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Birth Plan Worksheet

Birth plan Worksheet NAME: _____. ATTENDANTS. I'd like the following people to be present during labor and/or Birth : Partner: _____. Friend/s: _____. Relative/s: _____. Doula: _____. Children: _____. AMENITIES. I'd like to: bring music dim the lights wear my own clothes during labor and delivery take pictures and/or video during labor and delivery HOSPITAL ADMISSION & PROCEDURES. I'd like the option of returning home if I'm not in active labor. Once I'm admitted, I'd like: my partner to be allowed to stay with me at all times only my practitioner, nurse, and guests to be present ( , no residents, medical students, or other hospital personnel).

As long as the baby and I are doing fine, I'd like to: have intermittent rather than continuous electronic fetal monitoring be allowed to progress free of stringent time limits and have my labor augmented only if necessary . BabyCenter Birth Plan worksheet – page 2 LABOR PROPS

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