Here's mine, with my own comments in red about why I asked for specific things:
(FWIW, I had a really nice intervention-free hospital VBAC!)
BIRTH PLAN – [mom’s name]
I wish to be treated as if my uterine scar does not exist. I am planning an intervention-free and natural birth. Residents/students are welcome to come in but please be respectful of my privacy by knocking and not turning on lights or making unnecessary noise. Assuming there are no medical complications, I request the following:
1ST STAGE OF LABOR
· In general, please leave me alone as much as possible. My body knows what to do. I thought this, and the intro bit, was good for setting up expectations
· No complete IV line, heplock only easy enough to ask, you may be able to refuse this altogether, but I didn’t think that was worth the fight.
· If required, telemetered EFM so that I can move around as needed this was the one thing I didn’t end up getting b/c it was broken. Still, the birth ball worked well for me
· Pain relief and vaginal examsby my request only
· I do not consent to artificial induction or augmentation of labor Probably not necessary to put in a birth plan, but I wanted it down just for the record
· All interventions consented to ONLY after a full verbal discussion of risks and benefits (rather than simply offering me a form to sign) This too. I think this one is more about the questions you ask at the time and probably doesn’t need to be in the plan.
2ND STAGE OF LABOR
· No directed pushing, please
· Birth in any position I would like
· I would like to catch my own baby if I am in a position to do so This was so special. Obviously doesn’t work if you end up on hands and knees, but it was very cool.
· Please offer Dad the opportunity to dry off the baby
3RD STAGE OF LABOR and POSTPARTUM
· Delay cord-cutting for 5 minutes. Offer Dad the opportunity to cut the cord. I specified a time rather than “until it stops pulsating” because a time is not subjective, which means it’s more likely to actually be followed I think.
· No active management of 3rd stage of labor unless medically necessary This translates to “no routine pitocin to deliver the placenta”. Obviously if I hemorrhage I would take the pitocin.
· Delay routines, APGARS to be performed while baby is held by me Unless baby needs to be resuscitated, there’s no reason they can’t honor this one
· I have tested negative for chlamydia; no erithromyocin in my baby's eyes please
· We will do the first bath, not the nurses We ended up letting the nurses do it, but not until later.
· If baby is a boy, he will not be circumcised
· Other parents may wish to put things about hep B vaccine etc. Honestly though, once the kid is born your mind will be back in the real world, so I think cluttering birth plans with things that are easy to ask for is not productive. Still, if you’re using your plan as a note to yourself and think you might forget, write it down.