Canberra Birth Plan Template
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1
2BIRTH PLAN –
HAVING A BABY IN CANBERRA
Name: ___________________________________
Partner’s Name: ___________________________
Date: ____________________________________
Due Date: ________________________________
Ob/Midwife: ______________________________
Hospital: _________________________________
Please note that I have:
I am planning a:
Group B Streptococcus
Vaginal delivery
I am RhD negative
Caesarean birth
Have gestational diabetes
VBAC
Water birth
During labour and birth, I would like to be kept informed of how things are progressing and the health and
wellbeing of my baby. I would like to be informed and involved in any decisions made about any
interventions or procedures that may be required. If I am unable to make an informed decision or give my
informed consent I would like my partner/support person to do so on my behalf.
I’d like the following people present during my labour and birth:
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
During labour, I would like:
The lights dimmed
To use the bath and/or shower
Music playing
As few vaginal exams as possible
My partner to be present always
Foetal monitoring only as required
To move around freely
I plan to manage pain using:
Breathing techniques
TENS
Acupressure
Walking / movement / active birth
techniques
Cold/heat packs
Nitrous oxide
Massage
Pethidine
Water immersion
Epidural anaesthesia
Warm shower
Meditation
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Parent category: Medical