Birthing Plan

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Pregnancy can be one of the most exciting experiences in life. It’s a time of change, excitement and new experiences. With so many changes occurring it’s always helpful to have a plan. During pregnancy creating a birth plan helps to reduce some anxiety from the unexpected and gives some focus when baby is ready to come. It also ensures that when the time comes your wants and needs during labor are expressed to everyone involved. There are several things to consider when creating your birth plan: such as a home birth vs. a birthing center, the use of a doula vs. a midwife and many other great things. It’s also a great way to bond with your significant other as you work together to create the plan. Have you created your birthing plan? Here's a sample you can start with or you can create your own! Care to share what you are most excited about?

 

Birth Plan

  

Name:

Partner’s Name:

Your Labor Support People:

Do you want visitors during labor? o Yes o No
Do you want to receive phone calls during labor? o Yes o No
What are your plans for pain relief during labor? (Please check all that apply)
o Non-medicated, natural childbirth with use of relaxation, massage, breathing techniques, shower
and/or Jacuzzi, birthing ball
o Use of pain medication
o Epidural
o Unsure at this time

How can our staff best support you?

Are there any special requests for your birth experience?

What are your expectations?

Baby Care Plan
Baby’s name if chosen:

Baby’s doctor:

Breast-feeding: o Yes o No
Do you have any previous experience breast-feeding? o Yes o No
Do you plan to return to work while breast-feeding? o Yes o No
Do you have concerns about breast-feeding? o Yes o No

Bottle-feeding? o Yes o No
Would you like your baby to have a pacifier? o Yes o No
Are there any siblings? o Yes o No
Names and ages:

Do you have any concerns or special requests about the care of your newborn? o Yes o No
If yes, please explain:

We encourage you to discuss your birth plan with your doctor, doula or midwife during your prenatal care. We understand that a birth plan must be flexible and that you may want to make changes or additions during your stay with us.

MD / CNM Review:

Admitting RN Review: