Sample Birth Plan
While it is
important to have a birth plan so that, legally, your wishes are
spelled out, you should realize just how hospital staff really feel
about you and your birth plan. Click Here to read an
excerpt from "Hard Labor" by Susan Diamond, who was for many years a
labor and delivery nurse, and can tell us firsthand how doctors and
nurses feel and speak about those with a birth plan.
Sample Birth Plan
My partner and I have prepared for a peaceful and gentle childbirth. We plan to labor and give birth ( at home, in birthing center room 3, in labor and delivery room 310, if available). We would like no interventions into our labor and delivery unless we request them. I plan to be upright and active during labor, and assume whatever position feels most comfortable or assists my body in delivering more effectively. I will need no pain medications, and request that neither my partner if I am at home nor my caregivers if at the hospital will at any time ask me if I want medication. I will ask for medications if I deem them necessary and do not want anyone to mention them until I do. I plan to eat and drink when my body gives me signals that it needs energy. If I feel hungry, thirsty or tired, I will respond to my body's needs accordingly. I would like to have a birthing tub available to labor in to ease any discomfort I may have. I have a (partner, labor assistant) to be with me during the labor and delivery to help me utilize physical and psychological pain coping techniques. I will wear my own clothing during labor and delivery, unless a caesarean section is required. I ( partner, mother, labor assistant) will be with me during the entire labor and delivery, and will not leave me unless I request it. By the same token, if I feel the need to be alone, my partner, labor assistant, midwife, and/or any doctors or nurses will immediately leave my presence until I request their presence again.
During the time I am laboring, I will not be disturbed for any reason unless I request assistance from someone. I will remove my clothing if I feel the need. I will talk, sing, yell, scream or moan if it feels good to me. If I feel the need to leave the birthing area for any reason, I will do so. I will need no monitoring or assistance unless I suspect an emergency at which time I will ask for the help I need. If you hear me making noise, do not assume that I need help. I will call your name if I need you. I will feel free to change / control the lighting, temperature, music, or any other aspect of my environment that is affecting my labor and delivery.
In the event of an emergency which arises, 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, even options that the doctors and/or nurses do not personally prefer. We cannot give informed consent unless we are informed or all options. At no time will we be forced to accept an intervention / treatment we do not want. At all times, my (partner, labor assistant) will be with me to be an advocate, as they know my wishes and will be able to see they are carried out in the event that I am unable to communicate my wishes.
I prefer not to use continuous electronic fetal monitoring. Instead, I will occasionally request that my (partner, labor assistant, midwife, nurse, doctor) listen to the fetal heartbeat. I will not be confined to my bed for any reason other than when I feel the need to rest, or if my body feels most comfortable giving birth that way. I intend, barring some emergency, to give birth in an upright position, preferably squatting, standing supported squat, kneeling or modified kneeling. Barring any emergency, I will be the first one to hold my baby, and request that no one touch my baby without my permission. I prefer to allow my tissues to tear naturally rather than have my tissues cut through an episiotomy. I prefer that patience be used during the delivery phase, and no forceps or vacuum extraction be used. I do NOT authorize the use of eye drops or ointment in my baby's eyes. I here certify that I do not have a venereal disease which would cause harm to my baby. I also do NOT authorize the use of a PKU test,as I plan to breastfeed. I will take my baby to a pediatrician at a later time for a PKU test. The umbilical cord will not be cut until it stops pulsing, and should someone besides myself or my partner have to cut the cord, they will ask my permission first.
I plan to breastfeed and do NOT want supplemental formula given to my baby. If birthing in the hospital becomes necessary, I will room in with my baby and breastfeed on demand. If my baby's blood sugar is deemed to be low, the baby will be breastfed and no sugar water will be given. No pacifier will be given to my baby under any circumstances. At no time will my baby be left alone in the nursery. If my baby must go to the nursery, my (partner, mother, labor assistant) will be allowed to accompany the baby wherever it must go.
This birth plan is enacted for the purpose of allow me to be in control of my birth experience at all time, in order to assure the best possible outcome for me and my baby. We appreciate the assistance of those others involved, but ask you to limit your assistance to times when we request it.
Sample Birth Plan
My partner and I have prepared for a peaceful and gentle childbirth. We plan to labor and give birth ( at home, in birthing center room 3, in labor and delivery room 310, if available). We would like no interventions into our labor and delivery unless we request them. I plan to be upright and active during labor, and assume whatever position feels most comfortable or assists my body in delivering more effectively. I will need no pain medications, and request that neither my partner if I am at home nor my caregivers if at the hospital will at any time ask me if I want medication. I will ask for medications if I deem them necessary and do not want anyone to mention them until I do. I plan to eat and drink when my body gives me signals that it needs energy. If I feel hungry, thirsty or tired, I will respond to my body's needs accordingly. I would like to have a birthing tub available to labor in to ease any discomfort I may have. I have a (partner, labor assistant) to be with me during the labor and delivery to help me utilize physical and psychological pain coping techniques. I will wear my own clothing during labor and delivery, unless a caesarean section is required. I ( partner, mother, labor assistant) will be with me during the entire labor and delivery, and will not leave me unless I request it. By the same token, if I feel the need to be alone, my partner, labor assistant, midwife, and/or any doctors or nurses will immediately leave my presence until I request their presence again.
During the time I am laboring, I will not be disturbed for any reason unless I request assistance from someone. I will remove my clothing if I feel the need. I will talk, sing, yell, scream or moan if it feels good to me. If I feel the need to leave the birthing area for any reason, I will do so. I will need no monitoring or assistance unless I suspect an emergency at which time I will ask for the help I need. If you hear me making noise, do not assume that I need help. I will call your name if I need you. I will feel free to change / control the lighting, temperature, music, or any other aspect of my environment that is affecting my labor and delivery.
In the event of an emergency which arises, 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, even options that the doctors and/or nurses do not personally prefer. We cannot give informed consent unless we are informed or all options. At no time will we be forced to accept an intervention / treatment we do not want. At all times, my (partner, labor assistant) will be with me to be an advocate, as they know my wishes and will be able to see they are carried out in the event that I am unable to communicate my wishes.
I prefer not to use continuous electronic fetal monitoring. Instead, I will occasionally request that my (partner, labor assistant, midwife, nurse, doctor) listen to the fetal heartbeat. I will not be confined to my bed for any reason other than when I feel the need to rest, or if my body feels most comfortable giving birth that way. I intend, barring some emergency, to give birth in an upright position, preferably squatting, standing supported squat, kneeling or modified kneeling. Barring any emergency, I will be the first one to hold my baby, and request that no one touch my baby without my permission. I prefer to allow my tissues to tear naturally rather than have my tissues cut through an episiotomy. I prefer that patience be used during the delivery phase, and no forceps or vacuum extraction be used. I do NOT authorize the use of eye drops or ointment in my baby's eyes. I here certify that I do not have a venereal disease which would cause harm to my baby. I also do NOT authorize the use of a PKU test,as I plan to breastfeed. I will take my baby to a pediatrician at a later time for a PKU test. The umbilical cord will not be cut until it stops pulsing, and should someone besides myself or my partner have to cut the cord, they will ask my permission first.
I plan to breastfeed and do NOT want supplemental formula given to my baby. If birthing in the hospital becomes necessary, I will room in with my baby and breastfeed on demand. If my baby's blood sugar is deemed to be low, the baby will be breastfed and no sugar water will be given. No pacifier will be given to my baby under any circumstances. At no time will my baby be left alone in the nursery. If my baby must go to the nursery, my (partner, mother, labor assistant) will be allowed to accompany the baby wherever it must go.
This birth plan is enacted for the purpose of allow me to be in control of my birth experience at all time, in order to assure the best possible outcome for me and my baby. We appreciate the assistance of those others involved, but ask you to limit your assistance to times when we request it.
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Copyright 2008 Judie C. Rall and The Center for Unhindered Living
Back to The Unhindered Living Knowledge Collection
Copyright 2008 Judie C. Rall and The Center for Unhindered Living