my birth plan

Topics: Childbirth, Obstetrics, Midwifery Pages: 3 (442 words) Published: November 29, 2013
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 No

If yes, midwife’s name: Midwife’s phone number:

Would you like your birthing partner(s) to be with you throughout labour? YesNot necessarily

What position would you like to be in for the birth?
StandingSquattingKneeling SittingIn bedSide lying Birth stoolBirth ballWater birth Other: How would you like the atmosphere in the room?
QuietLow lightingMusic/radio playing in the background
Other: (please specify)
If possible, would you prefer to be cared for and delivered by a woman? Yes NoI 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 NoI don’t mind

Pain relief

Would you like any pain relief?
Yes NoWould like to be advised by midwife
As little as possibleI’d like to decide at the time

What pain relief would you like?
Entonox (gas & air) Pethidine I don’t mind TENS EpiduralBirthing pool Alternative therapy i.e. massage, aromatherapy:


Assisted delivery

If an assisted delivery is necessary, which method would you prefer? Ventouse ForcepsWill allow midwife / obstetrician to make choice

How do you feel about an episiotomy if required?
Only if necessaryI’d like to avoid having one

After the birth

Would you like your partner to cut the umbilical cord?
Yes No

Would you like your baby put straight onto your tummy or cleaned up first? Onto my tummyCleaned up first

Would you like to be told the sex of your baby?
Yes No, I want to make the discovery myself
I already know the sex of my babyI would like my partner to tell me

How would you like the placenta to be delivered?...
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