Labor And Birth Plan (Page 2 of 2) in pdf

8. Do you have any concerns or fears about labor? If so, what? __________________________________

______________________________________________________________________________________

9. Insurance usually covers two days for a vaginal birth or three days for a cesarean birth.

Would you prefer to go home early? ú If YES, How soon? ______________________________ ú NO

10. Who will be your baby s doctor? ________________________________________________________

Is your baby covered under your insurance? ú YES

ú NO

11. Make sure that you register your baby with your insurance provider as soon after the birth as possible.

ú YES

ú NO

12. Have you spoken with or interviewed your pediatrician regarding your wishes?

13. Areas of baby care you would like some assistance with while you are in the birthing suite. (Please check)

ú Feeding

ú Comforting a crying baby

ú Bathing

ú Stimulating the baby

ú Discovering your baby

14. Do you have any concerns or fears about caring for your baby? If so, what? ___________________________

_________________________________________________________________________________________

15. Have your heard of the circumcision controversy? ú YES ú NO Will your baby be circumcised? ú YES ú NO

ú YES

ú NO

16. Do you understand the newborn medications offered in the hospital?

Do you want the baby to receive the following:

Hepatitis B - ú YES

ú NO

Erythromycin - ú YES

ú NO

Vitamin K - ú YES

ú NO

PLANS FOR WHEN YOU GO HOME

1. Who will be with you during the first few days at home? ___________________________________________

2. How would you like this person to help you?

ú Housework

ú Cooking

ú Errands

ú Help caring for the baby

ú Help with other children

3. Do you have the following ready for the baby?

Clothes, diapers, car seat, name, crib, room, etc.

4. Do you have a name chosen? ________________________________________________________________

5. What do you plan to use for birth control following your delivery?

ú NONE

ú Natural family planning

ú Foam

ú Condoms

ú Diaphragm

ú Pills

ú Tubes tied/Sterilization

ú Shot

ú Norplant

ú IUD

ú Undecided

ú Husband having vasectomy

ú Would like help deciding.

Labor And Birth Plan Page 2

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