Sample Birth Plan

(Last Name) Family Birth Plan
Mother:
Father:
Doula:
 


We understand that certain emergency or other medical circumstances may not allow for the accommodation of the goals listed below.

Home Labor Goals

  • We would like to labor at home as long as possible, with our doula present, before going to the hospital.


Hospital Labor Goals

  • We plan to have present at the birth and/or labor:
  • We ask that all other visitors and unnecessary staff be turned away until we (mom and dad) have had time alone with our new baby.
  • I prefer not to have catheter unless determined to be required for another procedure to facilitate delivery.
  • The birth environment is important to us.  We ask that lights be kept dim, noise be kept to a minimum, be able to play soothing music, door kept closed for privacy.
  • I would like to wear my own clothing, although the staff may offer a hospital gown.
  • I would like the opportunity to be up out of bed as much as possible during labor.
  • I would like the option to eat when desired.
  • I prefer a monitoring method that allows me to remain mobile.


Birth Goals

  • We are attempting to have a natural, unmedicated birth without unnecessary medical intervention.
  • We understand that there are procedures which may become necessary.
  • Except in the case of an emergency, we ask that we be given the opportunity to accept or refuse any procedure or medication.
  • We request that the least invasive or restricting versions of procedures be used.


Induction (if necessary)

  • We ask that non-chemical induction methods be tried first: walking, breast stimulation, sexual intercourse.

Pain Management Goals

  • We plan to handle pain with relaxation, massage, fitness ball, changing positions, walking breathing, and/or water (shower or tub).


Delivery Goals

  • I would like to push at my own pace (Mother-Directed Pushing).
  • I prefer not to have an episiotomy unless determined to be medically necessary.  I would first like to try perinea massage, support and warm compresses.
  • If labor or delivery seems stalled, we would like the opportunity to try different positions (hands and knees, squatting, birth stools, etc.)
  • We would like to have the baby placed on the mother’s chest with skin-to-skin contact immediately after the birth and for the first 1 to 2 hours following the birth.
  • We would like to try to have the baby breastfeed as soon as possible.
  • We would like the staff to help the mother change position if necessary to facilitate breastfeeding.


Umbilical Cord

  • Please do not cut the cord immediately.  We would like to delay a bit after birth before this is done.
  • Please offer the father the opportunity to cut the cord.


Newborn Care Goals

  • We would like to be present at the baby’s first bath.


Circumcision (if boy)

  • We would like at least one parent to be present at the circumcision.


Cesarean Section (if medically necessary)

  • I would like to be conscious
  • We would prefer that our baby breastfeed immediately or as soon as possible afterward in the recovery room.
  • We prefer the baby and father remain in the recovery room with the mother.


Birth Recovery Goals

  • We prefer to have a private room, if available, and that the father and baby be allowed to room-in.

Breastfeeding Goals

  • We would like to establish breastfeeding.  please do not offer any bottles to the baby without parental notification of a medical need.
  • We would like to meet with a lactation consultant before leaving the hospital to have techniques checked.


Thank you for taking the time to help us achieve a natural childbirth for our first baby!