Birth Plan Worksheet (Page 3 of 4) in pdf

Birth Plan Worksheet Page 3

BabyCenter Birth Plan worksheet – page 3

VAGINAL BIRTH

During delivery, I'd like:

to view the birth using a mirror

to touch my baby's head as it crowns

the room to be as quiet as possible

to give birth without an episiotomy

my partner to help "catch" our baby

After birth, I'd like:

to hold my baby right away, putting off any procedures that aren't urgent

to breastfeed as soon as possible

not to get oxytocin (Pitocin) after I deliver the placenta unless it's

necessary

to wait until the umbilical cord stops pulsating before it's clamped and cut

my partner to cut the umbilical cord

C-SECTION

If I have a c-section, I'd like:

my partner present at all times during the operation

the screen lowered a bit so I can see my baby being delivered

the baby to be given to my partner as soon as he's dried, if appropriate

to breastfeed my baby in the recovery room

CORD BLOOD BANKING

I'm planning to:

donate cord blood to a public bank

bank cord blood privately

neither

POSTPARTUM

After delivery, I'd like:

all newborn procedures to take place in my presence

my partner to stay with the baby at all times if I can't be there

to stay in a private room

to have a cot provided for my partner

I'd like:

24-hour rooming-in with my baby

my baby to room-in with me only when I'm awake

my baby brought to me for feedings only

to make my decision later depending on how I'm feeling

my other children brought in to see me and meet the new baby as soon as

possible after the birth.

Birth Plan Worksheet Page 3