How To Prepare A Birth Plan Page 4

Janet Whalley, and Anne Keppler,

Adapted from Pregnancy, Childbirth, and the Newborn: The Complete Guide, By Penny Simkin,

Deephaven, MN: Meadowbrook Press, 1991, 3

edition.

BIRTH PLAN for _______________________________________________

My Primary caregiver is ____________________________________________________

My due date is ___________________________________________________________

My support people will be __________________________________________________

I will give birth at _________________________________________________________

Introducing ourselves:

Important issues, fears, concerns:

First Stage of Labor preferences:

Controlling pain

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Medical Interventions

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Second Stage preferences:

Positioning

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Pushing efforts

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Medical/surgical interventions

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Parent category: Medical