Preparing For Childbirth Birth Plan Page 2

Preferences for Unexpected Events

Induction and prolonged or complicated labor:

Cesarean birth:

Premature or sick baby:

Stillbirth or death of baby:

Preferences for Post Partum in Hospital for New Mother

q Breastfeed

q Formula feed

I plan to

Concerns and questions:

Feelings about visitors:

Controlling pain:

Educational needs:

Follow-up after discharge:

Adapted from the form prepared by the authors of Pregnancy, Childbirth, and the Newborn

PFC Birth Plan.pub 2/5/03

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Parent category: Medical