|
|
|
|
|
|
 |
|
|
|
|
| Helpful Moms |
| Public group from Jacksonville Beach, FL |
|
|
| |
|
|
The ________________ Family Birth Plan.
Mother: ________________________________________________
Father: _________________________________________________
Support Persons: ________________________________________
_______________________________________________________
_______________________________________________________
Due Date: ___________________
Practitioner: _____________________________________________
Place of Birth: ___________________________________________
This birth plan is intended to express the preferences and desires we have for the birth of our baby. It is no intended to be a script. We fully realize that situations may arise such that our plan cannot and should not be followed. However, we hope that barring any extenuating circumstances, you will be able to keep us informed and aware of our options. THANK YOU!
FIRST STAGE OF LABOR:
__ Would prefer dim lights, peace and quiet, and music of our choice.
__ Would prefer vaginal exams only upon our request or when done by the obstetrician.
__ Would like to maintain mobility (walking, rocking, up to bathroom, etc.)
__ Do not want continuous fetal monitoring unless it is required by the condition of our baby.
__ Do not want an internal monitor unless our bay has shown some sign of distress.
__ Would like access to clear fluids and ice chips.
__ Do not want an IV unless agreed to by myself or father/husband.
__ Do not want to be offered pain medications, as I will ask for them if I want them.
__ Would like to use relaxation techniques for pain management (breathing, focusing, etc.)
__ Would like access to water (Shower or Tub), heat or cold packs, massage, and acupressure.
__ Would like to use any positioning as desired.
INDUCTION/AUGMENTATION:
__ Would prefer to use natural methods to start labor.
__ Do not wish to have the amniotic membrane ruptured artificially unless signs of fetal distress requires internal monitoring.
__ Would prefer to use natural methods (i.e. walking) to speed labor.
CESAREAN (C-SECTION):
__ Unless absolutely necessary, I would like to avoid a Cesarean.
SECOND STAGE OF LABOR (BIRTH):
__ Would like choice or positions, including hands and knees, squatting, or the sideline position.
__ Would like to be allowed a prolonged stage length if progress is being made.
__ Would like to wait to push for the urge to do so.
__ Do not wish for anyone to count while I am pushing.
__ Do not wish for forceps or vacuum to be used unless absolutely necessary.
__ Would prefer to tear a small amound rather than have an episiotomy, but please use compresses, massage, and position to minimize tearing.
__ Would like my husband to be able to catch the baby when he/she comes out if he so chooses.
BABY CARE:
__ Would like to have the baby places on my stomach/chest immediately after delivery.
__ Plan to keep our baby near us following birth and would appreciate if the evaluation of our baby can be done with the baby on my abdomen unless there is an unsual situation.
__ Would like to delay the cord custting until after the cord stops pulsing and would like my husband to cut the cord if he chooses to do so.
__ Do not want a routine injection of pitocin after the delivery to aid in expelling the placenta.
__ Plan to breastfeed our baby and would like to begin nursing very shortly after birth, with no artificial nipples or supplementation of any sort given at any time.
__ Would like there to be no separationg of Mother & Baby.
__ If the baby must be taken from our room, he/she will be accompanied by the mother and/or father at all time. If this must occur a preference of at least one breastfeeding session should have been completed prior to him/her leaving unless there is an emergency.
__ Would like to opt out of the application of eye ointment to the baby's eyes.
Copywritten by Rose Mary Danforth B.S.H. (Member of DONA) Circle of Life-Celtic Doula. |
| Posted by Jennifer on 01/22/2009 07:26 PM
| edit | delete |
|
|
|
| |
| Be the first to reply to this post! |
| |
| |
|
|
|
| |  |
| |
|
|
|
