Since you asked: Birth Plan Template

You all have been asking for it, so here it is – Deena’s ever  fabulous birth plan template! This is a bit longer than I usually suggest. Your birth plan should be one page, chronological, bullet points. It should cover the most important points to you. These are *my* important points. So, if you are OK with routine IV fluids, take that line out!

Have some flexibility too. Know your 3-5 non-negotiable, key points, and advocate for those points. Know where you can (and should!) compromise. Understand why your doctor/midwife is requesting certain medical interventions, before you say “no”.

Use your BRAINS questions!

Remember your birth plan is a communication tool. You communicate with your partner first; then your doctor/midwife at a prenatal visit; then with your nursing staff and doctor/nurse when you get to the hospital or birth center.

The Template:

My name:                    Husband/Partner’s name:
Who else will be in the birthing room? Grandma? Doula?
My doctor/midwife:
Pediatrician:

Our intention is to have a natural labor with minimal medical intervention

I understand that certain tests, medications and procedures may become medically necessary during labor, birth or postpartum. Please ensure that I have full informed consent before administering any tests, medications or procedures. Please ensure that my husband (partner) is present during the explanation of all benefits and risks of said intervention, so that we may make collaborative decisions. I understand I have the right of informed refusal

 Special notes:

• Example: I’m deaf in my left ear, please speak to me on my right side
• Example: My husband is diabetic.

 During labor

• I prefer to have the lights low, the temperature comfortable and the environment quiet.
• Please limit extraneous staff – no medical students, etc.
• I intend to move around freely (walking, bathroom, birthing ball, etc.) and change positions.
• I intend to wear my contact lenses or glasses. (as needed)
• I intend to eat and drink as I see fit.
• I prefer no routine IV fluids. I am comfortable with a saline-loc.
• I prefer to have intermittent fetal monitoring. If that is unavailable, please offer me wireless monitoring.
• If my labor needs to be augmented for any reason, please offer natural methods first (nipple stimulation, walking, etc) before suggesting medication.

Pain relief

• Please do not offer me pain relief medications. I will ask for them if I need them.
• If I ask, please offer me all of my choices, not just the epidural.

 Pushing

• I intend to push as my body needs me to. Please no routine ‘directed pushing’.
• I intend to try pushing in multiple positions.
• Please use warm compresses and massage to help me avoid tearing.
• I prefer to tear rather than to have an episiotomy.

Immediately after birth for the baby

• Please delay clamping or cutting the umbilical cord until after it has stopped pulsing and delivering blood to the baby (90 seconds, minimum). Alternately: We intend to donate or bank our cord blood. Please collect it for such purposes.
• My husband/partner would like to cut the umbilical cord.
• Baby is to be placed immediately on my chest or belly.
• I will breastfeed before any tests, procedures or medications are given to baby.
• After our first breastfeeding, tests, procedures and medications may be done, with baby still in my arms.
• My husband/partner will then have skin to skin time with our baby.

If a C-section becomes necessary

• Place my heart monitors on my back instead of on my chest.
• IV in my non-dominant arm.
• The drape to be lowered so I can see my baby immediately. (or not, as you prefer)
• Delayed cord clamping as listed above.
• The newborn tests and procedures to be delayed until after we’ve breastfed for the first time.
• Skin to skin contact with mom in the operating room.
• To breastfeed as soon as possible, preferably in the operating room.
• My husband/partner to hold the baby as soon as possible.

Additional Postpartum for Baby

• I plan to breastfeed exclusively.
• No formula or pacifiers.
• I prefer to meet with a lactation consultant as soon as possible.
• Please delay the newborn bath till baby is 24 hours old.
• I intend for baby and my husband to stay in my room all the time.
• Boy – Circumcision (not at all? In hospital? In the pediatrician’s office later?)

Complications for Baby

• My husband and/or I to accompany baby to the NICU.
• To breastfeed or provide pumped breastmilk/colostrum.
• To hold baby whenever possible.

As always, I am happy to review your birth plan and offer suggestions.

Sat Nam.

Additional Blog posts which may interest you:

• The Dual Purpose Birth Plan
• Attachment to your Ideal Birth
• Does your attitude towards the hospital staff affect how they treat you?