Birth Plan of a First Time Mom This was the birth plan that we used when we were about to become first time parents. Now I read this and laugh! I can only imagine what the nurses thought of us when they read this! Probably “puh-leeze” {eye roll}!! What can I say? I was about to be a brand new mom and this was all completely foreign to me! I didn’t grow up around kids, babies or people who were having babies. This was the total unknown for me and I was bewildered! So I researched and identified all of the variables that I could possibly include on a birth plan and laid it out meticulously here. I really thought that the providers would read it and adhere to my wishes. I was so naïve! They don’t have time for all of this! Not to mention that a lot of the items I addressed were outdated and no longer common practice (at least not around here!) That being said, I think this gave me enough of an illusion of control that it gave me comfort. If you need that right now please feel free to take this template and modify it for your needs! I will share both the ridiculous things we did at the hospital that first time AND my updated, pared down birth plan that I prepared 6 years later…stay tuned if this one wasn’t quite the right fit!
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Our Birth Plan: Baby Boy {Baby’s Last Name}
Mother-to-be: {Mother’s Name} Father-to-be (COACH): {Partner’s Name}
Additional Support People: {Relationship #1}, {Name #1} & {Relationship #2}, {Name #2}
Due Date: {EDD}
Doctor’s Name: {DR/Midwife Name} Hospital Name: {Hospital/Birth Center}
Objective: I, {Mother’s Name}, and my coach, {Partner’s Name}, are creating this birth plan prior to our labor in order to express our wishes clearly to our doctor & nurses at the hospital where I am delivering. This is our “best case scenario” plan and these are the items that we consider important in the birth of our unborn baby. We would like them to be followed as closely as possible whenever able. Deviations from this plan are welcome in the event that the safety of the baby and/or mother is at risk. We will be flexible, although we ask to be kept informed ahead of time during every aspect of our labor. We reserve the right to change our mind at any time. We also request the opportunity to discuss important decisions & changes privately if time allows. Thank you for your assistance in this process.
- Please note that I am: Allergic to {List Allergies}
- My delivery is planned as: Vaginal & Natural
- I’d like the following support person(s)…
- Partner/COACH: {Name}
- {Relationship #1} {Name #1}
- {Relationship #2} {Name #2}
… to be present before AND/OR during labor
- Environment:
We would like to recreate an atmosphere that is similar to a spa experience; a peaceful & soothing ambiance where possible:
- Atmosphere
- Music (I will provide)
- Lights dimmed
- Flameless/Battery Operated Candles (I will provide)
- Peace & quiet when possible
- Scent Diffuser (I will provide)
- Visitors
- My partner to be present at all times
- Allow approved visitors during early labor & after delivery
- During active labor only my partner, mother & sister
- I do not mind if interns, residents, or students are present
- Mobility
- I would like the freedom to move around unless/until pain medication is administered
- I plan to bring a birthing ball for use during labor
- I would like the option to take a bath or shower in early labor
- Hydration/Nutrition
- Freedom to eat & drink as approved by my doctor
- Please keep water/ice chips close by
- Miscellaneous
- I would like to keep my contact lenses in at all times
- Unlimited photos/video are OK during early labor
- Atmosphere
- Labor: We would like this process to be as natural as possible, but I may request pain medication at some point
- I.V.
- Prefer to utilize an I.V. only if dehydrated or recommended by staff
- Please attempt to insert I.V. on my left side
- Pain Management
- I plan a natural birth, but may change my mind during labor
- We have not ruled out the possibility of epidural (low dose)
- Request for pain medication will be more likely if labor does not start/progress naturally
- Massage (hand, back, foot, counter pressure, etc…)
- Positioning as desired (birth ball, squat bar, etc…)
- Acupressure, Heat or cold packs, Hypnotherapy, etc…
- Relaxation techniques (breathing/focusing, etc…)
- Open to other recommendations/options
- I plan a natural birth, but may change my mind during labor
- Monitoring
- I’d prefer external monitoring, unless the baby has shown signs of distress
- Intermittent or continuous based on doctor’s preference
- Catheterization
- I would like to avoid catheterization unless absolutely necessary
- Augmentation/Induction
- First attempt by natural methods:
- Herbal, walking, changing position, membrane stripping, etc…
- Moving to medical methods when necessary ONLY
- Pitocin, prostaglandin gel, etc…
- Would rather not have the amniotic membrane ruptured artificially, unless signs of fetal distress require internal monitoring.
- First attempt by natural methods:
- I.V.
- Delivery: We do have certain preferences, but are open to any suggestions that may assist in the productivity/comfort of delivery.
- Position
- Semi Reclined, but am open to alternate suggestions
- Use people for leg support (Support person(s), nurses, etc.)
- Pushing
- Please advise & direct the proper time to push & for what length of time
- Avoid use of forceps & vacuum unless deemed necessary by the doctor
- Episiotomy/Tearing
- First attempt perineal massage, warm compress & positioning
- Episiotomy preferred rather than risk a tear (only as necessary)
- Please perform with local anesthesia for procedure & repair
- Miscellaneous
- No video/photography below the waist
- Use a mirror to see the baby crown & allow me to touch the head
- Let my partner ‘catch’ the baby
- I would like to have the lights turned low for the actual delivery
- I would appreciate having the room as quiet as possible when baby is born
- Position
- Cesarean: If a C-Section is deemed necessary, I would like…
- To stay conscious if possible
- My partner to remain with me until baby is delivered
- The screen lowered so I can see baby come out
- My hands left free so I can touch the baby
- Allow my partner to accompany the baby while I am stitched up
- Bring the baby to my recovery room for bonding/breastfeeding ASAP
- Immediately After Delivery: Bonding is our main priority aside from baby’s health and we would like the opportunity to facilitate this as soon as possible.
- Bonding
- Please lay the baby on my chest while he is wiped clean
- I would like to hold the baby during placenta delivery/episiotomy repair
- Please allow me to breastfeed immediately before cleaning/eye drops, etc.
- If possible, I would prefer to provide body heat vs. heat lamps
- Umbilical Cord
- Please allow the cord to stop pulsating before clamping or cutting cord
- Please allow my partner to cut the cord
- If no additional charge we would like to donate the cord blood
- Medical exam & procedures
- I would like the baby to be examined in my presence
- If not, please allow my partner to remain with the baby at all times
- Bonding
- Postpartum: These are the things that we find to be important towards the end of this process; again bonding & family are key.
- Feeding
- I plan to exclusively breastfeed my baby
- I would like the baby to feed on demand
- I would appreciate the assistance of a lactation specialist
- Baby Care
- To avoid nipple confusion please do not give the baby a pacifier or bottle
- Please do not give the baby sugar/glucose water or formula unless necessary
- If possible, we would like to be present for the baby’s first bath
- I would like the baby to remain in my room unless I request that he go to the nursery temporarily so I can rest
- Circumcision
- {Your Preference Here}
- Privacy
- I would like a private room
- Please allow approved family & friends to join me & baby right after delivery
- Miscellaneous
- I would like to remain in the hospital as briefly as possible
- Please allow my partner to stay overnight with unlimited visiting
- Please provide me with Tylenol or Percocet for post delivery pain
- Feeding
- Trauma/Illness: In the unfortunate event that our baby is unwell or needs specialized care we would prefer the following options~
- My partner and I would like to accompany him to NICU
- I would like the option to breastfeed or pump breast milk for the baby
- I would like to hold him or participate in “Koala Care” where possible
Mother Signature: ________________________________________________________________
Printed Name: ___________________________ Date: ____________________________
Father Signature: ________________________________________________________________
Printed Name: ___________________________ Date: ____________________________
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