back	samples 1 2 3 4 5 6 7 8

*If any of the items on this birthing plan are not possible or permissible please feel free to discuss those openly with me. I will be happy to accommodate any reasonable modifications to protect the welfare of the baby and to respect the midwives, medical staff and hospital policy as long as the changes are openly discussed with me prior to any alteration of the birthing plan. I understand that unforeseen medical circumstances may necessitate variations from our wishes.

BIRTHING PLAN

During the first stage of labor, I intend to be at home with my husband, my doula and my mother. We intend to leave to the hospital once the contractions are 4 minutes apart.

I would like to give birth in a tub equipped labor/delivery room in ___________ Hospital.

In my labor/delivery room the following is important to me:
• An alternative to the word "pain" and/or anything else that is negative: I have no pre-conceived notions of pain during labor and would like to avoid being conditioned to expect discomfort.
• Dimmed lights
• Quiet (Soft) Voices
• Hypnobirthing CD's playing softly (probably through headphones)
• Lavender linen spray from home
• My body pillow
• A labor tub

I would like to have my midwife, my mother, my husband, and my doula in the birthing room with me.

I would like to stay hydrated by drinking distilled water that we bring from home.

In preparation for my delivery, I would prefer:
• Not to use an enema.
• Not to have epidural offered to me. If I find it necessary, I will ask for it.
• Not to have a routine IV.
• Not to be bound to anything that restricts my movement .
• Not to have routine catheterization.
• Not to be medically induced unless I approve it.
• Intermittent or portable fetal monitoring

I prefer the following natural methods of induction before the suggestion of oxytocin/syntocinon (Pitocin), if permissable:
• Walking
• Nipple Stimulation
• Intercourse
• Acupuncture
• Any other natural methods that my midwife or doula suggests

I prefer to manage my contractions by the following methods:
• Deep meditation/Hypnosis
• Massage from my husband
• Breathing & Relaxation
• Positioning and Massage by my doula

Unless it is medically necessary, I would prefer not to have an episiotomy offered to me. In the event that an episiotomy is necessary or there is risk of severe tearing, I would like a local anesthetic to be offered.

I prefer to give birth in a squatting or kneeling position.

I would prefer infrequent internal medical exams. I prefer that internal exams are done by my midwife.

During the birth (pushing, delivery, etc.):
• If an assisted birth becomes medically necessary, I prefer forceps over vacuum extraction, if possible
• I would like a mirror available to see my baby's head
• I do not want residents or students to be present
• As much as possible, I prefer that only my midwife, my doula or my husband speak to me during the birth.
• I request that cell phones/pagers be silent in my labor/delivery room to avoid unnecessary distractions from hypnobirthing.

We will be banking the baby's cord blood with CryoCell International.

My husband would like to cut the umbilical cord if permissible.

If oro-nasal suctioning is necessary, I prefer that my midwife or a pediatrician perform the suctioning.

I prefer to postpone weighing the baby and administering eye drops until after I have met him/her.

I would like to hold and breastfeed the baby immediately after birth, if possible.

If a c-section becomes necessary, I would like the following:
• My husband and doula to stay with me at all times before, during and after the operation
• To be conscious (no general anesthesia)
• To have one hand free to touch the baby
• Immediate contact with the baby
• To nurse the baby within one hour of his/her birth

My husband would like to be present at the weighing of the baby, administration of eye drops, first pediatric exam and baby's first bath (accompany the baby to the nursery).

If my newborn leaves my presence for any reason, I would like my husband to accompany him/her.

Room Preferences:
• I would prefer a room with a view of the lovely garden.
• I would like 24-hour rooming-in with my baby.
• I would like my husband to spend the night in my room.

I plan to nurse the baby according to his/her hunger, unless it becomes necessary to nurse according to a schedule.

Please do not feed the baby formula or offer the baby any artificial nipples.

If the baby is a boy, we would like him to be circumcised in the hospital.

If possible, any postpartum procedures or medications that would interfere with breastfeeding should be avoided.