Free Post Birth Plan

The creator of this birth plan is [YOUR NAME]. This person's contact email is: [YOUR EMAIL].

I. General Information

Birth Details

• Parent's Full Name: [PARENT'S FULL NAME]

• Partner's Full Name (if applicable): [PARTNER'S FULL NAME]

• Due Date: [DUE DATE]

• Healthcare Provider's Name: [HEALTHCARE PROVIDER'S NAME]

• Preferred Birth Location: [PREFERRED BIRTH LOCATION]

• Contact Number: [CONTACT NUMBER]

• Alternate Contact Number: [ALTERNATE CONTACT NUMBER]

Support Team

• Partner's Name: [PARTNER'S NAME]

• Doula's Name (if applicable): [DOULA'S NAME]

• Other Support Persons: [OTHER SUPPORT PERSONS]

II. Immediate Post-Birth Preferences

Skin-to-Skin Contact

• Preferred duration: [PREFERRED DURATION]

• First skin-to-skin with: [NAME OF PARENT]

Initial Breastfeeding

• Preferred: [YES/NO]

• Assistance Required: [YES/NO]

• Alternate feeding method if necessary: [BOTTLE-FEEDING/FORMULATED MILK]

III. Baby’s Medical Care

Cord Care

• Delayed Cord Clamping: [YES/NO]

• Cord Blood Banking: [YES/NO]

Vitamin K Injection

Administer: [YES/NO]

Eye Ointment

Administer: [YES/NO]

IV. Mother’s Post-Birth Care

Pain Relief

Preferred Methods:

• Oral medication: [ORAL MEDICATION PREFERENCE]

• medication: [IV MEDICATION PREFERENCE]

Breastfeeding Support

Consultation with Lactation Specialist: [YES/NO]

Rest and Recovery

• Preferred Quiet Time: [PREFERRED QUIET TIME]

• Visitation Preferences: [VISITATION PREFERENCES]

V. Additional Notes

Any other specific instructions or preferences: [ANY OTHER SPECIFIC INSTRUCTIONS OR PREFERENCES]

VI. Emergency Situations

C-Section Birth: [PREFERRED PROCEDURES/CONTACTS]

Emergency Contacts:

• Contact 1: [CONTACT 1 NAME AND NUMBER]

• Contact 2: [CONTACT 2 NAME AND NUMBER]

Thank you for respecting our wishes and supporting us during this significant and exciting time!

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