Scribd Logo
Upload

Welcome to Scribd!

  • 22 views

    Birth Plan

    Uploaded by

    Chaitanya Lanka
    This document is a birth plan for an expectant mother. It outlines her preferences for labor and delivery including who she wants as her birth partner, her desired birthing positions, use of pain relief methods, immediate skin-to-skin contact with the baby after birth, cutting of the umbilical cord, and whether she plans to breastfeed or bottle feed. It also addresses her preferences in case of unexpected situations like a C-section, special needs like medical conditions or religious requirements, and environmental factors in the delivery room.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Birth Plan

    Uploaded by

    Chaitanya Lanka
    22 views2 pages
    This document is a birth plan for an expectant mother. It outlines her preferences for labor and delivery including who she wants as her birth partner, her desired birthing positions, use of pain relief methods, immediate skin-to-skin contact with the baby after birth, cutting of the umbilical cord, and whether she plans to breastfeed or bottle feed. It also addresses her preferences in case of unexpected situations like a C-section, special needs like medical conditions or religious requirements, and environmental factors in the delivery room.

    Original Title

    birth-plan

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document is a birth plan for an expectant mother. It outlines her preferences for labor and delivery including who she wants as her birth partner, her desired birthing positions, use of pain relief methods, immediate skin-to-skin contact with the baby after birth, cutting of the umbilical cord, and whether she plans to breastfeed or bottle feed. It also addresses her preferences in case of unexpected situations like a C-section, special needs like medical conditions or religious requirements, and environmental factors in the delivery room.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    22 views2 pages

    Birth Plan

    Uploaded by

    Chaitanya Lanka
    This document is a birth plan for an expectant mother. It outlines her preferences for labor and delivery including who she wants as her birth partner, her desired birthing positions, use of pain relief methods, immediate skin-to-skin contact with the baby after birth, cutting of the umbilical cord, and whether she plans to breastfeed or bottle feed. It also addresses her preferences in case of unexpected situations like a C-section, special needs like medical conditions or religious requirements, and environmental factors in the delivery room.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    You are on page 1of 2

    Page 1 of 2

    My Birth plan

    Name: .......................................

    Due date: ....................................

    Name(s) of birth partner(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

    Contact number of birth partner(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

    What relationship are they to you? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

    Do you want your birth partner(s) to be with you at all times? Yes No

    Labour and birth positions


    Do you want to remain mobile for as long as possible? Yes No

    What birthing positions would you like to try? Kneeling Squatting Standing

    Lying down Other

    Birthing pool
    Do you want to use one if available? Yes No

    Will this be for pain relief or giving birth? Pain relief Giving birth

    Pain relief
    Do you want to use pain relief? Yes No

    What would you like to use? TENS Gas and air Pethidine Epidural Other

    What order would you like it in? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

    After the birth


    Would you like immediate skin-to-skin contact? Yes No

    Would your birth partner like to cut the cord? Yes No

    Would you like your baby to be given vitamin K? By injection Orally Not at all
    Page 2 of 2

    Delivery of the placenta


    Do you want to deliver it naturally, if possible? Yes No

    Do you want an injection to speed up the delivery? Yes No

    Feeding your baby


    Do you plan to breastfeed or bottle-feed? Breastfeed Bottle-feed Combination

    Unexpected situations
    Are you happy to have a caesarean, if necessary? Yes No

    If assisted delivery is required, which would you prefer? Forceps Ventouse Midwife’s recommendation

    Special needs
    Do you have any medical conditions or disabilities? Yes No

    If yes, please give details . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

    Do you have any particular needs? (Religious, cultural or dietary requirements.) Yes No

    If yes, please give details . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

    If English is not your first language, do you need an interpreter? Yes No

    If yes, please give details . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

    General
    Do you mind if students attend or assist at the birth? Yes No

    Other considerations
    Would you like ambient lighting in the room, if possible? Yes No

    Would you like the option of music during labour and birth? Yes No

    Would you like a commentary from your midwife on your progress? Yes No

    If you don’t know the sex of your baby, how would you like to find out? By midwife Discover myself

    Would you like your voice to be the first your baby hears? Yes Don’t mind

    You might also like