Birth Plan

Just one little reminder...

A Birth Plan is just that...a plan. You don't have to include everything written below. Its merely an outline. And you also need to remember that deviating from the plan after you've gone into labor is not failure. A Birth Plan is like a written goal - not an expectation. After all, you are the one that wrote it - so doesn't that mean that you're aloud to change it at any given moment? 

 

Birth Plan

Personal Information

Name:
Partner's name:
Home Phone:
Cell Phone:
Due Date:
___ We have attended or are planning to attend prenatal classes.
___ We have taken or are planning to take a hospital tour.

About your labor support team
Name and phone number of your doctor/midwife:
Name and phone number of your doula or other labor support person(s):
Name and phone number of baby's doctor:
Name and ages of any children who will be attending the birth:

The Onset of Labor: 
You may want to think about when you would like to head to the hospital, if that is where you'll be delivering. You should ask yourself if you'd like to head in at the onset of early labor or if you'd like to call the doctor and let them know that early labor has started and you'll head over when the contractions pick up to around 4 minutes apart, 1 minute long, for 1 hour.

Laboring environment:
While I am in labor, I would like (check as many as apply)
___ to have the lights dimmed
___ to have noise and distractions in the area where I am laboring kept to a minimum
___ to labor in the bathtub, Jacuzzi, or shower (circle your choices)
___ to have access to the following birthing equipment during labor:
      ___ birthing bed
      ___ birthing stool
      ___ birthing chair
      ___ squatting bar
      ___ birthing pool/tub
      ___ a mirror so that I can view my baby's birth
___ to be able to listen to music
___ to be able to wear my own clothes or no clothing at all
___ to have my partner and/or other labor support person(s) with me at all times, unless an emergency situation arises
___ to leave my contact lenses in place throughout my labor, unless it becomes necessary for me to undergo anesthesia
___ to be permitted to have photographs and/or videos taken of my labor and my baby's birth

Choices about the labor
If my labor
___ has not yet started when my water breaks, I'd like to wait at least 24 hours before an induction is attempted
___ has not yet started and I'm two weeks overdue, I'd like to be induced
___ has not yet started and I'm two weeks overdue, I'd prefer not to be induced
___ has not progressed very far when I arrive at the hospital, I'd like to be given the option of returning home until my labor is further along

Laboring positions
While I am in labor, I would like
___ to walk around as much as possible, and to be free to experiment with a number of different laboring postions
___ to labor on my side
___ to labor in a squatting position (either using a squatting bar or sitting on the toilet)
___ to be offered the option of having a massage
___ to be given the opportunity to consume clear fluids and ice chips during my labor

Pain relief
I'm planning to use the following pain-relief measures during my labor:
___ Relaxation
___ Breathing techniques/distraction
___ Changing positions
___ Laboring in water (shower and/or bathtub):
      ___ alone or ___ with my partner
___ Heat or cold therapy
___ Massage
___ Acupressure
___ Acupuncture
___ Hypnosis
___ I am ok with an IV in place
___ I am ok with a heparin lock
___ Pain medications as Stadol, Nubain, or Demerol
___ Anesthetic gases such as Nitronox
___ An epidural
___ Other (please specify):

Induction/augmentation of labor  
(Note: maybe you want to check which options apply or you could number them from 1 (being your first choice) and on)
If it becomes necessary to induce or augment my labor, I would prefer that the following technique(s) be used, if possible:
___ Natural methods of getting labor started (walking and sexual intercourse)
___ Nipple stimulation
___ Prostaglandins gel
___ Synthetic oxytocin (Pitocin)
___ Stripping membranes
___ Amniotomy (rupturing the membranes)

Labor, Delivery, & Baby:  
The following are approved
___ External fetal monitoring
___ Internal fetal monitoring
___  Vacuum extractor
___ Forceps


Delivery Positions:
I am intending to deliver my baby in the following position:
___ sitting
___ on my side
___ squatting
___ on all fours
___ on my back
___ Other (please specify):

After the birth
Once the baby has been delivered, I would like:
___ the baby suctioned
___ to have my baby placed on my chest as soon as possible
___ to have my baby wrapped in a blanket before he or she is handed to me
___ to have my partner cut the umbilical cord
___ to breastfeed my baby as soon as possible
___ to avoid any unnecessary separation from my baby
___ to have 24-hour rooming in (sharing a room) with my baby
___ to be present myself or have my partner present for any weighing, exams, baths, or tests my baby may require (e.g., PKU/TSH heel prick blood test)
___ to receive instruction on routine baby care procedures such as diapering, bathing, and so on
___ cord blood banking

Cesarean section
If I have a cesarean, I would like to have
___ my partner present at the delivery
___ my labor support person present at the delivery
___ a screen placed in front of my face to block my view of the delivery
___ as much information as possible about what's happening on the other side of the screen
___ the delivery photographed or videotaped
___ to touch my baby as soon as possible after the delivery
___ to have my partner cut the cord
___ to breastfeed as soon as possible

Feeding
I'm intending to
___ breastfeed
___ formula feed

Circumcision
If my baby is a boy, I am intending to
___ have him circumcised
___ not have him circumcised

Length of stay (if you're having a hospital birth)
I'm intending to leave the hospital within
___ 6 hours of the delivery
___ 12 hours of the delivery
___ 24 hours of the delivery
___ 48 hours of the delivery
___ 3 to 5 days of the delivery

We have written this birth plan according to our wishes for our baby's birth. We understand that medical emergencies may force us to deviate from this plan, but, as much as possible, we would like everyone who is present at our baby's birth to respect the choices we have outlined here.
Your signature:
Your partner's signature:
Date:

What were some of my birth plans?

My biggest plan was to forgo pain medication and I didn't want pitocin.

Unfortunately, my labor didn't do anything more than just hurt a ton after my water was broken, so pitocin was used after hours and hours of no progress. I was disappointed, but thought it would help speed things along. Unfortunately again, it did not.

Looking back now, I would have loved to have a doula! Consider that as an option!

What helps one, wont necessarily help another. I, personally, had no music on. I was focused and needed quiet. I also did have the lights dimmed. I get headaches easily so I may have ended up with one had the lights been bright. Ick.

I was allowed to labor in the tub - it had a ton of jets and it felt great on my lower back! I didn't want to try the shower because my contractions were so intense I felt safer in the sitting position. Or even on my side.

I did use the birthing ball; it helped in the beginning stages. When things got too intense I was such a mess I didn't want to move. That probably didn't help things much, as my body was tense. Try not to do that - don't tense up if at all possible.

I remember a time when I was in the bathroom (actually, twice) and all I wanted to do was be alone and have my baby right there in the toilet (haha!) - no, but seriously...the toilet felt really good to sit on (and apparently, there have been quite a few babies born in the toilet!).

I wore my own clothes in labor. I hate those stupid gowns.

I ate - there's an area below that talks about drinks and ice chips. I ate. I didn't eat a lot, but I munched and I drank lots of Gatorade. At one point I was so hungry for turkey that I made my husband go find me some. He got back and I wanted nothing to do with it (but I did eat it after I was all done!). I recommend soup and Gatorade. You wont be able to eat after an epidural is in if you decide to get one, so eat while you can to keep your energy up.

Breathing did nothing for me, but I know it really helps some people!

Something I did for my back labor that wasn't listed below is counter-pressure. It felt great!

My best advice that I kept remembering all throughout my laboring was: "Every contraction you have is just one more closer to your baby being born." Try to remember that! Instead of thinking "Oh no, another contraction!" Think to yourself that you're just one more contraction closer to the end.