Thread: Birth plans
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Old 05-04-2006, 06:09 PM   #3
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Re: Birth plans

Birth Plan Worksheet

When writing your own Birth Plan, keep the following points in mind.

1. A Birth Plan should not come across as being an order to the medical staff. Keep it as friendly as you can.

2. Your Birth Plan should be no longer than one page. A medical staff member should be able to quickly look at the paper and get a good understanding of where you are coming from.

3. Make it personal. Mention a procedure you definitely want to avoid, or a major fear you might have.

4. Don't get too detailed. Understand that some things, such as totally avoiding electronic fetal monitoring in a hospital setting, is practically impossible. Be willing to compromise. For example, you might agree to intermittent fetal monitoring.

5. Put your desires in bulleted form. This makes everything easy to read and understand.


Mother's Name:
Support Person/People:
Place of Delivery:

Introduction: This should be a brief statement saying something about your general goal for your birth experience, including any fears you have or any interventions you definitely want to avoid. If you have had any complications during your pregnancy that may affect your labor or your outlook on labor, you may include that here.

Here are my/our main preferences for this birth experience:

v Point number one

v Point number two

v Point number three

v Point number four

In the case of an emergency cesarean birth, I/we would like these wishes to be honored:

v Point number one

v Point number two

v Point number three

I/We would like to thank you in advance for respecting our wishes. We will forever remember this experience.
Zona:mom to 10
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