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Birth Plan Worksheet - BabyCenter

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). to wear my contact lenses, as long as I don't need a c-section to eat if I wish to to try to stay hydrated by drinking clear fluids instead of having an IV. to have a heparin or saline lock to walk and move around as I choose OTHER INTERVENTIONS. 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.

BabyCenter Birth Plan worksheet – page 2 LABOR PROPS If available, I'd like to try a: birthing stool birthing chair squatting bar birthing pool/tub I'd like to bring the following equipment with me: birthing stool beanbag chair birthing pool/tub

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