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Birth Plan Generator

When it comes to giving birth, things never go exactly according to plan. But that doesn’t mean you shouldn’t have an idea of how you want your experience to be. Fill out our interactive birth plan to record all of your birthing wishes; then share them with your doctor, midwife, spouse, and anyone else involved in your big moment. Even if you can’t control the details, it’s important to know what you want. Just remember, when it comes to giving birth, flexibility should be at the top of every mom-to-be’s list. Would you like to save your birth plan? Log in to your account or sign-up for an account here before you start.

Please fill in only the fields that apply to you.

First name

Last name

Due date

Family doctor

OB-GYN delivering baby

Doula

Coach

Birth location

If home birth, name of hospital if complications ensue

Support staff

I would like support staff to have access during

Previous children

I would like my children to have access during

Birth philosophy

Induction/augmentation

Use only when it is determined the mother or baby�s health would be improved by the birth of the baby
Try all natural methods first such as eating spicy foods, walking, nipple stimulation and sex

If natural methods fail I would like to try (in this order):

Herbal inductions
AROM (artificial rupture of membranes)
Prostaglandin gel
Pitocin
Cytoec
Other

Environment during labor

Whenever possible I would like to

Wear my own clothes
Listen to music before birth
Listen to music during birth
Dim the lights
Keep the room as quiet as possible
Wear contact lenses or glasses at all times when conscious
Have minimal vaginal exams
There to be no students or residents present
Keep hydrated by:
Remain mobile
Enjoy other comforts such as

Pain relief

Mobility is important to me and I would like to have a walking epidural low dose
I would like to have a standard epidural and realize this will limit my mobility
I would like a natural birth if possible
I wish to have access to a bath or shower to help comfort me
A masseuse and/or acupuncturist will be present
I wish to use the following relaxation methods
I prefer to use IV medications to help ease my pain

Monitoring

I do not wish to have continuous fetal monitoring unless it is required by the condition of the baby
I do not want an internal monitor unless the baby has shown some sign of distress

Labor, delivery & episiotomy

I would like a squat or birth bar to aid in pushing
I prefer foot pedals to allow me to sit up while pushing
I prefer stirrups to allow me to lay back during pushing
I prefer my coach or doula to support my legs when pushing
I would like to try to deliver in a hands-and-knees position
I wish to be able to move and change positions throughout my labor
I do not want an IV unless I become dehydrated
Even if I am fully dilated, and assuming the baby is not in distress, I would like to wait until I feel the urge to push before beginning the pushing phase
I would appreciate guidance in when to push and when to stop pushing
I prefer not to have an episiotomy unless absolutely required for the baby's safety
If possible, I would like to use perineal massage to help avoid the need for an episiotomy
I would prefer an episiotomy rather than a tear
I would like a local anesthetic to repair a tear or an episiotomy
Unless necessary for the safety of my baby I do not want forceps or a vacuum extractor
I would like a mirror available so I can see the baby's head when it crowns
I would like the chance to touch the baby's head when it crowns
I wish to have cameras in the room during
I wish to have a video in the room during

Cesarean

Unless absolutely necessary, I would like to avoid a Cesarean birth
I would like my coach present at birth if the baby requires a Cesarean delivery
I would like a ceiling mirror so I can view the birth of my baby
Immediately after birth, If the baby is not in distress, the baby should be given to:

Baby care

I prefer the umbilical cord stops pulsating before it is cut
I would like the following person cut the cord:
I would like to have the baby placed on my chest immediately after delivery
I would like to hold the baby while I deliver the placenta and any tissue repairs are made
I do not want an injection of pitocin after the delivery to aid in expelling the placenta
I would like to breast feed within first 30 minutes if possible
I would like to have the baby evaluated in my presence
I would like the following person accompany the baby if the baby must be taken from me to receive medical treatment
I prefer to hold the baby rather than have him or her placed under heat lamps
I would like to donate the umbilical cord
I would like to bank the umbilical cord. Please list arrangements
I would like to keep the placenta
Unless medically necessary, I do not wish to have any bottles given to the baby (including glucose water or plain water)
I plan to exclusively breastfeed the baby
I plan to bottle feed my baby
I would like to meet with a Lactation Consultant
If male, I wish to have the baby circumcised
If male, I would like the baby to be circumcised before checking out of the hospital

Environment after delivery

I would like a private room, if available
Unless required for health reasons, I do not wish to be separated from my baby
I wish to have a TV in my room
I wish to have music in my room (please list type)
I wish to use my own blanket and pillow
My husband or partner will be spending the night
I would like books and magazines to read (please list)

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