You’ll find a sample birth plan below. Remember, this format is not etched in stone, but it will give you an idea of things you’ll want to include, such as a statement of purpose, your preferences, and things you’d like to avoid.
Statement of Purpose
My partner and I have planned and prepared for a peaceful and natural childbirth. We would like to allow our labor and delivery to unfold naturally, with as few interventions as possible. We would like to be informed about all procedures and tests before they are performed. We want to be aware and informed of all of our options in the event of an unexpected emergency.
Our Preferences
* Labor and delivery will take place: at home, in a freestanding birth center, in
an alternative birthing center within a hospital, in a small hospital, in a
teaching/large hospital.
* Partner or labor coach, doula, and midwife present throughout labor and birth
* Children present throughout labor and birth
* Freedom to walk, move, and change positions as desired throughout labor and birth
* Freedom to eat and drink throughout labor and birth
* Use of the shower or a tub as desired
* Ability to use relaxation and pain relief methods as desired, including herbal
therapy, homeopathy, and aromatherapy
* Ability to control the environment including temperature, lighting, and music
* Use of gentle, controlled pushing
* Use of an upright labor position
* Massage and support of the perineum to avoid tearing
* Natural methods of strengthening labor, if needed, such as walking and nipple
stimulation
* After the birth, immediate contact between mother and baby: baby placed on
mother’s chest, breastfeeding encouraged, mother and baby left undisturbed for
one hour following birth, and any newborn procedures performed afterward
* Delay of clamping and cutting umbilical cord until blood stops pulsing
* Placenta delivered spontaneously
* Give parents full informed choice regarding all newborn procedures, including
eye ointment, Vitamin K injection, PKU test.
* All baby examinations done with the permission, and in the presence, of a parent
What We Wish to Avoid
* Medications. Please do not offer pain relief. We will use natural pain relief
methods.
* Shaving
* Enemas or IV [IV is often automatically hooked up upon arriveal. May not be
assumed under drugs]
* Electronic fetal monitoring
* Stripping of membranes or breaking of bag of waters
* Use of Pitocin or other drugs to induce, speed up, or strengthen labor
* Supine (laying down) position for pushing stage
* Episiotomy
* Use of forceps or vacuum extraction
* Supplemental bottle-feedings
* Unnecessary medical tests and procedures, such as medical circumcision
Mandy-Saint Louis Doula
