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Sample Birthing Plan

Thank you for your cooperation in helping us accomplish our goal of having a
natural, unmedicated childbirth, to the extent that it is safe and viable for mother
and. Ideally, we would like to avoid all medication if possible (including, but not
limited to, Pitocin, IV, epidural, etc.). If an event should arise where medication
and/or medical intervention is needed we would like to discuss alternatives and
consequences with the medical team, have some time to discuss in private before
making our decision and be allowed to accept or refuse except in the case of
extreme emergency.
LABOR WISHES

Wed like to play music and have the option to dim the lights.
Wed like to use the following labor items/props:
o Bathtub
o Birthing stool
o Exercise ball
o Squatting chair
Wed like to be free to change positions and walk around for as long as
possible throughout active labor.
We would like to avoid an IV and excess of vaginal exams; only as and when
necessary.
Mother would like to be able to sit on the edge of the bed, a chair or birthing
ball even during fetal monitoring.

PAIN RELIEF To manage pain we plan to change positions as often as needed and
use breathing/massage techniques and the bathtub. Any other natural suggestions
from the medical team are welcomed. However, please do not offer an epidural
or other pain medication; we will request if needed.
DELIVERY

During delivery mother would like to be able to squat and use a birthing stool.
Mother would like the option to touch babys head as it crowns.
Ben would like to help catch the baby.

INTERVENTIONS

As long as mother and the baby are fine, we would like to be free of time
limitations and not have labor augmented.
Pitocin None. We ask that non-chemical induction methods be attempted
first (e.g. walking, nipple stimulation, etc.).
Forceps/Vacuum Avoid unless absolutely necessary.
Episiotomy Avoid, unless an existing tear is threatening to become severe.
Local anesthesia after birth for the repair.
1

C-Section We would like to avoid a C-Section if at all possible but


understand this may be necessary in an emergency. If a C Section is
necessary, we would like the following:
o Ben to be present at all times.
o Screen lowered a bit to see baby delivered.
o Baby to be given to mother/father to hold as soon as possible.
o Mother to attempt breastfeeding as soon as possible in the recovery
room.

POST-DELIVERY

Mother would like skin-to-skin contact with our baby immediately.


Please allow Ben to cut the umbilical cord, but only after it has stopped
pulsating.
Mother would like to breastfeed as soon as possible after birth. We hope to
breastfeed exclusively and would like to consult a lactation specialist for
breastfeeding assistance.
Per the above, please do not offer the baby formula. If there is an emergency
that requires it, we need to be consulted in advance.
Please do not offer the baby a pacifier.
Baby to remain in our room as much as possible, including during testing. If
he needs to be taken away for a procedure, please postpone as long as
possible to allow Ben to stay with him at all times.
We would like a circumcision and would like to be present for it.
We would like to give the baby his first bath, with the medical teams
assistance.

Thanks again for your support in allowing us to attempt a natural childbirth for our
first baby!

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