Birth Matters! Series / Birth Plan Resources / Resources

Sample Birth Plan 2

Jane and John’s Birth Plan
We have planned for our labor and delivery to happen naturally, with as few interventions as possible. Please consult us before any procedures or tests are performed. We wish to be informed of all options if an emergency arises. Thank you for respecting our plan and assisting in our birth!

WE WOULD LIKE:
• Husband, doula, and midwife present throughout labor and birth
• Freedom to walk, move, and change positions
• Ability to eat and drink
• Use of shower or tub as desired
• Ability to control the environment including temperature, lighting, and music
• Gentle and controlled pushing
• Freedom to choose birthing positions, ie: squatting
• Perineal massage to avoid tearing
• After the birth, immediate contact between mother and baby, and immediate opportunity to breastfeed.
• Delayed clamping and cutting of umbilical cord until blood stops pulsing
• Placenta delivered spontaneously
• All baby examinations done with the permission, and in the presence, of a parent
• Full, informed choice regarding all newborn procedures, such as eye ointment, Vitamin K injection, and PKU test.

WE DECLINE:
• Medications. Please do not offer pain relief.
• IV: We prefer a Hep Lock
• Constant electronic fetal monitoring
• Stripping of membranes or amniotomy
• Use of Pitocin or other drugs to induce or speed up labor, unless deemed medically necessary
• Episiotomy
• Use of forceps or vacuum extraction
• Supplemental bottle-feedings
• Vitamin K shot
• Eye ointment
• Hepatitis B vaccine
• Circumcision

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