Here is my birth planDear Healthcare Providers:
This birth plan is intended to express the preference and desires we have for the birth of our baby. It is not intended to be a script. We fully realize that situations may arise such that our plan cannot and should not be followed. However, we hope that barring any extenuating circumstances, you will be able to keep us informed and aware of our options. Your support and understanding are very much appreciated. Thank you.
Please attach this to my prenatal record and make it available to all physicians/ staff who may be attending the birth should you not be attending us. I will provide extra copies.
**I trust that my practitioner will seek out my opinion concerning all of the issues directly affecting my birth BEFORE deviating from my plan.
First Stage of Labor
We have chosen the HypnoBirthing method of a quiet, relaxed natural birth.
1. If possible, to be assigned a nurse who is partial to natural birthing.
2. If I am less than 5cm dilated, I would like the option of returning home.
3. To self-hydrate and decline routine IV prep upon admission.
1. Upon arrival at the hospital I prefer to have my husband with me at all times. As well as my doula.
2. Please no residents or students attending my birth.
3. If birth equipment is available I would like to use: a birthing bed, a yoga ball (will bring with me), a birthing stool, and a squatting bar.
4. We would like dim Lights, peace and quiet, and music of our choice (or my preference to wear a headset). We kindly ask that medical personnel speak softly.
Please only offer pain medications if I ask for them. If I choose drugs, my preference is a walking epidural.
I am prepared to try to handle pain with these natural and alternative methods:
-Hypnotherapy, breathing techniques, massage, deep (or guided) relaxation.
-Ultimately I want to be able to walk around and move as I wish while in labor.
- Please keep my door always closed during labor.
I prefer the baby to be monitored intermittently using Doppler.
Second Stage of Labor
As long as the baby and I are healthy, I prefer to have no time limits on pushing.
I would like to be encouraged to try the following different positions for labor: Squatting, classic semi-recline, hands and knees, on the toilet, standing upright, side lying, or whatever feels right at the time.
I prefer to have no episiotomy and risk tearing (unless I’m having a medical emergency).
To help prevent tearing, please use warm-oil compresses. No perinatal massage to perineum.
1. If possible, please allow the shoulders and body of my baby to be born spontaneously.
2. Please use local anesthetic for repairs.
It is important to me to push instinctively. I do not want to be told how and when to push.
After baby is born:
1. As long as my baby is healthy, I would like my baby placed immediately on my abdomen.
2. We request complete birthing before suctioning baby’s nose and throat.
3. Please put my baby skin to skin on my abdomen with a warm blanket over it.
4. Please do not separate me and my baby until after my baby has successfully breastfed.
5. Please delay all essential routine procedures on my baby until after the bonding and breastfeeding period (ie. Bathing)
Third Stage of Labor
PLEASE WAIT FOR THE UMBILICAL CORD TO STOP PULSATING BEFORE IT IS CLAMPED OR CUT.
Please allow my partner to cut the cord.
Placenta: I would prefer for the placenta to be born spontaneously without the use of pitocin and/ or manual extraction. We would like the baby brought to the breast to assist in placenta expulsion.
If the baby has any problems, I would like my husband to be present with the baby at all times.
I would like all newborn procedures performed in my presence.
- No administration of eyedrops to my baby and I am willing to sign a formal waiver if need be.
- Please do not administer vitamin K to my baby.
- I prefer all immunizations be postponed until a later time.
Please allow vernix to be absorbed into baby’s skin; delay “cleaning or rubbing.” Use of a soft cloth, not terry, when rubbing is appropriate.
Bathing baby: We would like to give our baby its first bath. Please help direct us in this process at the hospital.
DO NOT CIRCUMCISE OUR BABY BOY.
OUR BABY WILL BE BREASTFED- NO BOTTLES, PACIFIERS, OR SUGAR WATER.
We are interested in early checkout from the hospital.
We thank you in advance for your support and kind attention to our choices. We know you join us in looking forward to a beautiful birth and celebration of this new life.