A Birth Plan should be a thoughtful reflection of your values. It can be a useful communication tool between you and your caregiver. Ideally, this communication starts early in pregnancy. The following is a sample introduction and a list of suggested topics you might want to address in your birth plan. Keep your birth plan simple and no more than one page long. Address only the things that are important to you:
Best Case Birth Scenario
We (I) have chosen Dr. ______________ and _______________ Hospital because of their excellent reputation in supporting women through the process of childbirth. We (I) understand that birth doesn’t always go “as planned”, and that’s why we have you on our team, however, barring any situations in which mother’s or baby’s safety is in jeopardy, the following “wish list” represents our best case birth scenario. It is intended not as a list of “demands” but as a tool to facilitate communication between us. We (I) ask that we (I) be included in the decision making process during our (my) birth, and together, we can make this a positive and joyous occasion.
Support
Presence of coach and/or doula during labor, delivery, etc.
Presence of interns, residents, other personnel
Labor
Continuous presence of father, doula, mother, etc.
Mobility
Fluids and food
Ambience of environment (i.e. quiet, dim lights, music, interruptions, etc.)
Medical interventions:
IV (this is usually required if dehydrated, GBS+, desire epidural, or need pitocin)
Amniotomy (breaking bag of water)
Monitoring (continuous or intermittent, external or internal?)
Vaginal exams (important to limit if bag of water is broken; also consider the psychological effect of learning you’ve not made as much progress as you thought)
Pitocin
Pain medication/epidural
Delivery
When to start pushing (waiting for urge to push, station of baby, etc)
Birthing positions (squatting, hands and knees, side-lying, etc)
Breathing during pushing stage
Support and encouragement
People in room, ambience
Mirror to see baby emerge
Perineal massage, warm compresses
Baby delivered to abdomen
Dad or Mom deliver baby?
Who cuts cord and when (allow to continue pulsating?)
Placenta (keep or see?)
Donate or bank umbilical cord blood
In the event of cesarean delivery:
Desire to be fully informed of all interventions
Coach and/or doula present for birth
Type of anesthesia (epidural or spinal)
Lowering of screen prior to delivery
Holding baby after delivery (by coach and/or mother)
Sedatives after see baby? (sedatives are associated with maternal amnesia)
Baby brought to recovery room for feeding
Immediately After Delivery
Hold the baby until…..
If baby must be taken away from mother for any reason, father accompanies
Skin to skin
Initiation of breastfeeding
Baby’s medications (Vitamin K, Erythromycin eye ointment, Hepatitis B)
Postpartum Period
Rooming In
Breastfeeding, bottles, glucose water, pacifiers
Circumcision—yes or no (if yes, request anesthesia?)
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