Here is an example of a natural hospital birth plan. 🙂 Shared with permission.
Birth Plan
My Due Date:
My Doctor:
My Partner:
My Doula: Kali Park 😉
Overview
We desire a labor and delivery that is as free from medication and other medical interventions as possible. We strongly prefer a vaginal delivery. Please discuss any suggested interventions or procedures with all of us and obtain our verbal consent before initiating. Thank you for working with us to help create a positive birth experience for me and my baby.
Pre-Labor
–I would like to go at least 12 to 14 days over my due date before considering inducing labor
First Stage Labor
–Intermittent monitoring
–No augmentation of labor such as pitocin, breaking the water unless non-medical techniques are not effective
–Husband and doula are to be present at all times
–No pain medication offered/mentioned
–Freedom to move/walk around during labor
–Eat and drink during labor
–No IV
–I would prefer to wear my own clothes
–If available, I would like to use: a tub, shower, and squatting bar
Second Stage Labor
-Please make sure baby is at least +1 or +2 station before suggesting pushing
-I desire to choose my own position for pushing
-No time limits on pushing if baby is healthy
-Spontaneous bearing down/no coaching
-Calm atmosphere, no loud voices, keep lights low
-No episiotomy
-Please apply: warm compresses, oil, counter pressure to perineum
-Gender of baby is unknown, please allow my partner to announce the sex
Third Stage
–Delay cord clamping until my partner has determined that has stopped pulsating
–Natural delivery of placenta
–No post-delivery pitocin or pulling on the cord
–I will be taking my placenta home with me, please save it on ice.
After Birth
-Immediate skin to skin for 1 hour+
–Baby to breastfeed immediately; please delay newborn procedures until baby has had the opportunity to breastfeed
–I do not consent to the following: erythromycin eye ointment, Hep B vaccination (or any vaccinations), and circumcision.
–Delay the administration of vitamin K up to 2 hours after birth unless medically necessary
–We would like to give our baby its first bath. Please help direct us in this process at the hospital
We appreciate all that you do. Thank you!
Gentle Cesarean Section Birth Plan
I respectfully request the following procedures during my planned cesarean birth/should a cesarean be necessary, assuming that my baby and I are healthy at the time of delivery and are not experiencing any unforeseen complications.
-I would like my partner and doula/birth photographer in the OR during the birth.
-I would like to have music of my choice playing during the operation.
-I would like my partner/doula/birth photographer to be able to take pictures and/or video during the birth.
-I would request that the talk in the operating room among my providers focus primarily on the birth, and not traffic, sports, weekend plans, etc. Please remember that I can hear what is being said during the birth, and will carry memories of it for many years.
-I do not want my arms strapped down during the operation.
-I would like the IV catheter, oximeter, and blood pressure cuff all placed on my (non-dominant) arm to give me a completely free arm to touch my baby.
-I would like ECG leads to be placed on my back, to make my chest free for skin-to-skin contact.
-I’d like a non-drowsy, anti-nausea med if possible (i.e. Zofran).
-I do not want to have the surgical drape form a ‘tent’ over my head, making me feel trapped or isolated from other people and the birth.
-I would like to use a mirror/have the drape lowered/use a clear surgical drape so that I can see my baby being born.
-I would appreciate a warm blanket during surgery if possible.
-I would like you to ask me ‘Are you ready to have your baby now?’ before operating.
-Please explain the surgery to me as it happens.
-I would like to have a slow delivery, with the intent of simulating the ‘vaginal squeeze’.”
-I would like for my partner/support person to be the one who announces the sex of the baby, even if I already know what it is.
-If possible, please keep the umbilical cord long for my partner to cut while baby is in my arms.
-I would like to see and touch the placenta and cord.
-I am KEEPING the placenta; please save it for me on ice.
-I request a ‘vaginal swab’ so that the baby can have a better chance at establishing a healthy microbiome.
-I would like the cord to continue pulsing after the birth until the cord is white/limp.
-I would like immediate skin-to-skin or as quickly as possible in the OR. Please don’t swaddle my baby while he/she is skin-to-skin.
-I would like to have the opportunity to breastfeed in the OR. I may need help to do this.
-Please do not give me sedatives during or after the birth. I want to remember my baby’s first day of life.
-I would like to have minimal separation from my baby. If the baby and I need to be separated for medical reasons, I would like my partner/doula to accompany our baby to the nursery.
-I wish to delay my baby’s first bath until the second day of life.
-I am willing to be up and walking as soon as possible.
-I would like my catheter out early the morning after surgery.
-I would like to eat and have the IV removed as soon as possible after surgery.
Newborn Care
-I do not consent to the following: erythromycin eye ointment, Hep B vaccination (or any vaccinations), and circumcision.
-I will administer oral Vitamin K; please do not give baby the shot.
Homebirth Birth Plan*
(courtesy of thebirthhour.com)
In Early Labor I plan on
- Eating and drinking light foods
- Taking walks and stretching
- Resting
- Taking showers
- Doing light activities to keep my mind off the clock
- Making plans for the other children
- Calling and update my birth team
- Setting up my birth supplies
In Active Labor I’d prefer
- Minimal cervical checks
- To be asked whenever touched
- Intermittent fetal monitoring with a fetoscope
- To be left to just myself and my partner while coping
- That there is minimal touching or talking while I’m in labor
- I would like to hear words of encouragement and to be told where I am in labor
- I would like to have my birth team surround me and help me
- I would like recommendations for pain relief techniques, hot compresses, cool cloth for my face, herbs, breathing techniques
- To be reminded to make low deep sounds
- To be reminded to relax and breath the baby down
- To be reminded to change positions (hands and knees, squatting, standing, sitting on the birth ball, left side lying, sitting on the toilet)
- I want freedom of movement
- I would like to take a shower
- To labor in the water birth pool
- A specific playlist to be on
- I want it to be silent
- I would like to be massaged
- I would like essential oils to be diffused in the air
- Low lights and minimal sound
- To have only liquids during labor
- To be encouraged and reminded to eat and drink during labor
- I would like to drink herbal teas like Red Raspberry Leaf Nettle and honey in labor to help keep me nourished in labor.
- I would like fruit and herbal popsicles to help keep my energy up
- A photographer to take pictures
- The following people are allowed to be present:
- The following people not allowed to be present:
In Birth (Pushing) I’d prefer
- To deliver in water
- To deliver “on land”
- To push instinctively, in my own way, in my own time
- To be reminded to make low deep sounds
- To be reminded to relax and breath the baby out
- To be reminded to change positions (hands and knees, squatting, standing, classic etc.
- I want to push on the birth stool
- To be offered a mirror to see the baby crowning
- To be helped and guided when I’m pushing if there is slow progress
- My midwife to count when I push
- My midwife to give perineal support
- My midwife to give perineal massage
- My midwife to NOT give perineal support or massage
- To have photos taken of the pushing stage
- To support/deliver/catch the baby myself
- For my partner to support/deliver/catch the baby
- To remain in the water until the placenta is delivered
- To leave the cord attached until it stops pulsating
- For my partner or child to cut the cord
- To have a lotus birth (cord never cut, placenta preserved until the cord falls off)
- To save my placenta for a smoothie or encapsulation, etc.
- To take an herb bath with baby after delivery
- To have the following high in protein meal after birth:
Newborn Decisions
- Do not administer Erythromycin Eye Prophylaxis
- Administer Vitamin K drops orally
- Do not administer Vitamin K
- Please perform the Newborn Metabolic Screen
- Please do NOT perform the Newborn Metabolic Screen
