My birth plan
Your first name:
Your surname: Name I like to be called i.e Catherine = Cathy: Your birthing companion’s name(s):
Your due date:
Is there a particular midwife you would like to be there if she / he is available? Yes
If yes, midwife’s name: Midwife’s phone number:
Would you like your birthing partner(s) to be with you throughout labour? Yes
What position would you like to be in for the birth?
Side lying Birth stool
Water birth Other: How would you like the atmosphere in the room?
Music/radio playing in the background
Other: (please specify)
If possible, would you prefer to be cared for and delivered by a woman? Yes
I don’t mind
Student midwives or medical students can provide invaluable support to parents during labour. If possible, are you happy to have them present at the birth? Yes
I don’t mind
Would you like any pain relief?
Would like to be advised by midwife
As little as possible
I’d like to decide at the time
What pain relief would you like?
Entonox (gas & air)
I don’t mind TENS
Birthing pool Alternative therapy i.e. massage, aromatherapy:
If an assisted delivery is necessary, which method would you prefer? Ventouse
Will allow midwife / obstetrician to make choice
How do you feel about an episiotomy if required?
Only if necessary
I’d like to avoid having one
After the birth
Would you like your partner to cut the umbilical cord?
Would you like your baby put straight onto your tummy or cleaned up first? Onto my tummy
Cleaned up first
Would you like to be told the sex of your baby?
No, I want to make the discovery myself
I already know the sex of my baby
I would like my partner to tell me
How would you like the placenta to be delivered?...
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