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Create a Birth Plan




Tuesday, August 22, 2017

My Birth Plan

My Birth Plan

We are looking forward to sharing your birth experience with you. We have created this birth plan in order to outline some of your preferences for birth. We would appreciate you reviewing this plan, and would be happy to do so with you. We understand that there may be situations in which your choices may not be possible, but we hope that you will help us to move toward your goals as much as possible and to make this labor and birth a great experience. We do not want to replace the medical personnel, but instead want to be informed of any procedures in advance, and to be allowed the chance to give informed consent. Please feel free to ask if you have any questions or comments. Thank you!


General Information


Birth Philosophy


Health Notes


Before Labor


Labor Induction/Augmentation


During Labor


Anesthesia/Pain Medication


Monitoring


Preparation/Equipment


2nd Stage of Labor


Episiotomy


Delivery


Cesarean Section Delivery


3rd Stage of Labor


Postpartum


Breastfeeding


Circumcision


My Hospital Stay


Additional Notes


Save My Birth Plan

By selecting the Save button, your information will remain available for two days. If this is a public computer, we don't recommend saving this form.

You may also print out your birth plan to have on hand during your pregnancy. Please consider the environment before printing.

By selecting the Reset button, your information will be cleared from all the above fields.

Next Steps

Once you complete your birth plan, we recommend the following next steps:

  1. Contact us to find out about tour options and maternity classes
  2. Print and discuss the birth plan with your doctor
  3. Bring a printed copy of the birth plan with you when you come to deliver at the hospital

General Internet communication is inherently not secure. DO NOT send data considered confidential or private in nature on this form. (e.g., Social Security Numbers, Diagnosis Information, Credit Card Numbers, etc.)