Created by the Center for Spirituality & Healing and Charlson Meadows.

Sample Birth Plans

Sample Birth Plan 1

To my midwife and labor nurses:

Welcome to my birth plan. I am Ginny Snell. My partner is Charles Peterson, and we will also be accompanied by our birth assistant, Cindy Smith.

I am a first time mother, so I am very curious to experience labor. I also tend to be a very cautious person. Charles is more adventuresome. We have done much preparation and hope to allow labor to progress at its own pace. We welcome your suggestions at any point. We plan to be flexible and hope that you will too.

First Stage:

  • I would like to spend my early labor at home. If you think that I have arrived at the hospital in early labor, I would like to return home.
  • I would like to eat and drink throughout labor if I feel like it. Please remind me to drink if I forget.
  • My primary plan to cope with pain is to use movement and water. To help me with freedom of movement, I would like the baby monitored intermittently. Charles and Cindy may also help with relaxation techniques.
  • I would like to use natural techniques to stimulate labor if necessary, such as nipple stimulation, before considering medications.

Second Stage:

  • I would like to follow my own urges to push in whatever position I find comfortable.
  • Please make suggestions if you think I could do something more effectively.
  • After the baby is born, Charles would like to help move the baby onto my abdomen and cut the cord.

Our wishes for our baby:

  • I plan to breastfeed the baby without bottles. I'd like to wait several weeks before I try a pacifier.
  • Charles would like to give the baby the first bath.
  • If our baby is a boy, we would like him to be circumcised, but only after we have successfully breastfed several times. Charles and I would like to be present and would like the baby to receive anesthesia for the surgery.

Sincerely,
Ginny and Charles

Sample Birth Plan 2

Dear Dr. Cox, my anesthesiologist, and my birth nurses:

I know you might be surprised to read a birth plan because, as you know, we are planning a repeat cesarean section. However, I do have some specific requests regarding my surgery and hospital stay that I hope you will consider.

I will be accompanied by my parents, Sue and Tim Lee. If possible, I would like to have both of them with me in the delivery room. In my family, it is traditional for the oldest male to be involved in making medical decisions, and I am comfortable with this. If any treatment decisions need to be made, please include my father in the discussion. We are adapting to new traditions, however, and if my father and I cannot agree on a plan, I will make the final decision. My father knows this, but he will be uncomfortable. Please be understanding of him.

I would like my baby to remain in the operating room and recovery area with me after she is born. I realize that this may require having an additional nurse assigned and that this might not be possible on a very busy day. But if possible, I hope that this request can be accommodated.

Anesthesia requests:

  • I would like to receive a spinal or epidural anesthesia for my birth, and would like to avoid receiving any medications after the birth that would make me drowsy or unable to interact with my baby.
  • I was very nauseated after my first cesarean birth, and would like you to plan for this and premedicate.

Post-birth requests:

  • If we could dim the lights in the recovery area to encourage my new baby to open her eyes I would appreciate this.
  • My mother will be remaining with me to help me care for the baby until I am able to be up and out of bed.
  • I would like to breastfeed exclusively.
  • Please remind me to take pain medication. I tried to go without last time, but I think it will be more helpful, and I will be more comfortable during my recovery if I take it.

Sincerely,
Karen Lee

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