Copy of My Birth Plan

Birth Plan for New Mama

Due Date: August 3, 2005

To my Health Care Providers:

This baby is the first for me and the fourth for my husband. I intend to birth as naturally as possible. These are my preferences:

Environment
• My husband and my doula will be with me during the birth.
• I would like to utilize the birthing tub if possible.
• I would prefer anyone entering the room to speak softly and not talk or perform any procedures during contractions.

IV
• I prefer to have no IV.

Pain Relief
• I will ask for pain medications if I need them.
• I want to be able to walk around and move as I wish during labor.

Monitoring
• I prefer the baby be monitored intermittently using a Doppler.

Second Stage 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 whatever position feels right at the time.

Episiotomy
• I prefer to tear rather than have an episiotomy.
• To help prevent tearing I would like to have my husband/my doula/the nurse apply hot compresses and oil and encourage me to push gently for slower crowning.

The Delivery
• I would like to be allowed to choose the position in which I give birth.
• I would like to touch my baby’s head as it crowns.
• I prefer to have the lights dimmed for delivery.
• I prefer to push instinctively; I do not wish to be told how or when to push.
• As long as the baby is healthy, I would like him placed skin-to-skin on my abdomen with a warm blanket over him immediately following the birth.

Immediately After Delivery
• I would prefer that the umbilical cord stop pulsating before it is cut by my husband.
• I would prefer that the placenta be born spontaneously without the use of pitocin and/or manual extraction.

Newborn Procedures
• Please delay routine newborn procedures until after the bonding and breastfeeding period.
• I do not wish to be separated from my baby. I would like to have my baby room in and be with me at all times. If my baby must be taken from me to receive medical treatment, my husband will accompany the baby at all times.
• Please do not bathe my baby.
• Please do not administer eye ointment to my baby.
• Please do not administer vitamin K to my baby.
• Please do not give my baby the Hepatitis B vaccination.
• We decline routine PKU testing at the hospital and have made other arrangements for this procedure at a later date this week.

Breastfeeding
• My baby is to be exclusively breastfed. I would like to see a lactation consultant as soon as possible for further recommendations and guidance.
• Do not offer my baby the following without my consent: formula, pacifiers, any artificial nipples, or sugar water.

Diapering
• We plan on cloth diapering our baby from the very beginning and will be providing our own diapers. Please do not put disposables on him.

Sincerely,

New Mama