Birth Plan Resources / Resources

Birth Plan Options Checklist

Not sure of what to include in your birth plan? Take a look at some of the options that may be important to you. Don’t feel you have to include EVERYTHING, but this list should give you some ideas:

Birth Plan OPTIONS Checklist

Pain Relief Choices

Meditation
 Freedom to eat/drink
 Control temperature/lighting/sound
Hot/ice packs
Hypnosis
 Music
Shower or bath tub
Breathing techniques
Room as quiet as possible
Movement (walking, swaying, rocking)
Acupressure
Acupuncture
 Massage
Epidural or spinal anesthesia
Narcotics
Sedatives and tranquilizers

Procedures

 Continuous Electronic Fetal Monitoring
 Internal Fetal Monitoring
 Intermittent Fetal Monitoring
 Continuous IV
 Heparin Lock instead of IV

Induction

Medical Induction

Pitocin
 Cervadil
Amniotomy (breaking of waters)
 Membrane sweeping
Prostaglandin gel
Cervadil

Non-medical Induction

Walk
 Castor Oil
 Acupuncture
Nipple stimulation
Sexual intercourse (only if water hasn’t broken)
Herbs

Episiotomy

Yes
No

Birthing Positions

Semi-sitting (Stirrups? Y/N)
Side-lying
 Flat on back
Squatting
Hands and knees
Standing
 Water birth
Spontaneous Pushing v. Directed Pushing

Birthing Equipment

Birthing chair
Birthing bed
Birthing ball
Birthing pool/tub
Beanbag chair
Squatting bar
Other

Miscellaneous Delivery Requests

 Perineal massage during second stage labor
 Request a mirror to see the baby’s head crown
I would like to touch my baby’s head as it crowns
I would like to have the baby placed on my stomach/chest immediately after birth

Extraction Devices

None unless baby’s health at risk
Vacuum extraction
Forceps

C-Section

Partner present at all times
 Prefer to be conscious
Screen lowered to view baby’s birth
One hand free to touch the baby
Immediate contact/breastfeeding with the baby

Cord Cutting

Partner to cut cord
I cut the cord
Neither
Other

Placenta

Cord Blood collection
Injection of Pitocin to aid with delivery
Spontaneous
Encourage with breast stimulation, baby suckling
Manual extraction
I’d like to see it
Use of placental tissue by the hospital

Newborn Procedures

Done in my presence
Done in my partner’s presence

Permit, delay or deny the following:
 PKU Blood Screening
 Hepatitis B vaccine
 Antibiotic (Erythromycin) eye ointment
 Vitamin K injection
 First bath

Circumcision

Yes
No

Feeding baby

Breast
Bottle
Both
 Access to lactation consultant

Separation

No separation
 Partial room-In
Nursery

Hospital Stay

Short as possible
Long as possible

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One thought on “Birth Plan Options Checklist

  1. Pingback: Tips For Writing An Effective Birth Plan | Wordy Gertie

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