Here's mine so far - I'm still tweaking (sorry so long!). I've stolen liberally from other people's birth plans on MDC. The names in mine have been changed to protect the innocent.
These preferences assume a normal pregnancy and labor, and a healthy mom and baby. We fully understand that should any emergencies arise, these preferences will have to be altered.General
• We are seeking a calm, natural, gentle birth with no stress, no medications, and no interventions. We are willing to take the time necessary.
• My support people, DH (Husband) and Doula (Doula), will be with me at all times.
• I would like time to discuss any interventions (monitors, labor augmentation, medications, etc.) with my husband and doula privately.
• We will control the lights and music in our room.
• We will be bringing our own TV and DVD player, and will control these as well.
The Labor
• I would like to be totally mobile during labor, free to walk or change positions at will.
• Unless medically necessary, I do not want an IV or hep-lock.
• I would like to be able to shower or soak in the Birthing Tub to aid relaxation.
• I would like to be able to have food and drink by mouth throughout labor.
• I would like to be reminded to stay hydrated by mouth.
• I would prefer to keep the number of vaginal exams to a minimum.
Monitoring
• We expect intermediate monitoring of the baby’s heart, however we wish to avoid continuous monitoring.
• I will not have any internal monitors (baby or contractions) unless the baby has shown some definite, repeated, or unchanging signs of distress.
Labor Augmentation/Induction
• I do not wish to augment labor and delivery or alter the natural process in any way. I prefer to employ natural methods of encouraging labor first.
• I do not wish to have the amniotic membrane ruptured artificially.
• I refuse Cytotec, which has not been approved by the FDA for use on pregnant woman, nor for labor induction, and has been proven dangerous.
• I would like to give labor a good opportunity to re-start naturally, if stalled, before Pit is administered.
Anesthesia/Pain Medication
• I am planning to use no drugs for pain relief, and would appreciate your encouragement to use other methods.
• I prefer not to have any pharmaceutical pain management suggested.
• If I do opt for pain medication, I prefer to utilize a short acting pharmaceutical such as Fentanyl first to try to regain natural management.
• I prefer to try a slightly longer acting narcotic pain relief (Nubain, Sublimaze, Stadol or similar) next.
• I prefer to try Demerol as a final pharmaceutical option.
• I will keep the option of an epidural as my last resort.
Cesarean
• Unless absolutely necessary I would like to avoid a Cesarean.
• I would like to attempt forceps or vacuum before a surgical birth.
• I would like the incision closed in such a way to promote a VBAC.
• I would like to hold the baby on my chest immediately after the delivery while I am closed; if not possible the baby should be given to DH – not placed on a warming table, in the nursery, or given to a nurse.
The Birth
• I would like to give birth in an upright, kneeling, supported squatting or all-fours position to give the baby maximum space to descend through my pelvis. I do not want to be on my back or semi-reclining unless that position seems right to me on the day.
• I would like to avoid perineal damage and would appreciate your guidance in giving birth gently to accomplish this. However, I would rather tear naturally than have an episiotomy.
• I would like to be offered the opportunity to feel the head as it crowns.
• My husband DH would like to do a four-handed catch with the attending midwife.
• When my baby is born, I would like him placed on my belly/chest.
Immediately Following Delivery
• The cord should be allowed to pulse until it naturally stops before being clamped and cut.
• DH would like to cut the cord himself.
• I wish no drugs to be used unless specifically indicated.
• I will hold the baby while I deliver the placenta and any tissue repairs are made. If this is not possible, DH or Doula will hold the baby.
• Please do not pull on the cord or use fundal pressure unless there is a specific indication to do so.
• All evaluations of the baby are to be done on my abdomen (or beside me on the bed), not the warming table.
• DH will take the baby to be weighed and return him to me.
Postpartum
• I will shower ASAP and change clothing, while DH holds the baby.
• We would like all medical equipment put away or removed ASAP and the bed remade.
• Unless required for the health of the baby, he is not to be removed from my presence for any reason.
• The baby will stay in my room, and all tests and exams will be done there. If he must be removed from my presence for the hearing and PKU test, DH will remain in physical contact with the infant at all times.
• If the baby must be removed from my presence for any other medical reason, DH or another adult designated by us will be with the baby at all times.
Care of the baby
• I will exclusively breastfeed our baby and will begin immediately after birth.
• If our baby is unable to nurse he should receive only mother’s milk (or medication) via a nasogastric tube. He should not be offered a bottle.
• We refuse the eye ointment.
• The baby will not be circumcised.
• The baby is to receive no medication or tests without prior consent of the parents.
• We do not want the baby admitted to a special nursery merely for observation.
: is useless during labor. Even HE needs a birthplan in order to remember what I/we want and don't want . . .
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