You’ll find a sample birth plan below. Remember,
this format is not etched in stone, but it will give you an idea of things
you’ll want to include, such as a statement of purpose, your preferences,
and things you’d like to avoid.
Article continues below
Statement of Purpose
My partner and I have planned and prepared for a peaceful
and natural childbirth. We would like to allow our labor and delivery
to unfold naturally, with as few interventions as possible. We would like
to be informed about all procedures and tests before they are performed.
We want to be aware and informed of all of our options in the event of
an unexpected emergency.
Our
Preferences
Labor and delivery will take place: at home, in a freestanding
birth center, in an alternative birthing center within a hospital,
in a small hospital, in a teaching/large hospital.
Partner or labor coach,
doula, and midwife present throughout labor and birth
Children present
throughout labor and birth
Freedom to walk, move, and change positions
as desired throughout labor and birth
Freedom to eat and drink throughout
labor and birth
Use of the shower or a tub as desired
Ability to use relaxation and pain
relief methods as desired, including herbal therapy, homeopathy,
and aromatherapy
Ability to control the environment including temperature, lighting,
and music
Use of gentle, controlled pushing
Use of an upright labor position
Massage and support of the perineum to
avoid tearing
Natural methods of strengthening labor, if needed, such
as walking and nipple stimulation
After the birth, immediate contact between
mother and baby: baby placed on mother’s chest, breastfeeding
encouraged, mother and baby left undisturbed for one hour following
birth, and any newborn procedures performed afterward
Delay of clamping and cutting
umbilical cord until blood stops pulsing
Placenta delivered spontaneously
Give parents full informed
choice regarding all newborn procedures, including
eye ointment, Vitamin K injection, PKU test.
All baby examinations done with the
permission, and in the presence, of a parent
What We Wish
to Avoid
Medications. Please do not offer pain relief. We will use natural pain
relief methods.
Shaving
Enemas or IV [IV is often automatically hooked up upon arriveal.
May not be assumed under drugs]
Electronic fetal monitoring
Stripping of membranes or breaking of bag
of waters
Use of Pitocin or other drugs to induce, speed up, or strengthen
labor
Supine (laying down) position for pushing stage
Episiotomy
Use of forceps or vacuum extraction
Supplemental bottle-feedings
Unnecessary medical tests and procedures,
such as medical circumcision