Sample Birth Plan
This is a modified version of our hospital birth plan with our first baby. Feel free to use it as a template and decide which elements are important to you and which you would like to leave out. Also, note that there is not a lot listed that has to do with labor. If you are planning on getting to the hospital on the earlier side, you may want to include details more specific to spending an extended time laboring in the hospital. In this case, I would be happy to discuss with you what elements you may consider including.
Dear Kaiser Staff,
We are so excited to be welcoming our new baby and are glad you are going to be taking care of us. We want you to know that we feel this is the safest place for us to have our baby. However, we are coming to you with a clear idea of our desires for this labor and birth (as peaceful and intervention-free as possible), and we need your support. We would like you to explain any non-emergency procedures to us before they are done and we are happy to sign waivers for anything we decline.
Our Birth Plan:
• I would like to push in whatever positions, including squatting, and with whatever breathing pattern I am comfortable.
• Please no counting, shouting or loud encouragement during the pushing phase.
• Please allow the baby the time to rotate spontaneously once his or her head is out and please avoid excessive manipulation of the baby unless there is a dystocia.
• Please keep suctioning of the baby’s nose and mouth to an absolute minimum unless there is meconium or another obvious indication for suctioning.
• I would like my husband to announce the sex of the baby.
• Please place the baby on me immediately after birth, and allow me to keep him or her for the first 2 hours. (I understand that this may not be possible if certain complications arise.)
• Please allow the cord to pulsate until it stops on its own, especially if the baby is “a little slow to start.”
o “Immediate clamping of the umbilical cord can reduce the red blood cells an infant receives at birth by more than 50%, resulting in potential short-term and long-term neonatal problems.” So concluded Judith Mercer, CNM and colleagues in a study reported in the fall of 2001 in the Journal of Midwifery and Women’s Health (Mercer, 2001). “Early clamping of the umbilical cord at birth, a practice developed without adequate evidence, causes neonatal blood volume to vary 25%-40%. Such a massive change occurs at no other time in one’s life without serious consequences, even death. Early cord clamping may impede a successful transition and contribute to hypovolemic and hypoxic damage in vulnerable newborns” (Mercer 2002).
• Please ask before administering Pitocin after the birth.
• Please allow us to initiate breastfeeding on our own, with the help of our doula, unless we request additional support.
• We understand that you will need to check the baby periodically, but would like all of these procedures done in our presence.
• We wish to decline the administration of erythromycin ointment in the baby’s eyes, as well as the vitamin K injection and Hep B vaccine.
• We would like to postpone giving the baby his or her first bath.
• We would like to keep our baby’s placenta.
In Case of Cesarean:
• We would like to stick to the above birth plan as closely as possible, but understand that some things may no longer be an option.
• Please do not use a vacuum to assist in delivering the baby.
• Please delay cord clamping, allowing the cord to pulsate – this is extremely important to us, regardless of whether we have a vaginal or surgical birth.
We would like to thank you in advance for honoring our wishes to the best of your ability and helping to bring our baby into this world in the most safe and peaceful way possible. Please enjoy the treats as a thank you for your efforts!
Becky and Jordan Gerson (and baby Gerson too!)