I will assist you in filling out a birthplan such as the one below. The birthplan preferences listed are just a sampling of some of the more common desires women have for their births. These do not have to be your desires, feel free to modify the birthplan as is appropriate for you.
What I most like about this birthplan is how organized, short and to the point it is. It is not necessary to list such things as “No bright lights, dim lights only” – such a request is easy enough to accomplish.
Note how positively this birthplan is phrased. It is not necessary to use words such as; no, don’t or never. With respect and creativity we will be able to relay your wishes to all involved.
Birthplan for ______________________
Paragraph about yourself and your birth team:
We would like:
- Natural, drug-free birth (remaining flexible) or Medication is desired and will appreciate support and decision making around this
- Calm atmosphere
- Be informed about all procedures/treatments
- Remain as mobile as possible = telemetry unit or intermittent monitoring if possible
- If guided pushing becomes necessary I would prefer calm gentle guidance from __________ and Felicia
- Protect the perineum with massage, slow guidance with pushing/stretching
- Baby placed on mothers belly and skin to skin as long as possible
- Please allow the cord to stop pulsating before clamping (even if it takes longer than 1 minute)
- 15-20 minutes of limited activity with baby after birth, if possible.
- I am sending my placenta with Felicia Y/N
- Vitamin K Y/N
- Eye ointment Y/N
- Hep B vaccine Y/N
Key Questions for when a medical procedure or treatment is suggested:
**These do not need to be included in your birthplan**
- Is there a problem?
- Is this an emergency or do we have time to wait?
- What are the benefits or advantages of doing this?
- What are the risks or disadvantages?
- If we do this, what other treatments or procedures might be needed as a result?
- What else could we try first or instead?
- What would happen if we waited before deciding?