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Birth Plan

Full name: Morgan

Todays date: September 10, 2014

Partners name:
Due date: October 20, 2014

Thank you so much to our medical team for taking the time to read our birth
plan. We are very excited to meet our son, Emmett, and glad that you are
part of the experience. We understand that birth does not always go as
planned so we know that this must be flexible. We ask that you please be
respectful and flexible with our wishes as long as mother and baby remain
We wish to be informed of all procedures and tests before they are
preformed. We do not want the labour, delivery or after birth to be rushed in
any way, regardless of routine procedures at (insert hospital name here).
During labour Id like

As few vaginal exams as possible

Fetal monitoring to be external and intermittent

Not to be offered pain medication unless requested

To avoid an IV unless dehydrated (a heparin or saline lock is okay)

My partner to be present at all times

Labour augmentation preformed only if baby is in distress or at risk

To avoid the use of pitocin until all other methods have been tried
During delivery I would like to:

Change positions as desired

Push spontaneously

Push without time limits, as long as the baby and I are not at risk

Avoid the use of forceps or vacuum extraction

An episiotomy is not to be performed

Immediately after delivery, I would like:

Delayed cord clamping until the cord stops pulsating

To deliver the placenta spontaneously and without pulling/tugging

Not to be given pitocin/oxytocin for the delivery of the placenta

The baby to be placed on my chest immediately for skin to skin


To delay medical procedures or have them preformed while baby is on

my chest

To attempt to breastfeed within the first hour

If a c-section is necessary, I would like:

To make sure all other options have been exhausted

To stay conscious

My partner to remain with me the entire time

The screen lowered so I can watch baby come out

To have immediate skin to skin contact on my chest with the baby

Or my partner to hold the baby immediately if I cannot

To breastfeed as soon as possible

After delivery, I would like:

All medical exams & procedures given in my presence with my

permission only

Medical exams & procedures delayed for the first hour when possible

Eye drops to be delayed for the first hour

Babys first bath to be given by my partner and I, without the use of

hospital soap or shampoo

To exclusively breastfeed immediately and on demand

Please dont use or give baby:

Sugar water


A pacifier

A circumcision is not to be preformed

If baby is not well, Id like:

My partner and I (if able to travel) to accompany him to the NICU or

another facility

To breastfeed or provide pumped breast milk