Birth Plan Template Page 3
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6birth plan
During delivery I would like to:
Squat
Use people for leg support
Semi-recline
Use foot pedals for support
Lie on my side
Use birth bar for support
Be on my hands and knees
Use a birthing stool
Stand
Be in a birthing tub
Lean on my partner
Be in the shower
I will bring a:
Squattng bar
Birthing stool
Birthing tub
Birthing chair
As the baby is delivered, I would like to:
Avoid forceps usage
Push spontaneously
Avoid vacuum extraction
Push as directed
Use whatever methods my doctor
Push without time limits, as long as the
deems necessary
baby and I are not at risk
Help catch the baby
Use a mirror to see the baby crown
Let my partner catch the baby
Touch the head as it crowns
Let my partner suction the baby
Let the epidural wear off while pushing
Have a full dose of epidural
I would like an episiotomy:
Used only after perineal massage, warm
Performed as my doctor deems necessary
compresses and positioning
Performed with local anesthesia
Rather than risk a tear
Performed by pressure, without local anesthesia
Not performed, even if it means risking
Followed by local anesthesia for the repair
a tear
Performed only as a last resort
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