In terms of being clear and concise, is my birth plan alright? any other suggestions would be very helpful. Thank you!
Typed out, this is one page in length.
Patient Name: Megan Lastname
Care Provider: ____ Midwives
To the _____ Hospital OB-GYN-NBN Staff,
We are planning a natural birth, which involves no medical intervention to instigate, progress or assist the labor and delivery, except in the case that there is an imminent, real threat to the health and well-being of the mother or baby. If any interventions are medically necessary, we would like to be informed completely beforehand. We thank you in advance for your care and cooperation.
I wish to have no visitors, except for my husband, during labor and delivery. Please double check with me before allowing visitors after our baby is born. My husband is to remain with me at all times.
1st Stage
-NO PAIN MEDICATION unless requested. Please do not ask me if I want them.
-NO Pitocin or any kind of labor augmentation.
-minimal intervention: limited cervical/internal exams, intermittent external monitoring ONLY, NO medical students or excess staff.
-maintain a comfortable environment: food and drink as requested, maintain mobility during labor (birthing ball, shower/tub, position of choice, ability to labor in my own gown)
-All other interventions, even minimal (oxygen, IV, etc.) only if medically necessary, and only after all of the risks and benefits are explained to us.
2nd & 3rd stages
-I do not wish to push until I feel the need, in the position of my choice, and without direction/counting.
-I prefer tearing to episiotomy, and I would like the area numbed before stitching.
-My husband will cut the cord once pulsating has stopped. Please don't clamp cord.
-Placenta is to be birthed naturally & without administration of Pitocin or pulling of cord.
-Immediate skin-to-skin contact with baby, & immediate establishment of breastfeeding.
In Case of C-Section
-Please lower the curtain so that we can view the birth of our baby.
-Please allow our camera in the operating room.
-If baby must leave the room, my husband, ______, is to accompany her at all times.
Care of Our Newborn
-If baby must be moved away from me (even to NICU), my husband will accomany her.
-Baby is to room-in with mom.
-Baby is to be BREASTFED only. No pacifiers, bottles, or any type of artificial nipple.
-Baby is not to be bathed, we will rub the vernix into her skin.
-We have the proper exemption forms, and baby is not to receive the following standard newborn procedures: Vitamin K vaccine, HepB vaccine, Silver Nitrate Drops/Eye Ointment, Hearing Screening, and PKU test (will be performed at a later date at doctor's office).
Thank you for taking good care of us and our baby!
We appreciate your understanding and care.
Signed:
____________________________________ Mother
____________________________________ Father
Typed out, this is one page in length.
Patient Name: Megan Lastname
Care Provider: ____ Midwives
To the _____ Hospital OB-GYN-NBN Staff,
We are planning a natural birth, which involves no medical intervention to instigate, progress or assist the labor and delivery, except in the case that there is an imminent, real threat to the health and well-being of the mother or baby. If any interventions are medically necessary, we would like to be informed completely beforehand. We thank you in advance for your care and cooperation.
I wish to have no visitors, except for my husband, during labor and delivery. Please double check with me before allowing visitors after our baby is born. My husband is to remain with me at all times.
1st Stage
-NO PAIN MEDICATION unless requested. Please do not ask me if I want them.
-NO Pitocin or any kind of labor augmentation.
-minimal intervention: limited cervical/internal exams, intermittent external monitoring ONLY, NO medical students or excess staff.
-maintain a comfortable environment: food and drink as requested, maintain mobility during labor (birthing ball, shower/tub, position of choice, ability to labor in my own gown)
-All other interventions, even minimal (oxygen, IV, etc.) only if medically necessary, and only after all of the risks and benefits are explained to us.
2nd & 3rd stages
-I do not wish to push until I feel the need, in the position of my choice, and without direction/counting.
-I prefer tearing to episiotomy, and I would like the area numbed before stitching.
-My husband will cut the cord once pulsating has stopped. Please don't clamp cord.
-Placenta is to be birthed naturally & without administration of Pitocin or pulling of cord.
-Immediate skin-to-skin contact with baby, & immediate establishment of breastfeeding.
In Case of C-Section
-Please lower the curtain so that we can view the birth of our baby.
-Please allow our camera in the operating room.
-If baby must leave the room, my husband, ______, is to accompany her at all times.
Care of Our Newborn
-If baby must be moved away from me (even to NICU), my husband will accomany her.
-Baby is to room-in with mom.
-Baby is to be BREASTFED only. No pacifiers, bottles, or any type of artificial nipple.
-Baby is not to be bathed, we will rub the vernix into her skin.
-We have the proper exemption forms, and baby is not to receive the following standard newborn procedures: Vitamin K vaccine, HepB vaccine, Silver Nitrate Drops/Eye Ointment, Hearing Screening, and PKU test (will be performed at a later date at doctor's office).
Thank you for taking good care of us and our baby!
We appreciate your understanding and care.
Signed:
____________________________________ Mother
____________________________________ Father
