- Keep it short.
- Use bullet points.
- Use positive language if possible.
- Include only major desires that could honestly conflict with normal procedure.
- Have a separate plan for the baby and postpartum care.
- Remember to say thank you at the bottom on each plan and add a sentence that you would be happy to discuss this plan.
Sample Birth Plan:
- Please do not ask me about my pain level.
- Please do not offer me pain medication. I will ask for it if I need it.
- I would like a minimal amount of monitoring and if extended monitoring is needed I would like to use the wireless monitoring.
- I want to move a lot during labor and be encouraged to change positions.
- I want a heparin lock instead of an IV.
- I want to eat and drink as I desire throughout labor.
- I want to push in the position of my choice and to be encouraged to change positions.
- We would like to delay cord clamping and all routine baby care.
- I would like skin to skin contact. Please do not clean up baby before handing to me.
- I would like to breastfeed immediately after birth.
- No episiotomy.
- If Pitocin is used, any changes to the amount is to be cleared with me first.
- We are saving the placenta for encapsulation.
Sample Baby Plan
- We are refusing the vitamin K shot, eye ointment, and Hep B Vaccination.
- I am a breastfeed baby. Please no bottles, formula, supplements, or pacifiers.
- I am rooming in with my mom.
- All procedures are to be done with either my mom or dad present.
- Please do not bath the baby.
Sample Post-Partum Plan
- I would like breastfeeding support.
- I will be rooming in with my baby.
