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Sample Birth Plan

mlrafikimlrafiki member
edited May 2014 in Natural Birth
I was cleaning out my computer and I came across my birth plan. I know we don't all agree on the procedures we want (or don't want), and some hospitals/birth centers are more receptive to plans than others, or you might not need one at all, BUT! I thought this might be helpful if you are trying to write one.

My doula helped me write this. Her biggest contribution was in encouraging me to include the part about my preferences in the event of a C-section. I was trying hard not to think about it, but considering the possibility really helped me make my peace with the idea, and I went into the birth in a very calm, serene state of mind.

My requests were respected and I had a great natural birth! Hope this helps (names redacted for privacy):

Hello [Hospital] Birth Center Staff!
Many of you have probably seen us here a lot over the past month, since mom has unfortunately had to come in for repeated kidney infections, but the it’s been very reassuring to us to become familiar with you and with the exceptional care you provide! We are beyond delighted to finally be welcoming our first child at Mills-Peninsula!  We know that births cannot be planned and understand that the health and safety of mom and baby outweigh any of our preferences, so we hope that the requests below can be accommodated as much as possible. This "birth vision" has been reviewed and approved by our doctor (Dr. Beddow). We appreciate your support in this process!
I am aware of all available pain management options and will request them if I feel they are needed; instead of rating the degree of pain, I would prefer questions about how well I am coping.
If possible, I would like access to a room with a bath and use of a birthing ball, to assist in my effort to use natural pain management techniques as much as possible.
I prefer cervical checks to be limited to the minimum frequency necessary, and please do not tell me how many centimeters dilated I am! (Ok to tell dad and doula, though.)
I am happy to accept a saline lock, but would prefer to avoid an IV unless it becomes necessary for hydration or requested/emergency medications.
I prefer intermittent or wireless heart monitoring to allow for maximum mobility.
I prefer to push in whatever position is most comfortable for me at the moment. If it is available, I would love to use a squat bar.
We would like our son to receive the standard Vitamin K shot, Hep B vaccine, and eye ointment after birth and some bonding time.


In the event that a Cesarean birth is necessary, we ask that:
One arm remains unstrapped, when possible.
Mom and baby have skin-to-skin contact as soon as possible after the birth.
Our doula can swap in if dad leaves to accompany baby while mom’s operation is completed.
For doula support in the recovery room.

Thank you again for your care and assistance!
Sincerely,[Mom and Dad]
"Can I call your baby 'Ze Munchkin,' or 'ZM' for short?" - my best friend

Re: Sample Birth Plan

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    mlrafikimlrafiki member
    edited May 2014
    Seriously, Bump? My formatting is gone AND there's no edit option? WTF???

    * Okay, found Edit but the formatting still doesn't show up right. Where's the years-overdue full rebuild of this forum?
    "Can I call your baby 'Ze Munchkin,' or 'ZM' for short?" - my best friend
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