Worksheet Template For Preparing Your Birth Plan With Samples Page 9
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14Pregnancy, Childbirth, and the Newborn
Birth Plan for Pat Rosen
My primary caregiver is Dr. Sally Doe, and my due date is July 5.
My support people will be my husband, Ken; a doula; and perhaps a friend.
Who We Are
•
Ken and I are both originally from the South, so we feel it’s a little exotic to have a kid born on the West Coast!
This is our first baby, and we don’t know if it’s a boy or girl. We figured, why spoil one of life’s big surprises?
Issues, Fears, Concerns
•
As a child, I had minor surgery involving my urethra, and I remember it as painful and quite frightening. So I have
lingering anxiety around vaginal exams and interventions (for example, needing a catheter). Not very convenient
when giving birth, I know, and I’ve tried to get around the anxiety, but it does crop up.
Preferences for the First Stage of Labor
•
Controlling pain: I’d like to use natural coping techniques (breathing, focused relaxation, the bath, the ball, com-
fort positions) to a point, but expect I’ll want pain meds in active labor.
•
Medical interventions: I’d like to avoid interventions; delay them until I get the epidural or if a problem comes up.
Preferences for the Second Stage of Labor
•
Positioning: I hope the epidural will be light enough that I can try different positions in the bed to help the birth.
•
Pushing efforts: I’d like to labor down and have help knowing when and how long to push.
•
Medical or surgical interventions: I’d like to avoid an episiotomy, forceps, and a vacuum extraction.
Preferences for Unexpected Labor Events
•
We’d like to make informed decisions, so please keep us informed if you have concerns about our baby’s well-being
or mine.
•
Cesarean surgery: I’d like to have at least two of my people with me.
Preferences for My Postpartum Care
•
I plan to breastfeed and would like a visit from a lactation consultant. I have inverted nipples and anticipate needing
extra help.
Newborn Care Plan
•
Immediately after the birth: Bonding time is very important to us. We’d like to have our baby placed naked on my
chest as soon as possible after the birth unless there’s a medical reason not to do so.
•
Newborn procedures—please honor these requests:
•
Don’t suction my baby’s nose and mouth if the baby is breathing okay.
•
Delay clamping my baby’s cord until it stops pulsating.
•
Delay other newborn procedures until after the first hour.
•
Feeding: We plan to breastfeed exclusively and on cue. We’d like advice from the lactation consultant, as this is all
new to us!
•
Vaccinations: Please don’t give our baby a hepatitis shot. We’ll have the pediatricians give vaccinations when recom-
mended.
•
If our baby is sick: We absolutely want our baby to have help if needed, and ask that you include us in the deci-
sion-making process so we can do all we can for our baby. We wish to stay with our baby so we can hold and feed
him or her as much as possible.
•
Visitors: We’d like our baby’s grandparents brought in to see us and meet their grandchild as soon as possible after
the birth; other friends can come as well, provided we have the energy to visit with them.
•
Our educational needs: Because this is our first baby, we need all the advice and help we can get about baby care
and feeding!
•
Discharge: We hope to stay in the hospital for as long as our insurance policy allows.
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