Basic Birth Plan
BASIC BIRTH PLAN
Prepared By: [Your Name]
Contact Email: [Your Email]
I. Introduction
We are looking forward to the birth of our baby and have created this birth plan to communicate our preferences and needs during labor and delivery. We understand that situations may arise that require flexibility, and we trust our healthcare team to provide the best possible care for us and our baby.
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Due Date: [Due Date]
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Primary Healthcare Provider: [Primary Healthcare Provider's Name]
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Preferred Hospital/Birth Center: [Preferred Hospital/Birth Center Name]
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Support Team: [Support Team Members' Names]
II. Labor Preferences
A. Environment
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Room Preferences
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Dim lighting
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Quiet room with minimal interruptions
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Use of personal music playlist
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Allowed Visitors
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Partner: [Partner's Name]
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Doula: [Doula's Name]
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Other: [Additional Support Person's Name]
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B. Mobility
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Preference to move freely and change positions as needed
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Use of birthing ball, squat bar, or other supportive equipment
C. Pain Management
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Non-Medical Pain Relief
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Breathing techniques
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Massage
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Warm bath/shower
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Medical Pain Relief
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Open to epidural anesthesia
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Use of nitrous oxide if available
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III. Delivery Preferences
A. Delivery Position
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Preference for upright positions, such as squatting or on all fours
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Open to suggestions from the healthcare team
B. Episiotomy
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Prefer to avoid unless absolutely necessary
C. Immediate Post-Birth
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Immediate skin-to-skin contact with baby
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Delay cord clamping for at least 1-2 minutes
IV. Newborn Care
A. Initial Procedures
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Delay all non-essential procedures until after bonding time
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Baby to stay in the same room as parents at all times
B. Feeding
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Plan to breastfeed exclusively
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Support from lactation consultant if needed
C. Vaccinations and Tests
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Administration of Vitamin K shot
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Newborn screening tests as recommended
V. Special Considerations
A. Allergies and Medical Conditions
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[Allergy/Medical Condition 1]
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[Allergy/Medical Condition 2]
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[Allergy/Medical Condition 3]
B. Other Preferences
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Open to discussing any necessary medical interventions
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Partner to cut the umbilical cord
VI. Emergency Plan
A. In Case of Cesarean Section
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Partner to be present in the operating room
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Skin-to-skin contact as soon as possible
B. Postpartum Care
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Support for immediate and continuous breastfeeding
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Assistance with mobility and recovery
VII. Contact Information
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Expectant Mother: [Your Name]
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Email: [Your Email]
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Phone Number: [Your Phone Number]
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Partner: [Partner's Name]
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Email: [Partner's Email]
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Phone Number: [Partner's Phone Number]
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Primary Healthcare Provider: [Primary Healthcare Provider's Name]
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Phone Number: [Healthcare Provider's Phone Number]
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Doula: [Doula's Name]
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Phone Number: [Doula's Phone Number]
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Thank you for respecting our wishes and helping us have a positive and empowering birth experience.
