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.