This Birth plan has help me and so many others... so help yourself.
Rewrite it to suit yourself, but be sure to make copies to hand to your Dr., Hospital, and all coaches.
FAMILY BIRTH PLANWHAT I WOULD LIKE:
During labor:
-the birth and labor to be as natural as possible
-for Dr. to check on me regularly
-to be able to shower, if desired
-to be able to walk around (the room and the hospital), if desired
-to eat or drink, if desired, things like fruit, popsicles, fruit shakes, etc...
-to use a battery operated radio/cassette player
-to use a camera (still or video) during labor, birth, and recovery
-to use the fetal monitor for 10 mins., or less, every hour to an hour & a half
-to have visitors before and after the birth (if everything is going normal)
-to be reminded to use the restroom every hour
-to keep my underwear on
-to sit on a portipotty or toilet ring in the labor room, instead of the chairs
-to maybe have an I.V. if I get too dehydrated, a half bag or less.
During and after birth:
-For Dr. to be at the Pushing stage and after
-to use a warm towel on my vaginal area
-to try to stand/squat while delivering
-to have a mirror so I can see the baby coming out
- my husband, to cut the umbilical cord
-For husband to help finish delivering the baby
-for me and husband to hold the baby first
-to have a Gatorade or juice drink immediately after birth of baby
-to be reminded to take pictures of event--no crotch shoots
-to breast feed the baby before it's bathed and measured
-for me and/or husband to be present when measuring the baby
-for me to bathe the baby with assistants
-for the baby to be with me or husband at ALL times
-for me and husband to witness the baby's name band being put on
-for the baby to be in the room with me (NOT IN THE NURSERY)
-to print footprint on baby book when doing the birth certificate
-for my two children, to come and stay with me, husband,
and the baby as soon as I am in the recovery room.
WHAT I DO NOT WANT:
During labor:
-to be on the fetal monitor the whole time
-my under wear to be off
-to have medication
During and after birth:
-I do not want the baby taken out of the room without me or husband
(even in an emergency)
-I do not want the baby bottle fed
-I do not want the baby staying in the nursery
-I do not want the baby bathed within the first few hours after birth
**All the instructions here are not in any way to tell the hospital staff or
doctors how to do their jobs, but rather so they know what kind of birth I
am hoping for, because once I'm in labor I may be to unfocused to convey
my desires for this birth.
These instructions I wish could be set in stone and followed to the tee, but this is based
on a normal birth and a normal baby; if an emergency, or something unexpected, should
arise a review and adjustments will be made by the consensus of me (name),
Name_______________ (my husband/coach), and Dr.________________.
Thank you for cooperation and time.
Thank you.
MR. & MRS. _________________
January 2001/Birth Plan
Please sign if you have read this birth plan:
__________________ _________________ ____________________
__________________ _________________ ____________________
__________________ _________________ ____________________
__________________ _________________ ____________________
FOR MY COACHES:
-don't always ask if I'm okay, or how I'm doing. If something is wrong I'll tell you.
-make sure you enforce the birth plan
-remind me to breathe by breathing the rhythm with me or calling what to
do, rather than telling me to breathe
-encourage me that the harder the contractions the better and faster the birth
-encourage me, if I wavier, not to use drugs, otherwise don't let anyone bring it up
-remind me it's okay to grunt and make noise, but do not let me get out of
control, with words, or noises
-remind me to relax and what to relax
-make sure someone is taking pictures of everything but my crotch
-remind me to go to the bathroom every hour
-try to read my body language if I need a distraction or if I need quiet concentration
-watch and listen if I become panicked or unfocused
-everyone of us is to use breath mints, or mouth wash, frequently
-give me ice chips regularly
____________: My husband, coach, and baby's advocate:
-finish delivering baby, if possible
-cut the umbilical cord
-watch them put on it's name bracelet and read it to make sure it's correct
-stay with the baby at all times unless it's with me, or I'm dying
-during labor stay with me
-please pray for all of us silently and out loud
-make most of the phone calls for us in the hospital room with me near
-massage my back like the Bradley Method, if needed
-make sure no one is getting in my way or on my nerves while in labor
-help me to walk around if labor is too slow, or slows down
________________: My advocate, transition and birth co-coach:
-stay with me at home and hospital through the placenta delivery and stitches I may need
-take care of any unsightly things on me
-encourage me when I am in doubt that this will pass
-keep track, and names of the nurses who help me (write it down)
-look at clock when it's born
-make sure husband is with the baby at all times
-take pictures during and after labor: no crotch shots
-take pictures as soon as baby is out
-remind me to breath naturally, and then breath with me
-stay by my side when pushing and call encouragement’s, because I'll
probably be focusing on your voice
-get me a drink as soon as the baby is getting weighed
-watch for wavering or becoming discouraged; try to encourage or if need be take over
-call whoever needs to be told
Give Name: ___________ Numbers_________________
Name: ___________ Numbers_________________
Name: ___________ Numbers_________________
Rewrite it to suit yourself, but be sure to make copies to hand to your Dr., Hospital, and all coaches.
FAMILY BIRTH PLANWHAT I WOULD LIKE:
During labor:
-the birth and labor to be as natural as possible
-for Dr. to check on me regularly
-to be able to shower, if desired
-to be able to walk around (the room and the hospital), if desired
-to eat or drink, if desired, things like fruit, popsicles, fruit shakes, etc...
-to use a battery operated radio/cassette player
-to use a camera (still or video) during labor, birth, and recovery
-to use the fetal monitor for 10 mins., or less, every hour to an hour & a half
-to have visitors before and after the birth (if everything is going normal)
-to be reminded to use the restroom every hour
-to keep my underwear on
-to sit on a portipotty or toilet ring in the labor room, instead of the chairs
-to maybe have an I.V. if I get too dehydrated, a half bag or less.
During and after birth:
-For Dr. to be at the Pushing stage and after
-to use a warm towel on my vaginal area
-to try to stand/squat while delivering
-to have a mirror so I can see the baby coming out
- my husband, to cut the umbilical cord
-For husband to help finish delivering the baby
-for me and husband to hold the baby first
-to have a Gatorade or juice drink immediately after birth of baby
-to be reminded to take pictures of event--no crotch shoots
-to breast feed the baby before it's bathed and measured
-for me and/or husband to be present when measuring the baby
-for me to bathe the baby with assistants
-for the baby to be with me or husband at ALL times
-for me and husband to witness the baby's name band being put on
-for the baby to be in the room with me (NOT IN THE NURSERY)
-to print footprint on baby book when doing the birth certificate
-for my two children, to come and stay with me, husband,
and the baby as soon as I am in the recovery room.
WHAT I DO NOT WANT:
During labor:
-to be on the fetal monitor the whole time
-my under wear to be off
-to have medication
During and after birth:
-I do not want the baby taken out of the room without me or husband
(even in an emergency)
-I do not want the baby bottle fed
-I do not want the baby staying in the nursery
-I do not want the baby bathed within the first few hours after birth
**All the instructions here are not in any way to tell the hospital staff or
doctors how to do their jobs, but rather so they know what kind of birth I
am hoping for, because once I'm in labor I may be to unfocused to convey
my desires for this birth.
These instructions I wish could be set in stone and followed to the tee, but this is based
on a normal birth and a normal baby; if an emergency, or something unexpected, should
arise a review and adjustments will be made by the consensus of me (name),
Name_______________ (my husband/coach), and Dr.________________.
Thank you for cooperation and time.
Thank you.
MR. & MRS. _________________
January 2001/Birth Plan
Please sign if you have read this birth plan:
__________________ _________________ ____________________
__________________ _________________ ____________________
__________________ _________________ ____________________
__________________ _________________ ____________________
FOR MY COACHES:
-don't always ask if I'm okay, or how I'm doing. If something is wrong I'll tell you.
-make sure you enforce the birth plan
-remind me to breathe by breathing the rhythm with me or calling what to
do, rather than telling me to breathe
-encourage me that the harder the contractions the better and faster the birth
-encourage me, if I wavier, not to use drugs, otherwise don't let anyone bring it up
-remind me it's okay to grunt and make noise, but do not let me get out of
control, with words, or noises
-remind me to relax and what to relax
-make sure someone is taking pictures of everything but my crotch
-remind me to go to the bathroom every hour
-try to read my body language if I need a distraction or if I need quiet concentration
-watch and listen if I become panicked or unfocused
-everyone of us is to use breath mints, or mouth wash, frequently
-give me ice chips regularly
____________: My husband, coach, and baby's advocate:
-finish delivering baby, if possible
-cut the umbilical cord
-watch them put on it's name bracelet and read it to make sure it's correct
-stay with the baby at all times unless it's with me, or I'm dying
-during labor stay with me
-please pray for all of us silently and out loud
-make most of the phone calls for us in the hospital room with me near
-massage my back like the Bradley Method, if needed
-make sure no one is getting in my way or on my nerves while in labor
-help me to walk around if labor is too slow, or slows down
________________: My advocate, transition and birth co-coach:
-stay with me at home and hospital through the placenta delivery and stitches I may need
-take care of any unsightly things on me
-encourage me when I am in doubt that this will pass
-keep track, and names of the nurses who help me (write it down)
-look at clock when it's born
-make sure husband is with the baby at all times
-take pictures during and after labor: no crotch shots
-take pictures as soon as baby is out
-remind me to breath naturally, and then breath with me
-stay by my side when pushing and call encouragement’s, because I'll
probably be focusing on your voice
-get me a drink as soon as the baby is getting weighed
-watch for wavering or becoming discouraged; try to encourage or if need be take over
-call whoever needs to be told
Give Name: ___________ Numbers_________________
Name: ___________ Numbers_________________
Name: ___________ Numbers_________________
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