How To Prepare A Birth Plan Page 5

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Other important items regarding labor and birth:
Unexpected labor events:
Complicated or prolonged labor or fetal problems
Cesarean delivery
Post partum for mother:
I plan to feed with:
Breastmilk
q
Formula
q
Concerns, questions, needs, feelings about visitors
Controlling pain
Follow-up after discharge
Educational needs
Acknowledgement: This Birth Plan form is adapted from the form prepared by Carla Reinke, RN, MSN, SNM, for use at
Virginia Medical Center, Seattle, WA.

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