Does anyone have a one-page birth plan?

hotcocoa07 · July 2013

As time is drawing nigh and my Braxton Hicks increase. I am wondering if anyone has a one-page birth plan they are willing to share?

MommyKristin88 · July 2013

Did you research what you do/do not want? My birth plan may not match your desires (especially since I'm planning a homebirth, so I left off a lot of stuff that I believe would be needed in a hospital birth plan).

hotcocoa07 · July 2013

I just need a template as I will tailor it to my needs. I am opting for pain management.

nurseclare9 · July 2013

My hospital provided a template my orientation and then the nurse went over it an clarified things with me. There are lots of templates free online

BelhurstBride · July 2013

My OB has a template she recommends pts use as a starting point. Maybe try there?

DaisyMaeMommy · July 2013

Mine is 2 pages, and honestly, I couldn't think of any way to make it shorter! <embarrassing!>

This is mine:

Birth Plan

Name: Emily
Partner’s Name: Travis
EDD: August 4^th, 2013
Address:***********
My Doctor: *******

Before Labor Begins

I’d like to go NO LONGER than one week past my due date.
I trust that my practitioner will seek out my opinion concerning all of the issues directly affecting my delivery before deviating from my birth plan.
I’d like to have my fiancé with me at all times.
If for some reason I am unable to make decisions for myself, I am giving my fiancé the legal power to make decisions on my behalf.
I would like only my practitioner, nurses and my guests (my fiancé and other visitors I allow) to be present.

Labor

Please do not perform preparatory tasks (shaving, enema, etc.) unless requested.
Please limit the number of vaginal exams, unless they are medically necessary and please ask my permission before giving one.
I would like to be free to move around, change position, use the restroom, etc. as I feel necessary, unless circumstances do not allow this.
I will remain hydrated through drinking water and approved beverages.
I do not want an IV unless I become dehydrated.
If my daughter is healthy I would rather she was monitored externally and intermittently with a fetal heart monitor.
I would like to have Pitocin to induce my labor if induction becomes necessary.

Environment and Equipment

I would like to keep visitors to a minimum and I would only like visitors during the early stage of labor.
I would like my fiancé in the room with me during all stages of labor and delivery.
I would like to take photos during my labor, but not during the actual delivery.
I would like my environment to be kept as quiet as possible.

Delivery

Even if I am fully dilated, and assuming my daughter is not in distress, I would like to try and wait until I feel the urge to push before doing so.
After the first initial push, I would like guidance in when to push and when to stop.
I would prefer not to have an episiotomy unless required for my daughter’s safety.
I would like to choose the position in which I give birth.

After Delivery

I would like my daughter placed on my abdomen/chest immediately after delivery.
I would like my fiancé to cut the cord after it has stopped pulsating.
I would like to hold my daughter while I deliver the placenta and while any tissue repairs are made.
I would like a local anesthesia to repair any tissue damage.
I would like an injection to help deliver the placenta.
I do not want to see the placenta, so please do not show it to me.
I would prefer to try and urinate on my own before being catheterized.

Newborn Care

I would like to speak with a lactation consultant right after delivery.
I want to try and breastfeed immediately after delivery.
Do not give my daughter any bottle, which includes sugar water and/or plain water.
My fiancé and I will decide if we want to give our daughter a bottle and/or pacifier.
Please hold off on any routine checks until after I have breastfed and both my fiancé and I have bonded with our daughter.
I plan to keep my daughter near me following birth and would appreciate if the evaluation of my daughter can be done with her on my abdomen, with both of us covered by a warm blanket, unless there is an unusual situation.
My fiancé and I would like to give our daughter her first bath, with some guidance from a nurse or doctor.
If my daughter must go anywhere for medical reasons, I’d like my fiancé or myself to go with her.
I’d like either my fiancé or myself with our daughter at all times.
If my baby’s health is in jeopardy I would like to accompany them if possible, along with my fiancé or someone I deem fit, otherwise just my fiance or someone I deem fit is to go along also. I would also like to breastfeed or express milk for my baby if appropriate and be allowed as much contact as I can.

Post Partum

I would like my baby to room in with me at all times, no separation, unless for medical reasons.
I would also like to have my fiancé room in so we can both bond with our baby.
I would like to have a limited amount of guests visit my baby and I while I am recovering.
If my baby and I are healthy, I’d like my stay to be as short as possible.

C-Section

I’d like to follow my birth plan as closely as possible. I understand that complications due arise and I trust that I will get the best care I need; In the event that I need to have a C-Section:

I would like to be fully informed on the procedures involved.
I would like my fiancé to be in the room with me.
I would like my practitioner to explain what pain relief options I have.
Unless medically unable to do so, I’d like to be the first to hold my baby and try to breastfeed.
If I cannot hold my baby, I’d like my fiancé to be the first to hold her.
Unless medically unable to do so, I’d like the rest of my birth plan concerning after delivery to be followed.

MommyKristin88 · July 2013

DaisyMaeMommy Edit out your address

BelhurstBride · July 2013

MommyKristin88 said:

DaisyMaeMommy Edit out your address

and full name.

kahlan82 · July 2013

My midwife told me not to even bother writing one up but to just make sure DH and I knew what we wanted and to speak up...no problem there

Soleil3 · July 2013

DaisyMaeMommy said:

Mine is 2 pages, and honestly, I couldn't think of any way to make it shorter! <embarrassing!>

This is mine:
Birth Plan

Name: E

Partner’s Name: T

EDD: August 4^th, 2013

My Doctor: *******

Labor
I would like to be free to move around, change position, use the restroom, etc. as I feel necessary, unless circumstances do not allow this.

I will remain hydrated through drinking water and approved beverages.

I do not want an IV unless I become dehydrated.

I would like to have Pitocin to induce my labor if induction becomes necessary.

Environment and Equipment

Delivery

Even if I am fully dilated, and assuming my daughter is not in distress, I would like to try and wait until I feel the urge to push before doing so.

After the first initial push, I would like guidance in when to push and when to stop.

I would prefer not to have an episiotomy unless required for my daughter’s safety.

I would like to choose the position in which I give birth.

After Delivery

I would like my daughter placed on my abdomen/chest immediately after delivery.

I would like my fiancé to cut the cord after it has stopped pulsating.

I would like to hold my daughter while I deliver the placenta and while any tissue repairs are made.

I would like a local anesthesia to repair any tissue damage.

I would like an injection to help deliver the placenta.

I do not want to see the placenta, so please do not show it to me.

I would prefer to try and urinate on my own before being catheterized.

Newborn Care

I would like to speak with a lactation consultant right after delivery.

I want to try and breastfeed immediately after delivery.

Do not give my daughter any bottle, which includes sugar water and/or plain water.

My fiancé and I will decide if we want to give our daughter a bottle and/or pacifier.

Please hold off on any routine checks until after I have breastfed and both my fiancé and I have bonded with our daughter.

I plan to keep my daughter near me following birth and would appreciate if the evaluation of my daughter can be done with her on my abdomen, with both of us covered by a warm blanket, unless there is an unusual situation.

My fiancé and I would like to give our daughter her first bath, with some guidance from a nurse or doctor.

If my daughter must go anywhere for medical reasons, I’d like my fiancé or myself to go with her.

I’d like either my fiancé or myself with our daughter at all times.

If my baby’s health is in jeopardy I would like to accompany them if possible, along with my fiancé or someone I deem fit, otherwise just my fiance or someone I deem fit is to go along also. I would also like to breastfeed or express milk for my baby if appropriate and be allowed as much contact as I can.

Post Partum

I would like my baby to room in with me at all times, no separation, unless for medical reasons.

I would also like to have my fiancé room in so we can both bond with our baby.

I would like to have a limited amount of guests visit my baby and I while I am recovering.

If my baby and I are healthy, I’d like my stay to be as short as possible.

C-Section

I’d like to follow my birth plan as closely as possible. I understand that complications due arise and I trust that I will get the best care I need; In the event that I need to have a C-Section:

I would like to be fully informed on the procedures involved.

I would like my fiancé to be in the room with me.

I would like my practitioner to explain what pain relief options I have.

Unless medically unable to do so, I’d like to be the first to hold my baby and try to breastfeed.

If I cannot hold my baby, I’d like my fiancé to be the first to hold her.

Unless medically unable to do so, I’d like the rest of my birth plan concerning after delivery to be followed.

Edited

you have a lot of junk in there that doesn't matter.

You don't mention pain relief preferences though.

WildRumpus · July 2013

I have one that us one page, I can post later if you don't find one that you like. I'm mobile at the moment

laceylavallee · July 2013

My birth plan was one page... I posted it on the Natural Birth board but I'll post it here as well. I received many compliments from my drs on it.

Birth Plan:
Mother to be- Xx
Spouse- Xx
Support Person- Xx
Due Date- 08/12/2013

*This birth plan is intended to express the preferences and desires we have for the birth of our baby. We understand unexpected situations may arise in which require deviations from our plan. In such cases, we trust our providers will communicate with us and allow us to be part of the shared decision-making.
Thank you- Xx

First Stage- Labor:
*Quiet encouraging environment
*Vaginial exams kept to minimum
*Maintain mobility
*Clear fluids/ice chips
*Heparin lock
*Attached external monitoring kept to minimum (intermittent Doppler monitoring)
*With hold pain meds unless requested
*Relaxation techniques
*Positioning as desired
*Water (shower/tub)
*Hot/cold packs
*Massage

Second Stage- Birth:
*Choice of pushing position
*No episiotomy (tear naturally)
*Mother directed pushing
*Birth to chest
*Save placenta

Baby Care:
*Delayed cord clamping
*Skin to skin contact
*Medical exams done while on chest
*Breastfeeding as soon as possible
*No artificial nipples
*Breastfeeding only

DaisyMaeMommy · July 2013

Soleil3 said:

DaisyMaeMommy said:

Mine is 2 pages, and honestly, I couldn't think of any way to make it shorter! <embarrassing!>

This is mine:
Birth Plan

Name: E

Partner’s Name: T

EDD: August 4^th, 2013

My Doctor: *******

Labor
I would like to be free to move around, change position, use the restroom, etc. as I feel necessary, unless circumstances do not allow this.

I will remain hydrated through drinking water and approved beverages.

I do not want an IV unless I become dehydrated.

I would like to have Pitocin to induce my labor if induction becomes necessary.

Environment and Equipment

Delivery

Even if I am fully dilated, and assuming my daughter is not in distress, I would like to try and wait until I feel the urge to push before doing so.

After the first initial push, I would like guidance in when to push and when to stop.

I would prefer not to have an episiotomy unless required for my daughter’s safety.

I would like to choose the position in which I give birth.

After Delivery

I would like my daughter placed on my abdomen/chest immediately after delivery.

I would like my fiancé to cut the cord after it has stopped pulsating.

I would like to hold my daughter while I deliver the placenta and while any tissue repairs are made.

I would like a local anesthesia to repair any tissue damage.

I would like an injection to help deliver the placenta.

I do not want to see the placenta, so please do not show it to me.

I would prefer to try and urinate on my own before being catheterized.

Newborn Care

I would like to speak with a lactation consultant right after delivery.

I want to try and breastfeed immediately after delivery.

Do not give my daughter any bottle, which includes sugar water and/or plain water.

My fiancé and I will decide if we want to give our daughter a bottle and/or pacifier.

Please hold off on any routine checks until after I have breastfed and both my fiancé and I have bonded with our daughter.

I plan to keep my daughter near me following birth and would appreciate if the evaluation of my daughter can be done with her on my abdomen, with both of us covered by a warm blanket, unless there is an unusual situation.

My fiancé and I would like to give our daughter her first bath, with some guidance from a nurse or doctor.

If my daughter must go anywhere for medical reasons, I’d like my fiancé or myself to go with her.

I’d like either my fiancé or myself with our daughter at all times.

If my baby’s health is in jeopardy I would like to accompany them if possible, along with my fiancé or someone I deem fit, otherwise just my fiance or someone I deem fit is to go along also. I would also like to breastfeed or express milk for my baby if appropriate and be allowed as much contact as I can.

Post Partum

I would like my baby to room in with me at all times, no separation, unless for medical reasons.

I would also like to have my fiancé room in so we can both bond with our baby.

I would like to have a limited amount of guests visit my baby and I while I am recovering.

If my baby and I are healthy, I’d like my stay to be as short as possible.

C-Section

I’d like to follow my birth plan as closely as possible. I understand that complications due arise and I trust that I will get the best care I need; In the event that I need to have a C-Section:

I would like to be fully informed on the procedures involved.

I would like my fiancé to be in the room with me.

I would like my practitioner to explain what pain relief options I have.

Unless medically unable to do so, I’d like to be the first to hold my baby and try to breastfeed.

If I cannot hold my baby, I’d like my fiancé to be the first to hold her.

Unless medically unable to do so, I’d like the rest of my birth plan concerning after delivery to be followed.

Edited you have a lot of junk in there that doesn't matter.
You don't mention pain relief preferences though.

I agree with some of these changes, but not all. I wanted to make sure my doctor knew who was to make medical decisions for me if I was not able to do so for myself. My own doctor told me to put that in there, for legal purposes.

WildRumpus · July 2013

Daisy, has your doctor seen this? That is WAY long...

interzone · July 2013

kahlan82 said:

My midwife told me not to even bother writing one up but to just make sure DH and I knew what we wanted and to speak up...no problem there

I didn't have one last time and things went pretty much as DH and I requested them to (minus that whole PPROM thing). I didn't bother with one this time either since I've already discussed it with my OB. DH is a physician (not an OB/GYN) so he has no problem being assertive in medical situations.

Mom2bois85 · July 2013

I'm a STM and I didn't write a birth plan but I have some simple requests...
I am trying for natural but if in too much pain I'm opting for epidural.
I want DH with me at all times!
I want no episiotomy unless its an absolute emergency!
I want to be able to give birth laying on my side like I did last time and I want DH to cut the cord
Plain and simple

DaisyMaeMommy · July 2013

Jill9288 said:

Daisy, has your doctor seen this? That is WAY long...

Yes, she has. Basically I won't need it if she's there helping me deliver. But her own baby is due within the next month and she wants to make sure everything is covered due to complications I had with my first childbirth.

I do have a short version as well, which is what's actually on file.

SarahinMD · July 2013

https://midwiferycareassociates.com/yahoo_site_admin/assets/docs/MCA_birth_plan.84160625.pdf on iPad and haven't done a link before so sorry if this isn't clicky

lydsyjane · July 2013

I'm probably just gonna scribble a few notes on a piece of paper, and call 'er good. I doubt they'll be able to remember it if I write down 3 pages of notes.

ELauren88 · July 2013

I have a 1/2 page birth plan. It's straight forward and to the point, but it's very specific to the birth I want/wish for. We aren't allowed to hand the hospital our birth plans until we are admitted as they become part of our charts, though. This is to prevent them from getting lost or people not reading them.

WashingtonQueen · July 2013

DaisyMaeMommy you still have not edited your OP.

Soleil3 · July 2013

@DaisyMaeMommy Your birth plan has no legal holding whatsoever. The hospital cant honor that, unfortunately.

WildRumpus · July 2013

OP, here's mine if you're interested. I am planning to go med-free though, so you would want to make those changes:

Jillian and Rick H. Birth Plan

We're very happy with our choice of Dr. M and Hospital for Ezra's upcoming birth-day party. In preparing for his arrival, we have participated in Bradley Method birth classes and have done everything that we can to stay healthy and low-risk during this pregnancy. We are looking forward to a beautiful, natural birth with Rick acting as the primary coach and would appreciate your understanding and cooperation in helping us to achieve this goal. Our end goal,however, is a healthy baby and mother, and we are prepared to talk about deviation from this plan if deemed necessary.

Jillian IS GBS+ and understands that IV antibiotics will be administered throughout labor. However, we wish to refrain from the use of: an epidural or any other additional drugs including pitocin, excessive use of electronic fetal monitoring or cervical checks, forceps, suction, or other forms of forced extraction.
When not receiving IV antibiotics, Jillian would like the option to have the IV capped and the ability to move about.
During labor and delivery, Jillian would like the ability to move freely and change positions based on what is most comfortable for her at the time.
Please refrain from directing pushing until baby is crowning, at which time pushing should be slowed to allow the perineum to stretch.
If deemed necessary Jillian would prefer that a pressure episiotomy be performed.
We would prefer immediate skin-to-skin contact, with all exams either being delayed, or performed with baby on Jillian's chest. A delay is requested for all non-essential routines (bathing, eye drops, etc) for at 1-2 hours to facilitate bonding and breastfeeding.
Please delay clamping the umbilical cord for 1-2 minutes (until pulsating has slowed or stopped) Rick would like the chance to cut it.
Jillian would prefer that the placenta be delivered spontaneously, rather than with the use of pitocin or controlled traction on the umbilical cord.
We would prefer that Ezra remain in the room at all times.
Jillian plans to exclusively breastfeed, so please do not offer artificial nipples of any kind.
In the event of an emergency, we would like for Rick to remain with the baby if possible.

If a C-section is needed, please allow Rick to be present for the duration.
Jillian would prefer an epidural or spinal anesthesia over general.
Rick should be allowed to hold Ezra ASAP.
Jillian would like Ezra to come to her in recovery ASAP.

Thank you for working with us to give us the best birth experience possible.

DaisyMaeMommy · July 2013

WashingtonQueen said:

DaisyMaeMommy you still have not edited your OP.

Oops, completely missed that. I think it's time this Mom takes a nap...LOL

DaisyMaeMommy · July 2013

Soleil3 said:

@DaisyMaeMommy Your birth plan has no legal holding whatsoever. The hospital cant honor that, unfortunately.

I have a legal document to go with it.

DaisyMaeMommy · July 2013

Jill9288 said:

OP, here's mine if you're interested. I am planning to go med-free though, so you would want to make those changes:
Jillian and Rick H. Birth Plan

We're very happy with our choice of Dr. M and Hospital for Ezra's upcoming birth-day party. In preparing for his arrival, we have participated in Bradley Method birth classes and have done everything that we can to stay healthy and low-risk during this pregnancy. We are looking forward to a beautiful, natural birth with Rick acting as the primary coach and would appreciate your understanding and cooperation in helping us to achieve this goal. Our end goal,however, is a healthy baby and mother, and we are prepared to talk about deviation from this plan if deemed necessary.

Jillian IS GBS+ and understands that IV antibiotics will be administered throughout labor. However, we wish to refrain from the use of: an epidural or any other additional drugs including pitocin, excessive use of electronic fetal monitoring or cervical checks, forceps, suction, or other forms of forced extraction.

When not receiving IV antibiotics, Jillian would like the option to have the IV capped and the ability to move about.

During labor and delivery, Jillian would like the ability to move freely and change positions based on what is most comfortable for her at the time.

Please refrain from directing pushing until baby is crowning, at which time pushing should be slowed to allow the perineum to stretch.

If deemed necessary Jillian would prefer that a pressure episiotomy be performed.

We would prefer immediate skin-to-skin contact, with all exams either being delayed, or performed with baby on Jillian's chest. A delay is requested for all non-essential routines (bathing, eye drops, etc) for at 1-2 hours to facilitate bonding and breastfeeding.

Please delay clamping the umbilical cord for 1-2 minutes (until pulsating has slowed or stopped) Rick would like the chance to cut it.

Jillian would prefer that the placenta be delivered spontaneously, rather than with the use of pitocin or controlled traction on the umbilical cord.

We would prefer that Ezra remain in the room at all times.

Jillian plans to exclusively breastfeed, so please do not offer artificial nipples of any kind.

In the event of an emergency, we would like for Rick to remain with the baby if possible.

In The Event of An Unexpected C-Section
If a C-section is needed, please allow Rick to be present for the duration.

Jillian would prefer an epidural or spinal anesthesia over general.

Rick should be allowed to hold Ezra ASAP.

Jillian would like Ezra to come to her in recovery ASAP.

Thank you for working with us to give us the best birth experience possible.

I didn't even think to use our actual names. I'm feeling alittle inadequate right now.

Want a personalized experience?

Does anyone have a one-page birth plan?

Re: Does anyone have a one-page birth plan?

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