How To Quickly And Easily Create A Birth Plan With A Template

Hypnobirthing Birth Plan

Amy Johnson – Due Date: 12 December

I have put together a simple birth plan. I would appreciate your effort to accommodate our wishes. However, we do understand that emergencies happen, complications arise, and therefore all our request may not be possible.

Labor

 Please let us know when we can take photos and videos;

 We are a hypnobirthing family;

 Please do not offer pain medication, do not assess my pain levels, or ask about my pain. If I need pain relief, I will ask for it;

 If possible, please keep the room warm and dimly lit;

 After a 20-minute NST strip, please allow intermittent monitoring and permission to walk in the room;

 Please allow me to labor down to crowning;

 If no antibiotic risk factors are present, I decline antibiotics from unknown GBS status I want to follow the CDC guidelines for intrapartum unknown GBS;

Delivery

 I do not wish to have students or extra people in the room;

 I wish to keep the lights dim if possible;

 I wish to keep the room as quiet as possible;

 I prefer no forced pushing or counting to 10 while pushing. Please allow me to do this my own way;

 Please allow for restitution, and do not pull my baby out. Allow me to push my baby out;

 Please offer warm perineal compresses;

 I do not wish to have an episiotomy, perineal massage or perineal ironing;

 If shoulder dystocia is suspected, please let me get on my hands and knees;

 Please allow me to birth in a position other than lithotomy, if that is working well;

 Please put my baby directly on my chest, skin to skin;

 Please delay cord clamping until the cord has stopped pulsating so that she gets all of her stem cells and blood volume.

 My husband would like to cut the cord;

 I do not have gonorrhea or chlamydia, so please do not administer erythromycin eye ointment;

 Please allow my baby to stay skin to skin and in my arms, instead of the warmer;

 Please do not add chemicals to the placenta and do not send it to pathology we would like to take it home with us.

Postpartum Care

 Please put us in a room with a sofa or roll-away bed for my husband to sleep on;

 I will breastfeed exclusively;

 Please keep my baby in the room with me;

 We decline a septic workup on the baby for unknown GBS status;

 I would like to request an early discharge if both my baby and I are stable. Thank you for sharing the birthing experience with us.