Birth Plan

Although it is impossible to plan everything that will happen during birth, you can at least think about what you would like to happen and let your wishes be known to your midwife or doctor and hospital. These are some things to think about, you’re sure to think of others as you get closer to your delivery date.

Labor

During labor do you want to:
a. Move around?
b. Stay in one place?
c. Be able to take a bath or shower?

During labor would you like to:
a. Eat?
b. Drink?
c. Use an IV?
d. Have ice chips?

How do you feel about pain medicine?
a. I want to use all appropriate pain relief options. (such as an epidural)
b. I would like pain medicine if the pain is too intense.
c. Pain medicine might affect me, my baby or my labor and I would like to avoid if possible.
d. I don’t want any pain medicine.

Do you want to try alternative pain relief methods? If so, which ones?
a. Breathing exercises.
b. Visualize/relaxation.
c. Massage.
d. Movement/position changes.
e. Other.

Whom do you want to be present during labor?
a. My partner
b. Another birth coach
c. A doula (a specially trained labor assistant)
d. Friends or family members
e. Older children

What do you want to have with you in the labor room?
a. Music or relaxation tapes.
b. Photographs.
c. Soft lighting.
d. Other.

In the delivery room, would you like to have:
a. A still camera?
b. A video camera?
c. No recording equipment?

How do you feel about enemas?
a. I would like to have one.
b. I would prefer not to have one.

How do you feel about induced labor?
a. It would be OK to speed up childbirth.
b. I would prefer not to have induced labor unless it is recommended for the safety of my baby or me.

Delivery

What delivery position(s) do you want to use?
a. The more traditional, semi-reclining posture.
b. I would like to move around and try different positions.

How do you feel about an episiotomy?
a. I would like one, if my doctor/midwife thinks I will tear.
b. I prefer a natural tear to a surgical cut.

In the event of a cesarean delivery, do you want:
a. To be conscious?
b. To see and touch your baby after the operation?
c. To have your partner present?

Would you like your partner to cut the cord?
a. Yes.
b. No.

Do you want a mirror positioned so that you can see your baby being born?
a. Yes.
b. No.

After Delivery

Would you like to hold your baby immediately after birth?
a. Yes.
b. No.

Do you want to postpone non-critical procedures until after you’ve had a chance to bond with your baby?
a. Yes.
b. No.

When do you want to have your baby with you?
a. All the time.
b. Whenever I am awake.
c. Whenever your baby is awake.
d. At scheduled feeding times.

Do you plan to:
a. Breast feed?
b. Use formula?

Is it OK for the hospital staff to give your baby a pacifier?
a. Yes.
b. No.

If you have a son, do you want him to be circumcised?
a. Yes.
b. No.

Do you want your older children to be able to visit you and the new baby?
a. Yes.
b. No.

Make a Birth Plan


To learn more see our Pregnancy Guide

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