About Baby Birth Plan (Page 4 of 4) in pdf

Right after delivery: (check all that apply)

[ ] We want to discover the sex of our baby ourselves. Don’t tell us!

[ ] I’d like to hold my baby skin to skin immediately

[ ] I’d like my baby dried off before being brought to me

[ ] I’d like you to wait until the umbilical cord stops pulsating before it is clamped and cut

[ ] I’d like my partner to cut the umbilical cord

[ ] I’d like to delay newborn procedures (such as bathing and measuring) for the ﬁrst hour to give me a

chance to feed and bond with my baby

[ ] Additional:

_________________________________________________________________________________

If I have a boy, a circumcision should: (check all that apply)

[ ] Not be performed during hospital stay

[ ] Be performed

[ ] Additional:

_________________________________________________________________________________

(Note: Check if your insurance covers circumcision; many insurance companies do not.)

Regarding my baby: (check all that apply)

[ ] Please give my baby a bath for me

[ ] Have my partner or me give the ﬁrst bath

[ ] I’m planning to feed only breast milk

[ ] I’m planning to feed only formula

[ ] I want to breastfeed and would appreciate a lot of support

[ ] I want to be consulted before my baby is given a bottle or paciﬁer

[ ] Please keep my baby with me at all times

Other requests:

_________________________________________________________________________________

1015

About Baby Birth Plan Page 4