Worksheet For Birthing Plan

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A birthing plan is a document that instructs your medical team about your labor, delivery, and postpartum preferences. Many hospitals provide a birth plan worksheet, template, or brochure to explain policies, the birth process, and what options you have.

The thing about plans, is that they can change at any moment, especially when it comes to labor. However, it’s still best to be prepared for what you’re getting into, and be well informed if the plan should change.

Some things to consider when writing your birth plan:
At what point in labor would you like to go to the hospital?
Who do you want to be present?
Would you like a doula?
Will there be family or friends present?
Would you like to move around or would you like to stay in bed?
…show more content…
Do you have a preference for certain pain medications?
Would you be willing to have an episiotomy? Or, are there certain measures you want to use to avoid one?
Use of vacuum extraction or forceps for assisted delivery?
Would you like a mirror when the baby is crowning?
When would you like to hold baby?
After delivery, after suctioning, after weighing, after being wiped clean and swaddled, before eyedrops or ointment are given?
What are your preferences for your baby’s care?
When to feed, where to sleep, when to cut the cord, cord blood banking?
Do you want a routine IV, a heparin/saline block, or neither?
Would you like to wear your own clothing?
Would you like to listen to music?
Would you like the lights dim?
Would you like to use a camera for photos or video?
Would you like to use a bathtub or shower?
For home and birth center births, what are your plans for hospital transport in case of emergency?
If you need a cesarean, do you have any special requests?
As you learn more about the birthing process, take notes, and determine which options you would are best for you and baby. Talk to your healthcare provider so see if she agrees with your birth plan preferences. When the time comes, be sure to print out several copies for your medical team. And remember, that sometimes these things don’t always go as planned, but it’s OK, because you will now be prepared and

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