Perhaps you already have decided how you wish to bring your baby into the world. If you have not considered a birth plan and you are expecting a new baby, now may be the time to do so. There are so many options for you to consider and if you wait until the last minute you may be disappointed that you did not have some sort of plan in writing. When you go into labor, things are easily forgotten, such as the choices you had considered in the previous 9 months. Everything from methods of pain relief, the environment of the room the baby will first be welcomed into, and who you wish to be in attendance with you. There are also many things you may have never thought about. Your birth plan can also help to prepare you psychologically, by giving you something to review prior to your birth. When you read your own birth plan, you may wish to highlight points you feel more strongly about. Below is a sample birth plan. While there are many things that you may wish to include or some that you may opt to remove from this plan, it is a good starting point and will help to give you some ideas as to how you will present your plan to your doctor or midwife. You may wish to add additional sections or remove those that do not apply.

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Name: Mother’s Name
Spouse: Spouse Name
Midwife or OB: Name of Doctor
Pediatrician: Babies doctor
Birth Center or Hospital: Birth Place
Approximate Due Date: ??/??/??

Personal Statement:

We understand that birth can be unpredictable. We are presenting this birth plan to encourage dialogue and to help us achieve a safe and satisfying birth. Our baby's health and well-being is of utmost importance to us. We look forward to working with you, and appreciate your cooperation in helping our family to achieve our personal birthing goals.

BEFORE LABOR BEGINS:

1. I expect, and trust, that my practitioner will seek my opinion, and that of my husband, (list husbands name), on all issues that may affect my birth experience or that deviate from this plan.

2. If the baby and I are fine, and if I go past my estimated due date, I would like to wait until I go into labor naturally.

3. If my water breaks at the onset of labor and there are no signs of infection, I would ideally like to wait at least 24 hours before induction is considered.

4. If my baby is overdue, prior to induction, I would like to try the natural techniques first (with the guidance and supervision of my doctor or midwife): i.e., Herbs, cohosh or penny royal.

FIRST STAGE OF CHILDBIRTH: LABOR

First Stage, Phase I - Latent Labor

• Upon entering my hospital or birth center, it is crucial for me that I will not be separated from my husband, at any point during labor or birth.
• My husband and I prefer the assistance of a Midwife if available.
• While I understand and can appreciate the need for training and teaching, I may prefer not to have residents or students walking in and out during my labor and delivery. Please respect my wishes as I state them while laboring and delivering.
• Ideally, I would like my environment to:
• -- have dimmed lights
• -- to have voices respectfully lowered
• -- to include music I provide - battery operated cd player
• I would like the opportunity to wear my own clothing if allowed.
• I would like (My husband) to have the opportunity to film and/or photograph labor and delivery.
• I would like the hospital or birthing staff to know that I may have my own personal style to birthing. I would be grateful for the personal space to do this comfortably without feeling hushed or rushed.
• Upon being admitted, I would like to avoid a routine enema.
• I am uncomfortable having my pubic area shaven unless it becomes medically necessary to do so. Please explain such a procedure beforehand.

First Stage, Phase II - Active Labor - Getting to 10 cm

• I understand that I will be working REALLY hard. I prefer to be allowed to eat lightly if I so request, However: If hospital rules do not allow food, I would like to have access to clear fluids, like water, Recharge®, Gatorade®, and/or ice-chips.
• I do not wish to have an IV. I am aware that if I do not have an IV it is my own responsibility and that of my partner to keep me hydrated with plenty of the above listed fluids. If an IV prep becomes necessary I would like a heparin/saline lock to be considered.
• Since mobility is important to me, I would like Intermittent Monitoring (ACOG Standards), using:
• -- Doppler
• -- External electronic monitor
• (My husband) and I would like to take a few moments to privately discuss my pain-relief options before a decision is made.
• Ideally, I'd like a drug-free birth. Only offer medications if I ask.
• I would like the opportunity to try non-medical, non-invasive pain-relief methods. Some therapies I feel would be useful for me include:
• -- Massage
• -- Guided relaxation
• -- Change in position
• Ideally, I would like to be allowed freedom of movement -- to walk, rock, use the bathroom or shower and move as my body dictates.
• I am interested in having access to certain birthing equipment. If available, I would like to use:
• -- Birthing chair
• -- Squatting bar
• I would like the mobility to use a birthing ball that I have provided to allow for comfortable position changes for pain control.

First Stage, Phase III - Transition

• I understand that transition is unpredictable. I may throw-up, my water may break if has not already, and/or I may expel other bodily fluids. I am appreciative of help that reduces my anxieties and my sense of vulnerability.
• At this point, my body may be most sensitive. If I am feeling that my support person's or staff member's voice and/or touch feels too much, I will indicate so.

SECOND STAGE OF CHILDBIRTH: PUSHING AND DELIVERY

Pushing

• I would like to have Lamaze like coaching.
• As long as it is clear that my baby's heart tones are good and that she is receiving sufficient oxygen, I would like to be free of time limits on pushing. It is important to me to allow my body to operate in its natural rhythm and timetable.
• If my doctor or midwife feels that pushing may not be progressing efficiently, I would like to be reminded that sometimes changing positions helps. Because I may be very internally-focused, I would like to be encouraged to try one or more of the following delivery positions:
• -- Squatting
• -- Kneeling, resting arms on bed/chair
• -- Whatever feels right in the moment
• I do not wish to push lying on my back.

Vaginal Delivery:

• I do not wish to have an episiotomy. I understand that there is a possibility that I may tear. To that end, I would like my practitioner/midwife or (My husband) to support me with:
• -- warm compresses applied to my perineum
• -- encouragement to breath with my urge push, allowing me to move with the flow and force of my uterus.
• If repairs (stitches) are needed, I would like local anesthesia.
• If my water breaks at the onset of labor and there are no signs of infection, I would ideally like to wait at least 24 hours before induction is considered.
• I would like my baby to be placed on my abdomen immediately following the birth and to breastfeed as soon as possible. If this is the case, she will be above the placenta and I would therefore like to wait until the cord stops pulsating before it is clamped and cut.
• If warming is necessary, please allow baby to be warmed on my abdomen, covered by blankets.

If Complications Lead to a Cesarean Delivery:

• It is important to me that (My husband) be present with me at all times during the birth.
• Ideally, I would like to remain awake and aware, avoiding general anesthesia if possible.
• Please discuss anesthesia options with me.
• Please use a low-transverse incision on my uterus and abdomen.
• At this time I feel that I would like the screen to be lowered, or be able to use a mirror, so I can witness my baby's entrance into the world. I will specify if I change my mind prior to surgery.
• Please leave at least one of my hands free so I may touch my baby when he or she is born.
• Ideally, I would like the opportunity for (My husband) to videotape and/or photograph our baby's birth.
• Assuming the baby is well, I would like to hold my baby on my chest and/or nurse my baby as soon as possible.
• Please remove my IV and catheter as soon as possible following my baby's birth.
• Please discuss options for postpartum medication, if needed, with me.
• Please provide me with nutritious food and drink as soon as possible.

THIRD STAGE OF CHILDBIRTH: DELIVERY OF PLACENTA OR AFTERBIRTH

• Ideally, I would like to deliver the placenta unassisted -- without Pitocin, uterine massage or cord traction. If I cannot deliver the placenta unassisted and if a procedure is necessary, please explain it to me.

IMMEDIATE NEWBORN CARE:

Suction and Cord Care:

• I would like my baby not to be suctioned unless medically necessary.
• As previously mentioned, in my ideal world, my healthy baby will be immediately placed on my chest. If this is the case, he or she will be above the placenta and I would therefore like to wait until the cord stops pulsating before it is clamped and cut.
• I would like the opportunity to cut, or have (My husband) cut, the baby's umbilical cord if he wishes.

Eye drops, Vitamin K and other Procedures:

• I understand that it is routine to administer antibiotic drops or ointment, such as erythromycin, to newborn baby's eyes to protect against gonorrhea and chlamydia, as well as other more common bacterial infections.
• I would like this treatment, but ideally, I would like it to be delayed until I have spent some time bonding with my baby, preferably for at least one hour.
• I understand that in the United States, it is routine procedure to give newborns a one-time injection of vitamin K.
• Ideally, I would like oral vitamin K to be used instead of the intramuscular injection.
• Ideally, with either a vaginal or cesarean birth, I would like to postpone routine newborn procedures until I have had a chance to bond with my baby.
• I would like to have any additional newborn procedures thoroughly explained to us.
• I would like to be present, or have (My husband) present during all newborn procedures.
• I would like to postpone any immunizations until a later time.

Bathing and Circumcision:

• I prefer that the baby be gently wiped down to remove fluids, and wrapped in a receiving blanket. Please do not bathe, to allow my baby's natural vernix to continue to soften and protect skin.
• Even though it has been determined by ultrasound we are having a girl, if the baby is a boy, I do intend to circumcise, and would like it done at the hospital or birth center by my baby's health care provider.
• I would like to be present, or have (My husband) present during this procedure.
• I would like anesthesia used for pain relief during the circumcision.
• If various procedures are available for performing circumcision, I would like these choices explained to me and (My husband).

Rooming-In and Feeding:

• My preference for in-hospital infant care is: Full rooming in -- no separation.
• Please do not offer my baby the following:
• -- Formula
• -- Sugar water
• -- Pacifiers
• -- Artificial nipples
• My feeding preference is:
• -- to breastfeed exclusively.
• I would like my older children to visit with my newborn and me as soon as possible.

Sick Baby and Postpartum Care:

• I would like to:
• -- breastfeed, or provide my expressed milk for my baby.
• -- have unlimited visitation for (My husband) and myself.
• -- hold, rock and care for my baby, if possible.
• I would like my hospital/birth center stay to be as short as possible.

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