A sample birth plan to use as a guide for your labor and birth.
Are your struggling with how to write your birth plan? Many parents find it helpful to have a place to start for writing a birth plan. Below is a sample to guide you.
John and Susan Brown – Due date June 30, 2021
Physicians: Drs. Smith and Lee
Doula: Jane Wright
We desire a labor and delivery that is as free from medication and other medical interventions as possible. We strongly prefer a vaginal delivery instead of a cesarean. Please discuss any suggested interventions or procedures with all of us and obtain our verbal consent before initiating any such interventions or procedures.
First Stage Labor
- FHR monitored by intermittent monitoring or telemetry (portable); no internal motniros please
- Vaginal exams only upon consent; as few and as gently as possible
- No augmentation of labor such as pitocin, amniotomy, or stripping of membranes unless non-medical techniques for augmentation of labor are not effective
- Husband and doula are to be present at all times
- No analgesia/anesthesia unless we ask for it
- Freedom to move/walk around during labor
- Freedom to eat and drink during labor as needed
- Heparin lock for IV
- Please avoid use of urinary catheter unless anesthesia is used and consent given
Second Stage Labor
- Choice of positions for pushing – no stirrups for birth please
- Prolonged length of second stage if progress is being made
- Spontaneous bearing down
- Would like to labor down until urge to push is felt
- We would prefer to tear rather than have an episiotomy – use of compresses, massage, coaching for slow birth of baby’s head and positioning other than lying down with stirrups to avoid need for episiotomy
- If assistance is delivery is needed, please use suction rather than forceps
- Baby to breastfeed immediately; please delay newborn procedures until baby has had the opportunity to breastfeed on both sides
- Natural delivery of placenta
- No post-delivery pitocin or pulling on the cord please
- If stitching of perineum is necessary, please use local anesthetic
- Delay cord cutting
- Newborn to stay with parents at all times
- Please perform all physical exams and procedures in room with mother
- Breastfeeding only: no bottles, pacifiers, artificial nipples, formula, or water
- No circumcision please
For more information about what to include, see Birth Plan.