Hospital Birth Plan
Hospital Birth Plan
Prepared by: [YOUR NAME]
Contact Email: [YOUR EMAIL]
I. Introduction
A. Overview
I, [YOUR NAME], together with my support team, have created this birth plan to outline my preferences and requirements for my upcoming birth at [HOSPITAL NAME]. This plan focuses on cesarean section, including anesthesia preference, partner involvement, and immediate skin-to-skin contact with the baby.
B. Purpose
The purpose of this birth plan is to communicate my preferences and needs clearly to the medical staff and ensure that everyone is on the same page.
II. Personal Information
|
Details |
Information |
|---|---|
|
Name |
[YOUR NAME] |
|
Partner’s Name |
[PARTNER’S NAME] |
|
Due Date |
[DUE DATE] |
|
Obstetrician/Midwife |
[OBSTETRICIAN/MIDWIFE NAME] |
|
Hospital |
[HOSPITAL NAME] |
|
Contact Number |
[YOUR CONTACT NUMBER] |
|
Emergency Contact |
[EMERGENCY CONTACT NAME] |
|
|
[YOUR EMAIL] |
III. Cesarean Section Preferences
A. General Preferences
-
If a cesarean section becomes necessary, I would like to be informed of the reasons and have any questions answered before proceeding.
-
I would prefer a calm and quiet environment during the procedure.
B. Anesthesia
-
Preferred anesthesia: - [TYPE OF ANESTHESIA PREFERRED, E.G., SPINAL, EPIDURAL]
-
Please explain the anesthesia process to me and allow my partner to stay with me until the anesthesia takes effect.
C. Partner Involvement
-
I would like my partner, [PARTNER’S NAME], to be present during the cesarean section.
-
My partner should be allowed to take photographs and videos, provided it does not interfere with medical procedures.
IV. Immediate Post-Birth Preferences
A. Immediate Skin-to-Skin Contact
-
I strongly prefer immediate skin-to-skin contact with my baby following the cesarean delivery, as long as my baby is healthy.
-
If I am unable to have immediate skin-to-skin contact, I request that my partner hold the baby first.
B. Delayed Cord Clamping
-
I would like delayed cord clamping for at least 1-2 minutes after birth, provided it poses no medical risk to the baby or myself.
C. Baby's Care
-
I would like all routine newborn procedures (weighing, measuring, etc.) to be delayed until after the initial bonding period.
-
I prefer that initial checks and procedures be done in my presence, or if not possible, in my partner's presence.
V. Special Requests
A. Additional Requests
-
Please allow my doctor or midwife to provide a detailed explanation of the cesarean section process.
-
Ensure gentle handling of the baby during the procedure and reduce loud noises and bright lights.
-
Allow me to have at least one support person (in addition to my partner) if possible.
VI. Contact Information
|
Name |
Contact Information |
|---|---|
|
Partner’s Name |
[PARTNER’S CONTACT INFORMATION] |
|
Doula/Support Person |
[DOULA/SUPPORT PERSON’S NAME] |
|
Hospital Contacts |
[RELEVANT HOSPITAL DEPARTMENT CONTACTS] |
VIII. Conclusion
Thank you for taking the time to review my birth plan. By adhering to these preferences, I believe we can work together to create a positive and supportive birth experience for both myself and my baby. Your understanding and cooperation are greatly appreciated as we navigate this important event. If there are any questions or concerns, please do not hesitate to reach out to me or my support team.
I appreciate your support in making this a positive and supportive birth experience.
