Delivery suite birth plan

The following is an example of what you may want to include in your birth plan when having your baby in the delivery suite. You can add, change or delete any aspects to suit your needs.


Your name...................................................
What you like to be called (e.g. Leanne or Lea)..............................
Your partner or support person's name ..............................

This plan outlines our preferences. We understand that the plan may need to change. In the event of complications, if it is not an emergency, we would like any proposed interventions discussed with us and options explored. We are aware that our preferences may change as the birth progresses. In the event that all progresses normally, we would prefer:

	To wear my own clothes rather than a hospital gown.
	To start labour spontaneously.
	To eat and drink as desired.
	To play my own music.
	To have access to a bean bag and floor mat if possible.
	Not to be continuously monitored routinely unless there are signs that the baby is distressed.
	If I do need monitoring I prefer an external monitor rather than an internal monitor.
	Not to have my waters broken routinely.
	To have vaginal examinations only if necessary (or if I ask for one).
	To use the shower and bath for pain relief (if available).
	Not to be offered medical pain relief, I will ask for it when I am ready.
	I do not have any preferences about pain relief, I would prefer to make my decisions as I labour.
	We would like to be given information on the risks and benefits of any procedures.
	If I need a catheter to empty my bladder, to have this removed for the pushing phase.
	To be able to push instinctively, not to be 'coached' when pushing.
	To tear rather than have an episiotomy.
	Not to have my genitals washed down with antiseptic solution.
	To have my 3 year old son and my mother present at the birth if appropriate.
	To hold my baby straight away.
	Not to have the baby suctioned unless medically indicated (e.g. meconium).
	For no one to announce the sex of our baby. We would like to discover this ourselves.
	I would like to donate cord blood if available.
	I would like to be shown my placenta before it is taken away.
	To use the gas if I need to have stitches.
	I would like my baby to have an injection of vitamin K after the birth.
	I do not want my baby bathed with antiseptic solution. I would prefer plain water (or not being bathed at all for a time period).
	For our baby to be with us at all times. If he or she is not well and needs to go to intensive care for my partner to be with him or her.
	To breastfeed my baby as soon as possible, preferably within an hour of birth.
	To room in with my baby on the postnatal ward.

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