Your Birth Plan Checklist

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124/124 EXAMPLES

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Your Birth Plan Checklist
Labor
1. During labor, do you want to
Move around
Stay in one place
Be able to take a bath or shower
2. For refreshment, would you prefer to
Eat
Drink
Have ice ships or popsicles
Use and IV (if you wish to avoid a routine IV, say so explicitly)
3. Do you want the baby's heartbeat to be monitored
With an internal electronic fetal monitor
With a portable telemetry unit (so you can walk)
With an external monitor
With a fetal or Doppler stethoscope
Intermittently, if at all possible
4. How do you feel about pain medications
I want to use all appropriate pain-relief options
I would like to take them if the pain is too intense
They should be avoided if possible
5. What nonmedical pain-relief methods would you like to try
Breathing exercises
Acupressure
Massage
Visualization
Hypnosis
Water (warm bath, shower)
Other:
6. Whom do you want to be present during labor
My partner
Another birth coach
A doula (professional labor assistant)
Friends or family members)
Older children
Delivery
1. What positions would you like to try for pushing
Reclining in bed
Squatting
All fours
2. How do you feel about an eposiotomy
I would like one if the doctor thinks I will tear
I would prefer that the birth attendants massage and stretch my perineum in order to avoid an episiotomy
3. Would you like your partner to cut the cord
4. In the event of a Cesarean delivery, do you want to
Be conscious
Watch the procedure
See and touch the baby after the operation
Have your partner present at all times
After Delivery
1. Do you want to postpone noncrucial procedures until after you've had a chance to hold your baby?
2. Do you want to try to nurse the baby immediately?
3. When do you want to have the baby with you (note that hospitals may have policies on this)
All the time
Whenever I'm awake
Whenever baby is awake
At scheduled feeding times or when baby is hungry
4. Is it okay for the hospital staff to give your baby
A pacifier
Sugared or plain water
Formula
5. If you have a son, do you want him circumcised?
6. Barring complications, how long do you want to stay in the hospital?
I want to rest and recover as long as I can
I want to go home as soon as possible
Setting your thoughts about labor on paper, or discussing them with your healthcare provider, can help crystallize your preferences. You'll find it helpful to read up on labor and delivery, and to take a child birth education class, before solidifying your opinions. Consider your stances on such topics below.