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Birth Plan Guide

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Mothers Name: Partners Name: Expected Due Date: Attendant's Name:

Delivery planned as: Vaginal C-Section Medical Concerns Water birth VBAC

Labour and Delivery I prefer to attempt all natural methods first Membrane stripping Membrane rupture Pitocin Prostaglandin gel Delivery: Touch the head as it crowns Help catch the baby Avoid episiotomy unless doctor deems necessary Use a mirror to see the baby Let my partner catch the baby Use methods recommended by the doctor Avoid the use of forcipes if possible Have the baby placed on my chest after delivery I would like to bank the umbilical cord. If Caesarean is needed, I would like: My partner present Screen to see my baby Immediate contact with my baby My partner to provide skin on skin contact

Environment during labour Listen to Music As few interruptions as possible Wear the clothes I have provided Videotape the labour and birth Take photos during the labour and birth Have my partner present at all times To have my children present To move and walk freely if possible Dim lighting
Things that are important to me during labour & delivery are:

Pain relief Natural birth if possible Kneel/squat Use birthing stool Stand Lie on my side Use birthing tub Use leg support Be on my hands and knees Epidural Please make suggestions for pain relief as needed Following Delivery: My partner to cut the umbilical cord Skin to skin contact with my baby as soon as possible Breast feed I plan to bottle feed my baby Babys medical exam: Given in my presence Given after we have bonded If a boy, I plan to: Internal Only in distress Circumcise Not Circumcise Additional Information:

Monitoring Continuous Intermittent Concerns

Breastfeeding Chart
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Babys Name: Date:

Breast Time
am 12



Feeding Duration

Formula (in ounces)



1: 2: 3: 4: 5: 6: 7: 8: 9: 10 : 11 :
pm 12

1: 2: 3: 4: 5: 6: 7: 8: 9: 10 : 11 :


Baby Milestone Tracker

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Babys Name:

First Smile Meets the Grandparents Establishes Eye Contact First Laugh Makes vowel noises Responds to own name Roll over: front to back Roll over: back to front Holds head up independently First tooth Sits independently Crawling First word (name) Cruising Imitates activities of others Grasping objects securely Drinks from a cup First solid meal Walking independently First word (object)



Babys First Holiday Babys First Friend


Potty Training Chart

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Childs Name: Date:








Draw a happy face or place a sticker in a box, each time your child successfully uses the potty. Use the space below to write down rewards and goals:

Teething Chart
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Babys Name: My First Tooth (Date)

Cut and Paste Your Childs Photo Here

My F irst Tooth!

Cut and Paste Your Childs Photo Here

My New Smile!
Write the date of arrival for every new tooth, for a record of your bright new smile! Notes: