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I went to www.earthmamaangelbaby.com and made my birth plan there. It was very thorough. A birth plan is a plan telling doctors and hospital staff exactly what you want and don't want and what you like and don't like. It's great to have one. I didn't want my son to have the VitK shot, HepB Vax, or eye drops and he didn't get it because it was in my birth plan. They didn't even have to ask and they didn't just do it. Let me know if you need any help.
Here is a copy of mine (not that I need one now that I am having a Home Birth )
Regarding Labor and Birth - Willow Karr
Due Date: July 4, 2007
Patient of **** **
Scheduled to deliver at *** ******* Hospital.
April 24, 2007
To the Doctors and Nurses at Day Kimball Hospital:
I am thanking you in advance for following my wishes. I have been through labor and delivery three times before, and feel that my body will tell me what to do. I am planning a Natural Lotus Birth. Please ask me if you have any questions about my Birth Plan.
I wish to move around, walk, and change position at will throughout labor.
I would prefer to keep the number of vaginal exams to a minimum.
I do not want an IV, unless I become dehydrated.
I would like to wear contact lenses or glasses at all times.
I wish to eat soups and other light meals during labor if I become hungry.
I do not wish to have continuous fetal monitoring unless it is required by the condition of my baby.
I do not want an internal monitor unless my baby has shown signs of distress.
I would prefer to be allowed to try changing position and other natural methods (walking, nipple stimulation, and sexual intercourse) before the amniotic membrane is ruptured.
I plan to use HypnoBirthing as my pain management method.
I realize that many pain medications exist I'll ask for them if I need them, please do not ask me.
I would prefer to tear rather than an episiotomy.
I would like to be allowed to choose the position in which I give birth.
Even if I am fully dilated, and assuming my baby is not in distress, I would like to try to wait until I feel the urge to push before beginning the pushing phase.
I would like to have my baby placed on my stomach/chest immediately after elivery.
Immediately After Delivery
I do not want a routine injection of pitocin after the delivery to aid in expelling the placenta.
I am having a lotus birth, please do not clamp or cut the umbilical cord.
I would like to hold my baby while I deliver the placenta and any tissue repairs are made.
I would like to have my baby evaluated and bathed in my presence.
I plan to keep my baby near me following birth and would appreciate if the evaluation of my baby can be done with my baby on my abdomen, with both of us covered by a warm blanket, unless there is an unusual situation.
I would like to delay the eye medication for my baby until a couple hours after birth.
We are aware of the risks and benefits of vaccination and have decided against it. Please do not administer any vaccinations to our baby.
I plan to breastfeed my baby and would like to begin nursing immediately after birth.
I do not wish to have any bottles or pacifiers given to my baby (including glucose water or plain water).
I would like to take photographs and video recording during labor and the birth.
I would prefer that no students, interns, residents or non-essential personnel be present during my labor or the birth.[/b]
We have it printed out and will bring it with us IF I need a transfer....but I doubt we will need this.
A birth plan is like an outline of exactly how you WANT your birth to go. Things that you want, things that you dont want. Its all your wishes. You fill out the birth plan and take it in to your doctor and go over it with them. Then you make sure he agrees. I would take TWO copies with you and have him sign one and you sign it to. This means that as long as there are no complications that he must abide by your rules. Keep that signed copy and put it in your birth bag so you have it at the hospital. Leave one for him to keep in your chart so that when you are admitted the nurses are also aware of your birth plan. You can find sample birth plans all over the internet. Basically you fill in the blanks. I would copy and paste it into word and add and subtract questions as you see fit. Its more like a good outline. JM has a birth plan outline that I used. JM birth plan link
Here is a sample copy of mine:
Partner's Name: Brad
Doula/labor assistant: Brad
Due Date: 1/22/07
Allergies: None Known Of
Blood Type: O+
Rh Factor: None
Health Care Provider Name: Birth and Women\'s Health Center
Hospital/Birthing Center where you plan to deliver: Birth and Women\'s Health Center
If I go past my due date if baby and I's health is not at risk, I would prefer not to be induced medically
I would prefer trying the following methods to induce labor:
* Breast Stimulation
* Sexual Intercourse
I would like the following to be present during labor: Brad
I would like the following to be present during actual birth: Brad, and Cindy
I would like to bring music.
I would prefer dim lighting.
I would like to wear my own clothes.
I would prefer to stay in one room during labor, birth, and post delivery if available.
I would like to be able to film or take pictures of baby's birth.
I would like to be able to walk around, mobility is important to me.
I would prefer a warm bath over walking. Please let me try that if I do not feel up to walking.
I would like the following equipment available to me, if possible.
* Birthing bed
* Birthing ball
* Birthing pool or tub
I would prefer not to be given an enema
I would prefer to be able to eat and drink during labor.
I would prefer no IV unless absolutely necessary.
I would prefer no monitoring to be done if there are no signs of distress.
Anesthesia - Pain medication
I would prefer to try laboring without pain medication. Please do not ask me.
First Stage of Labor
I do not want to be seperated from my partner during labor or birth.
I would like the option of returning home if my labor is not progressing.
I would like no time limits on laboring and prefer labor not to be augmented unless medically necessary.
I would prefer my water not be broken during labor.
I would prefer vaginal exams kept to a minimum.
I would like encouragement throughout labor.
I'd prefer not to have an episiotomy.
Second Stage of Labor (pushing)
I would like a mirror present to view birth, if possible.
I would like to be able to touch baby's head when it crowns.
I would like coach and/or nurse to support my legs when I push.
I would like to be able to try any position comfortable during pushing.
I would like to wait to push until I feel the urge even if I am fully dilated.
I would like no time limits on pushing.
I would like to have baby placed on my chest immediately after birth.
I would like to have my partner cut the cord.
I would like to wait on cutting the umbilical cord until it stops pulsating.
I would like to have baby's first bath and assessment to be done in my presence.
I would prefer to give the baby his first bath myself, or my partner.
I would prefer that the vernix not be washed right off, but for me to rub it in instead.
I would like to see my placenta after birth.
I would like to take my placenta home with me after birth.
I would like baby to room in with me.
I would like to be discharged as soon as possible.
I would like to opt out of vit. K shots and eye ointment.
I would like to let my baby go straight to breast when born, before anything else is done.
I would prefer trying to nurse the baby to clear out airways instead of aggressive suctioning of the mouth and nose after birth.
I would like to avoid a c-section if possible.
If c-section is necessary, I would like my partner present
I would like to touch baby after birth.
I would like partner to hold baby after birth.
I would like screen lowered so I can view birth.
I would like to breastfeed baby as soon as possible.
I do not want my baby to have a pacifier.
I do not want my baby given any formula or water.
I do not want my baby to have a bottle. I would prefer cup feeding or finger feeding if supplements are necessary.
I actually just did this today. I did it on Birthplan.com. This is mine:
I would prefer to avoid an enema and/or shaving of pubic hair.
I would like to be free to walk around during labor.
I wish to be able to move around and change position at will throughout
I would like to be able to have fluids by mouth throughout the first
stage of labor.
I will be bringing my own music to play during labor.
I would like the environment to be kept as quiet as possible.
I would like the lights in the room to be kept low during my labor.
I do not want an IV unless I become dehydrated.
I would like to wear contact lenses or glasses at all times when
I would like to try to shower during labor to help ease pain.
I have brought a labor ball that I would like to use in different
Positions throughout labor.
I do not wish to have continuous fetal monitoring unless it is required
by the condition of my baby.
I do not want an internal monitor unless my baby has shown some sign of
I do not wish to have the amniotic membrane ruptured artificially
unless signs of fetal distress require internal monitoring.
I would prefer to be allowed to try changing position and other natural
methods (walking, nipple stimulation) before pitocin is administered.
I realize that many pain medications exist I'll ask for them if I need
Please do not suggest pain medications to me.
Unless absolutely necessary, I would like to avoid a Cesarean.
If a Cesarean delivery is indicated, I would like to be fully informed
and to participate in the decision-making process.
I would like my husband, Billy Whiteside present at all times if my
baby requires a Cesarean delivery.
If my baby is not in distress, my baby should be given to my husband
immediately after birth.
I am hoping to protect the perineum. I am practicing ahead of time by
squatting, doing Kegel exercises, and perineal massage.
I would appreciate guidance in when to push and when to stop pushing so
the perineum can stretch.
I would like a local anesthetic to repair a tear or an episiotomy.
I would like to be allowed to choose the position in which I give
birth, including squatting.
I would like my husband, my mother and/or nurses to support me
and my legs as necessary during the pushing stage.
I would like the chance to touch my baby's head when it crowns.
I would like to have my baby placed on my stomach/chest immediately
Immediately After Delivery
I would like to have my husband, Billy Whiteside cut the cord.
I would like to hold my baby while I deliver the placenta and any
tissue repairs are made.
I would like to hold my baby for as long as possible before
he is photographed, examined, etc.
I would like to have my baby evaluated and bathed in my presence.
I plan to keep my baby near me following birth and would appreciate if
the evaluation of my baby can be done with my baby on my abdomen, with
both of us covered by a warm blanket, unless there is an unusual
If my baby must be taken from me to receive medical treatment, my
husband, Billy Whiteside or some other person I designate will accompany my
baby at all times.
I would prefer to hold my baby rather than have him placed under
I would like a private room, if available.
Unless required for health reasons, I do not wish to be separated from
I would like to have my baby 'room in' and be with me at all times.
I plan to breastfeed my baby and would like to begin nursing very
shortly after birth.
Unless medically necessary, I do not wish to have any bottles given to
my baby (including glucose water or plain water).
I do not want my baby to be given a pacifier.
If my baby is hungry and I’m sleeping, please wake me up to breastfeed him.
I would like My baby to be circumcised before we check out of the
I would like to take still photographs during labor and the birth.
I would like to make a video recording of labor and/or the birth.
__________________ Gestational Surrogate for one fabulous little family!