Birth Plan

Please copy this into your own document, print several copies and take them with you to the hospital.  This is very complete so if there are issues here that do not suite your desires, please feel free to modify this in any way before printing.


We are both very excited about the upcoming birth of our child, and have been preparing ourselves extensively in order to stay healthy, low risk and educated throughout this pregnancy.  Because this is such a special and significant event in our lives, we have some preferences that may be different from your standard routine.  As we discussed in consultation with our doctors, we expect to rely on the normal physiological process of labor and delivery without the use of medications or unnecessary interventions.  We do recognize that if a clear problem does arise, we may need to modify our requests and cooperatively confer with our doctors whose judgement we respect and trust.  In the event of some unforeseen complication, we would appreciate a detailed explanation in order to have a clear understanding of the problem, possible outcomes as well as our choices.  We sincerely appreciate your support and encouragement with regards to our requests.


1.   Freedom of movement to walk around and labor in any position.
2.  No offer of medication during labor, words of encouragement gladly accepted.
3.   Minimum use of electronic fetal monitoring.
4.   Allow for normal spontaneous labor without the rupturing or stripping of membranes.
5.   Limited vaginal exams (at initial arrival and once prior to pushing)
6.   Allow mother to drink fluids orally instead of an I.V. drip, but have a saline lock in place.
7.   Mother and father are to be allowed to remain together at all times.
8.   Besides our doctors we would like to limit people in birthing room to the husband (________), Mother’s mom (____________l) and friend (____________).


1.   Freedom to change positions during second stage delivery.
2.   Upon reaching 10 cm, we ask that there be no “time limit” on pushing, but that we are allowed to follow the natural urge to push until baby is born.
3.   Spontaneous delivery of baby without traction, forceps or vacuum extraction.
4.  Allow father to participate as much as possible. (i.e. catch baby)
5.  If not too much time lapse, then let shoulders deliver with next contraction
6.  No routine episiotomy: allow for perennial massage and warm compresses with direction from the doctor for a slow delivery of baby’s head with counterpressure to allow stretching of perineum and prevent tearing.


1.   To hold and breastfeed baby immediately after delivery.
2.   Allow umbilical cord to stop pulsating before clamping and cutting.
3.   Suction of baby only if necessary.
4.   Assist father in cutting the umbilical cord.
5.   Spontaneous separation and delivery of placenta without time limits.


1.  No eye drops, vitamin K, Hepatitis B shots or any other non-lifesaving procedures to be performed without written parental consent.
2.  Provide newborn care in the presence of parents.
3.  Baby allowed to breastfeed on demand.  No pacifiers, formula or sugar water.
4.  24-hour rooming-in to begin as soon as possible.  We will not need the nursery.
5.  If male child, NO circumcision.

We have discussed these requests and agree that each of us will do our part to facilitate a natural and healthy birth.  Thank you again for your support and encouragement.

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