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How do you feel about the following issues?

Use the following topic guide as a worksheet to get to know your position on many issues surrounding birth. Once you know how you feel about a topic, then you can decide how to make your feelings known or whether it is important enough to include in your birthplan.

After you have prioritized, then it's time to organize the information and write the actual birthplan... OR you can use one of the sample birthplans from which to work.

Birth Attendants: ____________________________________________________

Enemas: ____________________________________________________

Vaginal Exams: ____________________________________________________

Intravenous Fluids: ____________________________________________________

Electronic Fetal Monitoring
(continuous vs. intermittent and doptone vs. fetoscope):
____________________________________________________

Eating during labor:
____________________________________________________

Drinking during labor: ____________________________________________________

Freedom of movement: ____________________________________________________

Induction or Augmentation of labor: ____________________________________________________

Artificial Rupture of Membranes (Amniotomy):
____________________________________________________

Positions for labor and birth: ____________________________________________________

Episiotomy: ____________________________________________________

Methods and Positions for 2nd stage pushing
(spontaneous vs. directive, squatting vs. lithotomy):
____________________________________________________

Massage, compress, & overall perineal support:
____________________________________________________

Forceps/vacuum extraction:
____________________________________________________

Parents helping to catch baby: ____________________________________________________

Immediate contact with newborn:
____________________________________________________

Breastfeeding:
____________________________________________________

Postnatal Oxytocin (Pitocin) vs. baby to breast:
____________________________________________________

Undisturbed time for bonding:
____________________________________________________

When to cut the cord: ____________________________________________________

Cord blood:
____________________________________________________

Delivery of placenta:
____________________________________________________

Nursery stay vs. non-separation:
____________________________________________________

Feeding on schedule or demand:
____________________________________________________

Eye Care:
____________________________________________________

Vitamin K shot: ____________________________________________________

Newborn exam: ____________________________________________________

Vaccinations: ____________________________________________________

Going Home (when): ____________________________________________________

Taking pictures/video: ____________________________________________________

Other Choices: ____________________________________________________