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Birth Plan birth plan Use this easy fill-in-the-blank birth plan to prepare yourself for delivery and communicate your wants and needs to your medical team. Full name: Today’s date: Doctor’s name: Partner’s name: Due date/Induction date: Hospital name: Please note that I: Have group B strep Am Rh incompatibility with baby Have gestational diabetes My delivery is planned as: Vaginal C-section Water birth VBAC I’d like... Partner: Parents: Other children: Doula: Other: ...present before AND/OR during labor During labor I’d like... Music played (I will provide) The lights dimmed The room as quiet as possible As few interruptions as possible As few vaginal exams as possible Hospital staff limited to my own doctor and nurses (no students, residents or interns present) To wear my own clothes To wear my contact lens the entire time My partner to film AND/OR take pictures My partner to be present the entire time To stay hydrated with clear liquids & ice chips To eat and drink as approved by my doctor Page 1 of 6 birth plan I’d like to spend the first stage of labor: Standing up Lying down Walking around In the shower In the bathub I’m not interested in: An enema Shaving of my pubic area A urinary catheter An IV, unless I’m dehydrated (and a heparin or saline lock IS/IS NOT okay) I’d like fetal monitoring to be: Continuous Intermittent Internal External Performed only by Doppler Performed only if the baby is in......

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