Birth Plan/preference List printable pdf download

Birth Plan/preference List

Women’s Health Matters

Birth Plan/Preference List

Date:

Name:

Reviewed with:

The following concerns are often important to expectant families. We encourage you to think about

them carefully and to discuss them with your partner and your health care provider. When complete,

share this birth plan with your health care provider.

1. All babies are monitored externally on admission to the UCSF Center for Mothers and Newborns

for 20–30 minutes. If this monitoring period does not indicate any problems, you may choose to be

monitored intermittently, unless continuous monitoring becomes medically necessary.

Notes: _________________________________________________________________________________

2. Intravenous (IV) fluids may be necessary if you are dehydrated from vomiting, long labor or to

administer medication. You may choose to labor without IV fluids unless it becomes medically

required.

Notes: _________________________________________________________________________________

3. Pain medication and/or anesthesia are available during labor, if you desire. Please read Pain Relief

for Labor and Vaginal Birth. Let us know your preference.

Notes: _________________________________________________________________________________

4. What kind of labor support and comfort measures do you prefer?

Preference: _____________________________________________________________________________

5. The usual hospital length of stay is 1–2 days after a vaginal birth and 3–4 days after a cesarean birth.

Notes: _________________________________________________________________________________

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Birth Plan/preference List