Hospital birthing plan

Sample Birth Plan | ACOG

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A birth plan is a written outline of what you would like to happen during labor and delivery. This plan lets your obstetrician–gynecologist (ob-gyn) know your wishes for your labor and delivery.

Go over your plan with your ob-gyn well before your due date. But keep in mind that having a birth plan does not guarantee that your labor and delivery will go according to that plan. Unexpected things can happen.

Remember that you and your ob-gyn have a common goal: the safest possible delivery for you and your baby. A birth plan is a great starting point, but you should be prepared for changes as the situation dictates.

Your name:
Name of your ob-gyn:
Name of your baby's doctor:
Type of childbirth preparation:

Labor

Choose as many as you wish:
[ ] I would like to be able to move around as I wish during labor.
[ ] I would like to be able to drink fluids during labor.

I prefer:
[ ] An intravenous (IV) line for fluids and medications
[ ] A heparin or saline lock (this device provides access to a vein but is not hooked up to a fluid bag)
[ ] I don't have a preference

I would like the following people with me during labor (check hospital or birth center policy on the number of people who can be in the room):
_________________________________________
_________________________________________
_________________________________________
_________________________________________
It's OK [ ] /not OK [ ] for people in training (such as medical students or residents) to be present during labor and delivery.

I would like to try the following options if they are available (choose as many as you wish):
[ ] A birthing ball
[ ] A birthing stool
[ ] A birthing chair
[ ] A squat bar
[ ] A warm shower or bath during labor. I understand that a bath would be used only for the first stage of labor, not during delivery.

Anesthesia Options

Choose one:
[ ] I do not want anesthesia offered to me during labor unless I specifically request it.
[ ] I would like anesthesia. Please discuss the options with me.
[ ] I do not know whether I want anesthesia. Please discuss the options with me.

Delivery

I would like the following people with me during delivery (check hospital or birth center policy):
_________________________________________
_________________________________________
_________________________________________
_________________________________________

[ ] I prefer to avoid an episiotomy unless it is necessary.
[ ] I have made prior arrangements for storing umbilical cord blood.

For a vaginal birth, I would like (choose as many as you wish):
[ ] To use a mirror to see the baby's birth
[ ] For my labor partner to help support me during the pushing stage
[ ] For the room to be as quiet as possible
[ ] For one of my support people to cut the umbilical cord
[ ] For the lights to be dimmed
[ ] To be able to have one of my support people take a video or pictures of the birth. (Note: Some hospitals have policies that prohibit videotaping or taking pictures. Also, if it is allowed, the photographer needs to be positioned in a way that does not interfere with medical care.)
[ ] For my baby to be put directly onto my chest immediately after delivery
[ ] To begin breastfeeding my baby as soon as possible after birth

In the event of a cesarean delivery, I would like the following person to be present with me:
_________________________________________

[ ] I would like to see my baby before my baby is given eye drops.
[ ] I would like one of my support people to hold the baby after delivery if I am not able to.
[ ] I would like one of my support people to go with my baby to the nursery.
[ ] I would like my support person to know what shots my newborn will receive.

Baby Care Plan

Feeding the Baby
I would like to (check one):
[ ] Breastfeed exclusively
[ ] Bottle-feed
[ ] Combine breastfeeding and bottle-feeding
It's OK to offer my baby (check as many as you wish):
[ ] A pacifier
[ ] Sugar water
[ ] Formula
[ ] None of the above

Nursery and Rooming-In
If available at my hospital or birth center, I would like my baby to stay (check one):
[ ] In my room with me at all times
[ ] In my room with me except when I am asleep
[ ] In the nursery but be brought to me for feedings
[ ] I don't know yet. I will decide after the birth.

Circumcision
[ ] If my baby is a boy, I would like him circumcised at the hospital or birth center.

HT001

Last updated: August 2022

Last reviewed: January 2021

This information is designed as an educational aid for the public. It offers current information and opinions related to women's health. It is not intended as a statement of the standard of care. It does not explain all of the proper treatments or methods of care. It is not a substitute for the advice of a physician. Read ACOG’s complete disclaimer.

The Bump Birth Plan Tool

While much of what happens during delivery is way beyond your (or anyone’s!) control, creating a birth plan will at least make your wishes clear. Definitely talk the plan over with your doctor—it’s important to make sure you’re both on the same page.

Read on for a checklist of things to consider when creating a birth Plan, and download The Bump Birth Plan form below. Remember that the options included on The Bump plan may not be available with every doctor or birthing center.

Birth Plan:

[ ] Full name: [ ] Partner’s name: [ ] Today’s date: [ ] Due date: OR Induction date: [ ] Doctor’s name: [ ] Hospital name:

Please note that I:
[ ] Have group B strep
[ ] Am Rh incompatibility with baby
[ ] Have gestational diabetes

My delivery is planned as:
[ ] Vaginal
[ ] C-section
[ ] Water birth
[ ] VBAC

I’d like…:
[ ] Partner:
[ ] Parents:
[ ] Other children:
[ ] Doula:
[ ] Other:
…present before AND/OR during labor

During labor, I’d like:
[ ] Music played (I will provide)
[ ] The lights dimmed
[ ] The room as quiet as possible
[ ] As few interruptions as possible
[ ] As few vaginal exams as possible
[ ] Hospital staff limited to my own doctor and nurses (no students, residents or interns present)
[ ] To wear my own clothes
[ ] To wear my contact lens the entire time
[ ] My partner to film AND/OR take pictures
[ ] My partner to be present the entire time
[ ] To stay hydrated with clear liquids and ice chips
[ ] To eat and drink as approved by my doctor

I’d like to spend the first stage of labor:
[ ] Standing up
[ ] Lying down
[ ] Walking around
[ ] In the shower
[ ] In the bathtub

I’m not interested in:
[ ] An enema
[ ] Shaving of my pubic area
[ ] A urinary catheter
[ ] An IV, unless I’m dehydrated (and a heparin or saline lock IS/IS NOT ok)

I’d like fetal monitoring to be:
[ ] Continuous
[ ] Intermittent
[ ] Internal
[ ] External
[ ] Performed only by Doppler
[ ] Performed only if the baby is in distress

I’d like labor augmentation:
[ ] Performed only if baby is in distress
[ ] First attempted by natural methods such as nipple stimulation
[ ] Performed by membrane stripping
[ ] Performed with prostaglandin gel
[ ] Performed with Pitocin
[ ] Performed by rupture of the membrane
[ ] Performed by stripping of the membrane
[ ] Never to include an artificial rupture of the membrane

For pain relief, I’d like to use:
[ ] Acupressure
[ ] Acupuncture
[ ] Breathing techniques
[ ] Cold therapy
[ ] Demerol
[ ] Distraction
[ ] Hot therapy
[ ] Hypnosis
[ ] Massage
[ ] Meditation
[ ] Reflexology
[ ] Standard epidural
[ ] TENS
[ ] Walking epidural
[ ] Nothing
[ ] Only what I request at the time
[ ] Whatever is suggested at the time

During delivery, I would like to:
[ ] Squat
[ ] Semi-reline
[ ] Lie on my side
[ ] Be on my hands and knees
[ ] Stand
[ ] Lean on my partner
[ ] Use people for leg support
[ ] Use foot pedals for support
[ ] Use a birth bar for support
[ ] Use a birthing stool
[ ] Be in a birthing tub
[ ] Be in the shower

I will bring a:
[ ] Birthing stool
[ ] Birthing chair
[ ] Squatting bar
[ ] Birthing tub

As the baby is delivered, I would like to:
[ ] Push spontaneously
[ ] Push as directed
[ ] Push without time limits, as long as the baby and I are not at risk
[ ] Use a mirror to see the baby crown
[ ] Touch the head as it crowns
[ ] Let the epidural wear off while pushing
[ ] Have a full dose of epidural
[ ] Avoid forceps usage
[ ] Avoid vacuum extraction
[ ] Use whatever methods my doctor deems necessary
[ ] Help catch the baby
[ ] Let my partner catch the baby

I would like an episiotomy:
[ ] Used only after perineal massage, warm compresses and positioning
[ ] Rather than risk a tear
[ ] Not performed, even if it means risking a tear
[ ] Performed only as a last resort
[ ] Performed as my doctor deems necessary
[ ] Performed with local anesthesia
[ ] Performed by pressure, without local anesthesia
[ ] Followed by local anesthesia for the repair

Immediately after delivery, I would like:
[ ] My partner to cut the umbilical cord
[ ] The umbilical cord to be cut only after it stops pulsating
[ ] To bank the cord blood
[ ] To donate the cord blood
[ ] To deliver the placenta spontaneously and without assistance
[ ] To see the placenta before it is discarded
[ ] Not to be given Pitocin/oxytocin

If a C-section is necessary, I would like:
[ ] A second opinion
[ ] To make sure all other options have been exhausted
[ ] To stay conscious
[ ] My partner to remain with me the entire time
[ ] The screen lowered so I can watch baby come out
[ ] My hands left free so I can touch the baby
[ ] The surgery explained as it happens
[ ] An epidural for anesthesia
[ ] My partner to hold the baby as soon as possible
[ ] To breastfeed in the recovery room

I would like to hold baby:
[ ] Immediately after delivery
[ ] After suctioning
[ ] After weighing
[ ] After being wiped clean and swaddled
[ ] Before eye drops/ointment are given

I would like to breastfeed:
[ ] As soon as possible after delivery
[ ] Before eye drops/ointment are given
[ ] Later
[ ] Never

I’d like my family members (NAMES):
[ ] To join me and baby immediately after delivery
[ ] To join me and baby in the room later
[ ] Only to see baby in the nursery
[ ] To have unlimited visiting after birth

I’d like baby’s medical exam and procedures:
[ ] Given in my presence
[ ] Given only after we’ve bonded
[ ] Given in my partner’s presence
[ ] To include a heel stick for screening tests beyond the PKU
[ ] To include a hearing screening test
[ ] To include a hepatitis B vaccine

Please don’t give baby:
[ ] Vitamin K
[] Antibiotic eye treatment
[ ] Sugar water
[ ] Formula
[ ] A pacifier

I’d like baby’s first bath given:
[ ] In my presence
[ ] In my partner’s presence
[ ] By me
[ ] By my partner

I’d like to feed baby:
[ ] Only with breastmilk
[ ] Only with formula
[ ] On demand
[ ] On schedule
[ ] With the help of a lactation specialist

I’d like baby to stay in my room:
[ ] All the time
[ ] During the day
[ ] Only when I’m awake
[ ] Only for feeding
[ ] Only when I request

I’d like my partner:
[ ] To have unlimited visiting
[ ] To sleep in my room

If we have a boy, circumcision should:
[ ] Be performed
[ ] Not be performed
[ ] Be performed later
[ ] Be performed with anesthesia
[ ] Be performed in the presence of me AND/OR my partner

As needed post-delivery, please give me:
[ ] Extra-strength acetaminophen
[ ] Percoset
[ ] Stool softener
[ ] Laxative

After birth, I’d like to stay in the hospital:
[ ] As long as possible
[ ] As briefly as possible

If baby is not well, I’d like:
[ ] My partner and I to accompany it to the NICU or another facility
[ ] To breastfeed or provide pumped breastmilk
[ ] To hold him or her whenever possible

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Birth plan | Articles by doctors of the EMC clinic about diseases, diagnosis and treatment

Soon you will have to draw up a detailed plan of childbirth together with your doctor.

Unfortunately, not always the expectant mother can participate in the planning of childbirth. As a rule, in most clinics, the sole decision is made by the obstetrician-gynecologist and all objections and wishes are rarely taken into account.

However, choosing the clinic where your baby will be born and the doctor who will help him to be born, you, of course, are already planning your ideal birth. It is our deep conviction that in order for the birth to go the way you want, even with the amendments and adjustments that life can make, first of all, we must hear the expectant mother and her wishes. nine0005

What do we mean by the birth plan and how it happens, - says the head of the EMC Perinatal Center prof. Natalia Kan.

What should be in the birth plan?

The first thing that the doctor evaluates is the possibility of having a baby through the natural birth canal. The size of the fetus, its location, the characteristics of the pelvis, and whether there are any aggravated factors in the form of somatic or obstetric pathology are taken into account. For us, the most important thing is the health of the mother and her unborn baby, even minimal risks must be taken into account. If a woman in labor has strict indications for a planned caesarean section, the doctor will discuss in detail all the risks that may be if you choose a different method, tell you why operative delivery is required. For example, with complete placenta previa, the doctor adds measures to prevent possible risks to the plan. nine0005

Most cases involve vaginal delivery or elective caesarean section. Then we provide all the possibilities for the imagination of future parents: do they want to be together in the birth unit, do they need to dim the lights, what music should be played, perhaps the woman wants to call her doula for childbirth or ease the contractions in the water, will the husband be present in the operating room and take the child first.

When drawing up a birth plan, the doctor and the patient discuss the possibility of inducing labor, the use of anesthesia, pain relief after cesarean, the ability to cut the umbilical cord and much more. nine0005

When is the best time to schedule a birth?

As a rule, at 36 weeks, so that the obstetrician-gynecologist has the most complete clinical picture based on the history of the course of pregnancy and the collected examination data.

What to do if things don't go according to plan?

Of course it could be. For example, during EP, situations may arise that cannot always be predicted in advance: acute fetal hypoxia, discoordination of labor, etc. In this case, the birth plan may change. In EMC, in such situations, the delivery room in a few seconds turns into an operating room with all the equipment necessary for the operation, but at the same time, all the wishes of the woman, which can be realized during operative delivery, will be taken into account. nine0005

We do our best to ensure that the birth of a woman takes place as calmly and safely as possible. Therefore, when drawing up a birth plan, we always take into account any wishes of a woman, if they do not contradict the safety of the mother and baby.

With us you will be calm and safe.

CHOOSE A DOCTOR FOR BIRTH | City Clinical Hospital. F.I. Inozemtseva

Nobody likes the unknown. She frightens us, but in childbirth this is not at all necessary: fear intensifies pain and spends more strength. So you should use every opportunity to create a pleasant and familiar environment for yourself during childbirth. And you need to start by getting to know the doctor who will take delivery. True, there is one nuance here: a personal doctor is possible only during contractual childbirth. nine0005

Determine the criteria

Before looking for a doctor, the expectant mother must decide how she sees her birth and what, in fact, she wants from the doctor? Does she want to give birth as naturally as possible or does she agree to some kind of intervention? Maybe the woman is set up for a vertical birth or is planning to spend the first stage of labor in some other way (for example, in a bath)? Does she expect active help from the doctor or does she only want observation and non-interference in the birth process? You can draw up a whole birth plan for yourself, in which you write all your wishes, doubts and questions. And only having understood something about your childbirth and about what kind of help is expected from a doctor, you can start looking for a specialist who will help to carry out all this. nine0005

Where can I find it?

Ideally, if the same doctor will manage the pregnancy and delivery. This is possible only in large medical clinics or in maternity hospitals, which have their own consultation centers. For nine months of constant communication, the doctor and the expectant mother will become, if not friends, then close acquaintances for sure. A woman will trust her doctor, and he will know all the features of her body, as well as the state of health and even the nature of her unborn baby. nine0049 But you can choose a doctor and immediately before childbirth, they sign a contract already from the 36th week of pregnancy. We advise you not to postpone the acquaintance, you need to meet with the doctor at least a few times to make sure how you fit each other. Indeed, sometimes the first impression is deceptive, and it will be too late to change the doctor during childbirth.

List of doctors and midwives for concluding a contract for childbirth in the maternity hospital at the GKB im. FI Inozemtseva on Fortunatovskaya street

F. I. Inozemtseva on Upper Pervomaiskaya Street

Who will help you find a doctor?

Probably the first thing that pregnant women look for when looking for a doctor is the reviews of friends and acquaintances who have already given birth, the so-called word of mouth. This is convenient: you can directly ask a young mother a bunch of questions, at the same time get yourself a first impression of the doctor - is this the person you need. Still, of course, you can read reviews on the Internet, but here it is difficult to count on reliability. After all, it is impossible to understand through the screen what kind of person is talking about the doctor, it is likely that his preferences will be very far from yours. Well, already having come to the clinic or maternity hospital, you can additionally ask for advice there. In the department where the contract for the management of pregnancy or childbirth is concluded, there are always specialists who will help you choose a doctor, taking into account the preferences of the expectant mother, and not even one. Well, then it remains only to go to get acquainted with the doctor. nine0005

First meeting

At the first meeting, in addition to any medical aspects, one should also pay attention to the character of the doctor. Some women need a kind doctor, others a strict one. Someone would prefer a talkative doctor, and someone - a laconic one. There are mothers who feel good with a cheerful person, while others need a serious specialist. All this is also important, because a woman should feel comfortable in the company of her doctor, she needs to establish contact with him. If the expectant mother takes her husband with her to the birth, then his opinion will also be important here, because then three people will already interact in childbirth. Therefore, it is necessary to come to the first meeting with the future dad. nine0049 There is one more thing - the doctor will also evaluate the couple with whom he will then have to work, so you need to take into account that he should also be comfortable with future parents.

We pay attention

Next, we look at whether the doctor is positive? Yes, there are doctors who immediately see a problem in every complaint, not a solution, expect the worst, and even voice their concerns to the expectant mother. You need to part with such a doctor, because how pregnancy and childbirth will proceed depends largely on the psychological mood of the mother. And where can I get it if the doctor scares the woman all the time? nine0049 The doctor should also be friendly to the expectant mother and take into account her opinion.

Important little things

Discuss with the doctor all the points that concern you: how to call him for childbirth, what time he will arrive, whether he will be on vacation and whether he will leave the city.