Free Natural Birth Plan Template

Natural Birth Plan

Prepared by: [YOUR NAME]



I. Personal Information

Name

[YOUR NAME]

Birth Partner’s Name

[PARTNER'S NAME]

Due Date

[DUE DATE]

Doctor/Midwife

[DOCTOR/MIDWIFE NAME]

Hospital/Birthing Center

[HOSPITAL/BIRTHING CENTER NAME]

Phone Number

[YOUR PHONE NUMBER]

A. Contact Information

Email Address

[YOUR EMAIL]

Address

[YOUR ADDRESS]

Emergency Contact

[EMERGENCY CONTACT INFORMATION]

B. Medical History

Allergies

[LIST ANY ALLERGIES]

Medical Conditions

[LIST ANY MEDICAL CONDITIONS]

Previous Births

[DETAILS OF ANY PREVIOUS BIRTHS]

II. Labor Preferences

A. Environment

Prefer a calm and relaxing atmosphere to enhance comfort and reduce stress.

  • Dim lighting to create a soothing environment.

  • Quiet surroundings to help maintain focus and relaxation.

  • Play calming music to support a serene ambiance.

  • Allow for movement and walking to facilitate labor progression.

  • Use birthing ball to aid in comfort and position changes.

B. People Present

Ensure support and comfort by having a familiar and minimal group of people present.

  • Birth partner present at all times for continuous support.

  • Doula: [DOULA'S NAME] for additional emotional and physical support.

  • Limited medical staff unless necessary to maintain a personal and intimate setting.

  • No students or unnecessary personnel to ensure privacy and comfort.

C. Pain Relief

opt for natural pain relief methods to manage labor pain without pharmacological interventions.

  • Breathing techniques to help manage contractions.

  • Hydrotherapy (bath/shower) for relaxation and pain relief.

  • Massage to reduce tension and discomfort.

  • Acupressure to alleviate pain and promote relaxation.

  • Avoid epidural and other pharmacological pain relief unless specifically requested.

III. Delivery Preferences

A. Pushing

Prefer to follow the body’s natural urge to push rather than directed pushing.

  • Change positions as needed to find the most effective and comfortable pushing position.

    1. Squatting to use gravity to assist with the descent of the baby.

    2. Hands and knees to relieve pressure on the back.

    3. Side-lying to rest and reduce strain.

  • Avoid directed pushing unless absolutely necessary for medical reasons.

B. Birth Position

Freedom to choose the most comfortable and effective birth position during delivery.

  • Squatting to open the pelvis and use gravity.

  • Kneeling to reduce pressure on the back.

  • Using a birthing stool for support and comfort.

C. After Birth

Prioritize immediate bonding and skin-to-skin contact with the baby.

  • Immediate skin-to-skin contact to promote bonding and regulate the baby’s temperature.

  • Delay cord clamping until it stops pulsating to ensure the baby receives maximum blood from the placenta.

  • Birth partner to cut the cord if desired to involve them in the birth process.

IV. Newborn Care

A. Immediate Post-Birth

Ensure the baby stays with the parents to foster bonding and initiate breastfeeding.

  • Baby to stay with parents at all times to encourage bonding.

  • Delay any non-essential medical procedures for the first hour to allow for uninterrupted bonding.

  • Breastfeeding as soon as possible to promote bonding and milk production.

B. Medical Procedures

Procedure

Purpose

YES

NO

Vitamin K Injection

To prevent bleeding disorders

Eye Ointment

To prevent eye infections

Hepatitis B Vaccine

For early protection against the virus

C. Other Preferences

Support exclusive breastfeeding and avoid artificial nipples.

  • No formula or pacifiers to be given to ensure successful breastfeeding.

  • Exclusive breastfeeding to support health and bonding.

V. Contingency Plans

A. Cesarean Section

Plan for a Cesarean section only if medically necessary, with preferences for a supportive environment.

  • Only if medically necessary to ensure the safety of mother and baby.

  • Birth partner present at all times to provide support.

  • Immediate skin-to-skin contact in the operating room if possible to promote bonding.

  • Breastfeeding as soon as possible after delivery to establish feeding and bonding.

B. Medical Interventions

Use medical interventions only when absolutely necessary, with clear communication and consent.

  • Use medical interventions only if absolutely necessary for the safety of mother and baby.

  • Explanation of all procedures and options before proceeding to ensure informed consent.

  • Prefer to avoid episiotomy; prefer natural tearing if it occurs to reduce recovery time and complications.

VI. Conclusion

Thank you for respecting our birth plan and supporting us during this special time. We appreciate your dedication to ensuring a safe and positive birth experience for our family. If you have any questions or need further clarification about any aspect of our plan, please feel free to discuss them with us.


"Thank you for respecting our wishes and providing excellent support during the natural birth. Your efforts during this significant moment mean a great deal to us."

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