Sample Birth Plan

(Last Name) Family Birth Plan

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!