    • Would like the baby placed on my chest immediately after birth
    • Please wait to cut the cord until it stops pulsing ?My husband would like to cut the cord
    • I will breastfeed my baby as I deliver the placenta?do not administer a pitocin shot unless absolutely necessary

     

    After Delivery

    • No eye medication
    • Do not want hepatitis B shot administered immediately after birth
    • Vitamin K shot for baby boy only
    • Baby boy will be circumcised
    • We will room-in with our baby
    • Please wait to bathe baby
    • I will be breastfeeding; please do not offer pacifiers or bottles
    • If baby needs medical attention one of us will always be present

     

    Cesarean Section

    • Jake will be present at all times
    • I would like one hand free
    • Would like immediate contact with baby, if possible
    • Please double suture incision

     

    Thank you for understanding; we know that you will do everything possible to make our stay in the hospital a pleasant one!

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    Neena Mae. 1/7/10
    "A baby nursing at a mother's breast is an undeniable affirmation of our rootedness in nature." - David Suzuki
    Pregnancy Ticker
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