Sample Birth Plan: Family Six
At the top is listed the name of the family, the hospital and the due date
This is our first child, and we are looking forward to having a natural birth. We have completed childbirth classes in the name removed method and have read as much as possible to prepare ourselves. We have decided to have a doula present to assist us in staying relaxed and comfortable. The main areas we feel strongly about are the environment at the birth and some of the procedures that may be necessary.
The mother is very modest and would be most comfortable in a room where the lights are dimmed, the doors are kept closed, and as few strangers as possible are present (no residents please). She would also like to wear her own nightgown and to remain mobile for as long as she is able. For this reason we would like a telemetric fetal monitor used intermittently if one is available.
We would like the mother to be able to walk the halls, use the stairs and use the shower and tub (if available) during labor. She would also like to be free to try different positions for pushing, including squatting or kneeling if it is comfortable.
Other than our doula, other people who might be present are our mothers, sisters and one friend. We would like to keep our fathers and any other men (besides necessary doctors or nurses) from coming into the room until after the birth when the mother is dressed.
We would like to try to avoid all medications during the birth, and instead use relaxation, heating pads and massage for pain relief. Please do not offer medication unless it is requested. We understand that some interventions may be necessary for the health of mom and baby, but we request the opportunity to accept or refuse any procedure except in the case of an extreme emergency.
If labor slows to the point that induction might be necessary, we would like at least 30 minutes to try natural methods of induction with our doula before any drugs are considered. However, if neither the mother nor baby are in distress, we do not want chemical induction.
If there is evidence of fetal distress on the external fetal monitor, we would like this to be verified with an internal fetal monitor before any action is taken.
We request that an IV be administered only if necessary.
We prefer not to have an episiotomy unless an existing tear is threatening to become severe.
We would like to avoid catheterization and instead be able to walk to the bathroom or use a bedpan.
In an Emergency
If a cesarean section is required, we would like the father to be present during the surgery.
After the Birth
We would like the mother to hold the baby and breastfeed immediately after the birth and during any evaluations when it is possible. If it is necessary for the baby to be taken from the room for any procedures, please postpone these as long as possible after the birth and allow the father to accompany the baby. Please wait to cut the umbilical cord until it stops pulsing.
Mom, Dad and Baby would like to all stay in the same private room until discharge unless we request that the baby be brought to the nursery.
The mom would like to stay in the hospital for as long as is permitted by our insurance company to allow for her rest and recovery.
Thank you for your support during the birth of our baby.