what's hot around the web

Tool: Birth Plan

While much of what happens during delivery is way beyond your (or anyone's!) control, creating a birth plan will at least make your wishes clear. Definitely talk the plan over with your doc -- it's important to make sure you're both on the same page. Also, remember that the options included on our plan may not be available with every doctor or birthing center. 

> Click the image below to download the pdf.
> Don't have Adobe Reader? Get it now.


 

Birth Plan:

[  ] Full name:

[  ] Partner’s name:

[  ] Today’s date:

[  ] Due date: OR Induction date:

[  ] Doctor’s name:

[  ] Hospital name:


Please note that I:
[  ] Have group B strep
[  ] Am Rh incompatibility with baby
[  ] Have gestational diabetes

My delivery is planned as:
[  ] Vaginal
[  ] C-section
[  ] Water birth
[  ] VBAC


I’d like…:

[  ] Partner:

[  ] Parents:

[  ] Other children:

[  ] Doula:

[  ] Other:

…present before AND/OR during labor


During labor, I’d like:
[  ] Music played (I will provide)
[  ] The lights dimmed
[  ] The room as quiet as possible
[  ] As few interruptions as possible
[  ] As few vaginal exams as possible
[  ] Hospital staff limited to my own doctor and nurses (no students, residents or interns present)
[  ] To wear my own clothes
[  ] To wear my contact lens the entire time
[  ] My partner to film AND/OR take pictures
[  ] My partner to be present the entire time
[  ] To stay hydrated with clear liquids and ice chips
[  ] To eat and drink as approved by my doctor

I’d like to spend the first stage of labor:
[  ] Standing up
[  ] Lying down
[  ] Walking around
[  ] In the shower
[  ] In the bathtub

I'm not interested in:
[  ] An enema
[  ] Shaving of my pubic area
[  ] A urinary catheter
[  ] An IV, unless I’m dehydrated (and a heparin or saline lock IS/IS NOT ok)

I’d like fetal monitoring to be:
[  ] Continuous
[  ] Intermittent
[  ] Internal
[  ] External
[  ] Performed only by Doppler
[  ] Performed only if the baby is in distress

I’d like labor augmentation:
[  ] Performed only if baby is in distress
[  ] First attempted by natural methods such as nipple stimulation
[  ] Performed by membrane stripping
[  ] Performed with prostaglandin gel
[  ] Performed with Pitocin
[  ] Performed by rupture of the membrane
[  ] Performed by stripping of the membrane
[  ] Never to include an artificial rupture of the membrane

For pain relief, I’d like to use:
[  ] Acupressure
[  ] Acupuncture
[  ] Breathing techniques
[  ] Cold therapy
[  ] Demerol
[  ] Distraction
[  ] Hot therapy
[  ] Hypnosis
[  ] Massage
[  ] Meditation
[  ] Reflexology
[  ] Standard epidural
[  ] TENS
[  ] Walking epidural
[  ] Nothing
[  ] Only what I request at the time
[  ] Whatever is suggested at the time

During delivery, I would like to:
[  ] Squat
[  ] Semi-reline
[  ] Lie on my side
[  ] Be on my hands and knees
[  ] Stand
[  ] Lean on my partner
[  ] Use people for leg support
[  ] Use foot pedals for support
[  ] Use a birth bar for support
[  ] Use a birthing stool
[  ] Be in a birthing tub
[  ] Be in the shower

I will bring a:
[  ] Birthing stool
[  ] Birthing chair
[  ] Squatting bar
[  ] Birthing tub

As the baby is delivered, I would like to:
[  ] Push spontaneously
[  ] Push as directed
[  ] Push without time limits, as long as the baby and I are not at risk
[  ] Use a mirror to see the baby crown
[  ] Touch the head as it crowns
[  ] Let the epidural wear off while pushing
[  ] Have a full dose of epidural
[  ] Avoid forceps usage
[  ] Avoid vacuum extraction
[  ] Use whatever methods my doctor deems necessary
[  ] Help catch the baby
[  ] Let my partner catch the baby
[  ] Let my partner suction the baby

I would like an episiotomy:
[  ] Used only after perineal massage, warm compresses and positioning
[  ] Rather than risk a tear
[  ] Not performed, even if it means risking a tear
[  ] Performed only as a last resort
[  ] Performed as my doctor deems necessary
[  ] Performed with local anesthesia
[  ] Performed by pressure, without local anesthesia
[  ] Followed by local anesthesia for the repair

Immediately after delivery, I would like:
[  ] My partner to cut the umbilical cord
[  ] The umbilical cord to be cut only after it stops pulsating
[  ] To bank the cord blood
[  ] To donate the cord blood
[  ] To deliver the placenta spontaneously and without assistance
[  ] To see the placenta before it is discarded
[  ] Not to be given Pitocin/oxytocin

If a C-section is necessary, I would like:
[  ] A second opinion
[  ] To make sure all other options have been exhausted
[  ]To stay conscious
[  ] My partner to remain with my the entire time
[  ] The screen lowered so I can watch baby come out
[  ] My hands left free so I can touch the baby
[  ] The surgery explained as it happens
[  ] An epidural for anesthesia
[  ] My partner to hold the baby as soon as possible
[  ] To breastfeed in the recovery room

I would like to hold baby:
[  ] Immediately after delivery
[  ] After suctioning
[  ] After weighing
[  ] After being wiped clean and swaddled
[  ] Before eye drops/ointment are given

I would like to breastfeed:
[  ] As soon as possible after delivery
[  ] Before eye drops/ointment are given
[  ] Later
[  ] Never


I’d like my family members (NAMES):

[  ] To join me and baby immediately after delivery
[  ] To join me and baby in the room later
[  ] Only to see baby in the nursery
[  ] To have unlimited visiting after birth

I’d like baby’s medical exam and procedures:
[  ] Given in my presence
[  ] Given only after we’ve bonded
[  ] Given in my partner’s presence
[  ] To include a heel stick for screening tests beyond the PKU
[  ] To include a hearing screening test
[  ] To include a hepatitis B vaccine

Please don’t give baby:
[  ] Vitamin K
[ ] Antibiotic eye treatment
[  ] Sugar water
[  ] Formula
[  ] A pacifier

I’d like baby’s first bath given:
[  ] In my presence
[  ] In my partner’s presence
[  ] By me
[  ] By my partner

I’d like to feed baby:
[  ] Only with breastmilk
[  ] Only with formula
[  ] On demand
[  ] On schedule
[  ] With the help of a lactation specialist

I’d like baby to stay in my room:
[  ] All the time
[  ] During the day
[  ] Only when I’m awake
[  ] Only for feeding
[  ] Only when I request

I’d like my partner:
[  ] To have unlimited visiting
[  ] To sleep in my room

If we have a boy, circumcision should:
[  ] Be performed
[  ] Not be performed
[  ] Be performed later
[  ] Be performed with anesthesia
[  ] Be performed in the presence of me AND/OR my partner

As needed post-delivery, please give me:
[  ] Extra-strength acetaminophen
[  ] Percoset
[  ] Stool softener
[  ] Laxative

After birth, I’d like to stay in the hospital:
[  ] As long as possible
[  ] As briefly as possible

If baby is not well, I’d like:
[  ] My partner and I to accompany it to the NICU or another facility
[  ] To breastfeed or provide pumped breastmilk
[  ] To hold him or her whenever possible

 

-- The Bump Editors

See More: Pregnancy Tools