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Birth Plan Template

Alina
July 3rd, 2024
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A birth plan is a document that outlines your preferences for labor and delivery, including details such as where you plan to give birth, who you want on your medical team, pain relief options, and any special requests you may have.

Using a birth plan template offers numerous benefits, such as providing a structured framework to organize your preferences, guiding discussions with your healthcare provider, and serving as a reference during labor. It can help you consider various scenarios and options, making it easier to adapt to changing circumstances during childbirth.

What to Include in Your Birth Plan Template

Include details such as any specific medical conditions, allergies, or previous birth experiences that may impact your childbirth choices. Your birth plan checklist should be a comprehensive document that addresses all aspects of your anticipated childbirth journey.

It’s also important to include information about what should happen in the event of unexpected complications or emergencies during labor and delivery. Discuss these scenarios with your healthcare provider and midwife so that everyone is prepared and knows how to proceed if the need arises.

Personal Information

Provide essential details about yourself. This will help avoid any confusion and ensure they can contact the right people if needed.

Full name;
Date of birth;
Contact information (phone number, email address);
Name of healthcare provider;
Partner’s or support person’s contact information;
Relevant medical history or allergies;
Hospital or birth center name.

Labour Preferences

Detail your preferences for labor, including how long you want to stay at home, pain relief options, and the type of support you prefer from your healthcare providers.

Labor at home as long as possible;
Use of pain relief medications;
Hands-on or hands-off approach from healthcare providers;
A preferred method for monitoring the baby’s heartbeat;
Positions or activities for managing labor pain (walking, birthing ball, warm bath);
Who should be in the birth room during labor;
Ambiance preferences (dim lighting, music).

Delivery Preferences

Outline your preferences for the delivery process, such as positions for labor and delivery, who should be present, and the birth environment.

Desired position for labor and delivery (squatting, lying on the side, using a birthing stool);
Who should be present in the delivery room;
Partner or support person cutting the umbilical cord;
Delayed cord clamping;
Immediate skin-to-skin contact;
Preferences for a natural or waterbirth;
Comfortable birth environment.

Pain Management

Specify how you want to manage pain during labor, whether through natural methods or with medications.

Natural techniques (breathing exercises, massage);
Openness to pain relief medication;
Avoidance of certain medications or interventions;
Alternative pain relief methods (acupuncture, aromatherapy);
Use of birthing tools (birthing ball, TENS machine);
Comfort level with epidurals and nitrous oxide;
Information on all pain relief options during labor.

Interventions

State your preferences regarding medical interventions during labor and delivery, including what you wish to avoid and under what circumstances.

Preferences for medical interventions (episiotomies, assisted delivery methods like forceps or vacuum, labour-inducing drugs);
Avoidance of specific interventions unless necessary;
Consultation before any intervention;
Handling of stalled labor;
Use of pitocin for induction or augmentation;
Concerns or previous experiences influencing decisions.

Newborn Care

Detail your preferences for newborn care immediately after birth, including feeding plans and initial procedures.

Delayed cord clamping;
Immediate skin-to-skin contact;
Feeding plans (breastfeeding, formula-feeding);
Delay of routine procedures (weighing, measuring);
Declining certain procedures or medications for newborns (vitamin K shot, eye ointment);
Rooming in with the baby;
Special feeding instructions.

Postpartum Preferences

Describe your care preferences after birth, including support and recovery plans to ensure a smooth postpartum experience.

Immediate skin-to-skin contact;
Timing for starting breastfeeding;
Limiting visitors for rest and bonding;
Postpartum support needed (lactation consultant visits);
Postpartum pain management;
Concerns about postpartum depression or anxiety;
Dietary preferences or restrictions during a hospital stay.

Emergency Situations

Prepare for emergencies by outlining your preferences for handling complications, and ensuring your wishes are respected even in urgent situations.

Preferences for cesarean section or other interventions in case of complications;
Being fully informed and consulted about emergency decisions;
Anesthesia preferences for a C-section;
Partner or support person present in the operating room;
Concerns or previous experiences affecting preferences;
Steps to ensure comfort and understanding during an emergency.

Additional Requests

Include any other important considerations to make your birth experience as comfortable and personalized as possible.

Cultural or religious preferences;
Preferences for the gender of healthcare providers;
Incorporation of cultural or religious rituals;
Use of comfort items (favorite pillow, blanket);
Environmental preferences (quiet room, specific music);
Other special instructions or considerations.

Signatures

Finalize your plan with signatures to ensure all parties are in agreement and understand your preferences.

Space for your signature;
Space for healthcare provider’s signature;
Space for a birth partner or support person’s signature;
Copies for personal records and hospital/birth center.

Remember to be flexible and open to changes, as childbirth can be unpredictable. Communication with your healthcare team is key, so don’t hesitate to discuss any concerns or questions you may have as you prepare for this important event.

FAQ

Can a birth plan be handwritten?

Yes, it can be handwritten. The most important thing is that it is clear and easy to understand. Whether it’s typed or handwritten, it should detail your preferences for labor, delivery, and postpartum care.

When do you start making a birth plan?

It’s generally recommended to start making a birth plan during your second trimester, around 28-30 weeks of pregnancy. This gives you ample time to research your options, discuss them with your healthcare provider, and make any necessary adjustments.

What is the golden hour after birth?

The “golden hour” refers to the first hour immediately following the birth of your baby. This is a crucial time for mother and baby to bond and initiate breastfeeding. Skin-to-skin contact during this period can help regulate the baby’s temperature, heart rate, and breathing, and promote maternal-infant bonding and breastfeeding success.

What is a natural birth plan?

A natural birth plan outlines your desire to have a drug-free labor and delivery. This might include preferences such as laboring at home for as long as possible, avoiding the use of epidurals or other medications, using natural pain relief methods (like breathing exercises, water immersion, and massage), and having minimal medical interventions. It may also specify a preference for a vaginal delivery without the use of forceps or vacuum extraction.

What can you refuse during labor?

During labor, you have the right to refuse certain procedures or interventions. These may include:

Epidural or other pain relief medications;
Continuous electronic fetal monitoring;
Routine IV fluids;
Episiotomy;
Forceps or vacuum-assisted delivery;
Cesarean section, unless medically necessary.

What to wear during labor?

What you wear during labor is largely up to you and what makes you feel most comfortable. Options include:

A hospital gown (typically provided by the hospital or birthing center);
A loose-fitting nightgown or oversized T-shirt;
A birthing wrap or robe;
Comfortable, easy-to-remove clothing.

Do you wear a bra in labor?

Wearing a bra during labor is a personal choice and largely depends on your comfort level. Some women prefer to wear a comfortable, non-restrictive sports bra or nursing bra for added support during labor, particularly if they plan to have photos taken or want to maintain a bit of modesty. Others might feel more comfortable without one. If you opt to use a birthing pool or shower, consider that you might need to remove it or switch to a waterproof option.

Where can I find birth plan examples?

You can find sample birth plan templates online, in books about childbirth, or by asking your healthcare provider for guidance.

Can I change my mind about my birth plan during labor?

Yes, it’s important to remain flexible and keep an open mind. Your checklist is a guide, but you may need to make adjustments based on the circumstances or how you are feeling at the moment.