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BIRTH PLAN FOR __________ AND __________

We have prepared this Birth Plan to help you understand our philosophy and the kind of care we hope to have for the birth of our child. The pregnancy has gone very well thus far. We have been careful to eat well and stay fit, and have done everything we can to prepare for a healthy and uncomplicated birth.

We have chosen our obstetrician, Dr. _________, because she shares our desire for a low-intervention birth and respects our need for good communication. We wish for as natural a birth as possible, avoiding unnecessary procedures and medications. However, if medications or procedures become necessary, we ask that you discuss them with us in advance so that we can participate in the decision making process.

It is important to us that we remain together at all times during the labor and delivery (vaginal or cesarean). We would like to have our labor coach, ____, stay with us throughout, as well.

We hope to avoid routine procedures (e.g., prep, enema), to delay introduction of an IV feed unless needed, and to keep the number of vaginal examinations to a minimum. If procedures or medications are proposed, we ask that you discuss them with us and suggest alternative therapies or comfort measures so that we can make well-informed decisions.

We would like to have the option of sucking on ice chips, and may also want to try walking, different labor positions, and perhaps a hot shower for pain relief in labor.

As long as things are progressing well, we prefer intermittent monitoring with an external fetal monitor. We very much want to avoid internal fetal monitoring unless it is specifically medically indicated.

Because we want labor to progress at a natural pace, we hope to avoid artificial induction or augmentation of labor (e.g., amniotomy, stripping of membranes, pitocin). We would also like to avoid an episiotomy and try perineal support o r hot compresses instead.

We would like to have a mirror placed so that mother can watch the birth, and, if things are progressing well, mother would like to be allowed to touch the baby's head as it begins to crown.

It is very important to us to hold and nurse our baby immediately after birth, and to have the weighing and bathing done in our room so that we can watch. If this is not possible, we would like to have the father stay with the baby at all times. Also, we ask that you discuss any routine neonatal procedures with us before they are performed.

We plan to exclusively breastfeed our baby, and therefore request that s/he not be given bottles, water, or a pacifier without our prior approval. We also would like to have a private maternity room with 24 hour rooming in, and a cot or comfortable chair for father.

We thank you for taking the time to go over this Birth Plan, and appreciate your cooperation in getting our new family off to great start.

Patient _________________________________

Coach __________________________________

Physician ________________________________