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Dear Dr. _______ and Birth Center Staff,

We are very pleased to be sharing our birth experience with you. We have worked very hard to make this pregnancy healthy and low risk and to prepare for the birth of our first baby: we attended a comprehensive birth class; read a number of books about pregnancy, labor, delivery, and child rearing; ___ religiously did 200 Kegel exercises every day, along with tailor sitting, pelvic rocks, squatting, and other exercises recommended during pregnancy; faithfully ate 80-100 g. of protein daily, as well as deep green and orange vegetables, a quart of milk, lots of high-fiber and vitamin C foods, wheat germ, and even some things never heard of before; together we practiced relaxation techniques for each stage of labor, as well as laboring and pushing positions. As you can see, we did all that is in our power to give our baby a good start in life. Now, as the pregnancy is approaching its final weeks, we are eager to share with you, our birth team, our hopes for a natural and trouble-free birth.

We hope for a normal, natural birth, and we feel well prepared and look forward to it. Any help you give us will be most appreciated. Of course, we realize that unusual circumstances may arise. It is for that reason that we chose excellent professionals like you. However, if the course nature takes appears to be within the limits of the ordinary, we do have preferences regarding routine hospital procedures for the mother and the baby. These preferences are expressed in the following Birth Plan.

Birth Plan for [names of parents]

Birth Team
We would like to be part of the decision-making team and to be consulted about and asked for our consent before any medical procedure is performed. We highly value our privacy, so we would like to keep the birth team to a minimum necessary number, which excludes residents, trainees, and other nonessential personnel.

Labor and Birth
We respectfully request that there be as little intervention as possible unless an emergency arises. This includes: routine IV, continuous electronic fetal monitoring, use of medications for pain or labor augmentation, amniotomyand frequent vaginal exams.

We would like to have freedom of motion and a choice of laboring positions, particularly in the second stage (this includes the possibility of a full or partial squatting position).

We ask kindly that a fetoscope be used for monitoring the baby's heart rate.

We would like to avoid a routine episiotomy; if one is deemed absolutely necessary, we would like to try for a pressure episiotomy when the baby's head is crowning. We would prefer not to use any medication for labor augmentation or anesthesia.

Baby
I would like to breastfeed our baby as soon as she/he is born. We kindly request that the cord not be clamped or cut before it has stopped pulsating. We prefer that there be no (or as little) separation from the baby as possible, particularly in the early hours after birth. In the case such circumstances should arise that the baby must be separated from the mother for a period of time, we would like ________ to be with the baby at all times. We plan that the baby be breast-fed exclusively, so we kindly request that no formula or any other kind of supplement be given to our baby in the hospital.

If the baby is a boy, we do not want him circumcised.

Special Cases
In the case that a cesarean section needs to be performed, we would prefer a regional anesthesia that would allow the mother to be awake and alert for the birth and the father to be present.

If the baby should need special care, we want to be involved in that care as much as possible and want the baby breast-fed or given expressed mother's milk from a bottle.