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Creating a Birth Plan & Sample Birth Plan

Around week twenty-eight, it’s a good idea to start thinking about and creating your birth plan. This is around the time when the fact that you’re having a baby really starts to sink in! A birth plan is a list of all of preferences and choices for your delivery that you share with your doctor, nurses and midwife. Because you might be on medication or unable to accurately convey your preferences, the birth plan is the map your birth and delivery team will use to follow your instructions.  
 


      

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Your Checklist
Creating a Birth Plan & Sample Birth Plan

Around week twenty-eight, it’s a good idea to start thinking about and creating your birth plan. This is around the time when the fact that you’re having a baby really starts to sink in!

 
     



A birth plan is a
list of all of preferences and choices for your delivery that you share
with your doctor, nurses and midwife. Because you might be on
medication or unable to accurately convey your preferences, the birth
plan is the map your birth and delivery team will use to follow your
instructions.

 
You
should have your birth plan written and ready to go by the time you’re
thirty-six or thirty-seven weeks. Your birth plan should cater to how
you want your delivery to go. Of course, remember this is only a plan
and plans often change. Your health and the baby’s health are the top
priorities here, so don’t get so wedded to your ideal delivery scenario
that it clouds your better judgment.

Here are some questions to ask yourself before writing your birth plan:

  1. Do you want to be able to move around while in labor?
  2. Do you want to have your baby at home, birth center, or hospital?
  3. Do you want to try to do without any pain medication?
  4. Do you want to try to avoid an episiotomy? What are your preferences if one cannot be avoided?
  5. If a caesarian becomes necessary, do you have any preferences?
  6. Do you want to breastfeed immediately after birth?
  7. Do you want to avoid giving the baby a bottle and/or pacifier?
  8. Would you like baby to stay in your room with you? Are there any special positions you would like to try during the birth?
  9. Would you like to listen to music?
  10. Do you want to be able to take a bath or shower during labor?
  11. Do you want your other children present? (Some hospitals may not accom modate this.)
 

 
Check out this sample birth plan:

 
Birth Plan for First,  Middle,  Last
Due Date: 1/25/06
Patient of Dr. Jane Doe
Scheduled to deliver at: Medical Center.
12/12/05

Dear Dr. Doe and the Medical Center Staff:

 
I
look forward to sharing my upcoming birth with you. I have created the
following birth plan to help you understand my preferences for my
upcoming labor and delivery. I fully understand that in certain
circumstances these guidelines may not be followed, but it is my hope
that you will assist me in making this the experience I hope for. If
you have any questions or suggestions, please feel free to share them
with me..

 
Sincerely,
First Last 

 
Labor
I would prefer to avoid an enema and/or shaving of pubic hair.
 
I wish to be able to move around and change position at will throughout labor
 
I would like to be able to have fluids by mouth throughout the first stage of labor.
 
I would prefer to have access to water at all times throughout labor.
 
I would prefer to keep the number of vaginal exams to a minimum.
 
Monitoring
I do not wish to have continuous fetal monitoring unless it is required by the condition of my baby.
 
Labor Augmentation/Induction
I do not wish to have the amniotic membrane ruptured artificially unless signs of fetal distress require internal monitoring.
 
Anesthesia
I would like to receieve an epidural.
 
Cesarean
If my primary care provider determines that a cesarean delivery is
necessary, I would like to obtain a second opinion from another
physician if time allows.
 
I would like my husband present at all times if have a Cesarean delivery.
 
I wish to have an epidural for anesthesia
 
If my baby is not in distress, my baby should be given to me immediately after birth.
 
Episiotomy
I would prefer not to have an episiotomy unless absolutely required for the baby’s safety.
 
Delivery
I would like my husband and/or nurses to support me and my legs as necessary during the pushing stage.
 
I would like a mirror available so I can see my daughter’s head when it crowns.
 
I would like to have my baby placed on my stomach/chest immediately after delivery.
 
After Delivery
I would like my husband to cut the cord.
 
I would like to have my baby examined and bathed in my presence.
 
If
my baby must be taken from me to receive medical treatment, my husband
or some other person I designate will accompany my baby at all times.
 
I would like a private room if available.
 
After the birth, I would prefer to be given a few moments of privacy to urinate on my own before being catheterized.
 
I would like to donate the umbilical cord blood.
 
Breastfeeding
Unless medically necessary, I do not wish to have any bottles given to my baby (including glucose water or plain water).
 
I do not want my baby to be given a pacifier.
 
Photos
I would like to make a videorecording of labor and/or the birth.
 
Other
My support people are my mother and husband and I would like them to be present during labor and/or delivery.
 
 

 

 

 

 



      

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