Birth Plan
--------- and ----------
Due Date: October 23, 2006
Dr. ------------
----------- Hospital
__________________________________________________ ___

Please Note
- I have mitral valve prolapse with mitral regurgitation.
- If the baby is a boy, we are not planning to have him circumcised.

Labor
- I prefer that doctors and hospital staff discuss all procedures with me before they are performed.
- I would like to be free to walk, change positions, and use the bathroom as needed / desired.
- I would like to remain hydrated by drinking moderate amounts of fluids (water, ice chips, juice).
- I would like a quiet, soothing environment during labor, with dim lights and minimal interruptions.
- I would like to play my own music.
- I would like to labor freely using the birthing tub / shower and/or a birthing ball.
- Please do not permit observers such as interns, students or unnecessary staff into the room without my permission.
- My husband is the only family member I wish to have with me until after the baby is born. I would like hospital staff to assist me in ensuring that family members do not enter until we are ready for them.
- I would prefer that everyone knock before entering.

Labor Augmentation
- I would like to avoid induction unless it is medically necessary.

Pain Medication
- I would like to avoid all anesthesia and narcotics unless medically necessary.
- Please offer me nonmedical choices for coping and remind me how close I am to the birth.

Cesarean Section Delivery
- I feel very strongly that I would like to avoid a cesarean delivery unless medically necessary.

Perineal Care
- I prefer not to have an episiotomy unless it is medically necessary.
- I would like help in guiding my pushing efforts, letting me know when to push and when to stop, and perineal massage.
- I would rather tear than have an episiotomy.

Delivery
- I would like the freedom to push and deliver in any position I like.
- I would appreciate help from my husband, Chad, and staff in supporting my legs as I push.
- I would like a soothing environment during the actual birth.

Immediately after the birth
- Please place the baby on my stomach or chest immediately after delivery.
- I would like to try to breastfeed the baby as soon as possible.
- Chad would like the option to cut the cord.

Newborn care
- I would like to hold the baby through delivery of the placenta, if possible.
- I would like the baby to be evaluated at my bedside.
- If our baby must go to the nursery for evaluation or medical treatment, I would like Chad to accompany the baby.

Postpartum
- I would prefer not to be catheterized until I’ve had some private time to attempt urination on my own.
- I would prefer to have my husband and the baby room in with me in a private room.
- Assuming both the baby and I are healthy, and I feel confident with breastfeeding, I would like to be released from the hospital 24-36 hours following the birth.
- I would like permission for access to my chart and the baby’s chart.

Breastfeeding
- I plan to breastfeed and would like to nurse the baby immediately following the birth.
- I would like to meet with a lactation consultant soon after the birth, and for as long or as frequently as possible. This is very important to me as I had many problems breastfeeding the last time. I would like as much help as possible to ensure that my baby gets a good start breastfeeding.