Sample Birth Plan

By Krista Gray, IBCLC. Last updated July 29, 2017.

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Labor:

  • Drugs – I desire a drug-free birth.  Please do not offer pain medication or Pitocin.
  • Vaginal Exams – Minimal
  • Monitoring baby – Intermittent only
  • Movement – I would like complete freedom of movement during labor.
  • Stripping of Membranes – Please do not strip my membranes.
  • Breaking of Water – Please allow my bag of waters to break naturally.

 During the pushing stage:

  • Positions – I would like the freedom to push in any position that is comfortable for me.
  • Perineum – I would like to try for an intact perineum with massage, support, hot compresses, controlled and guided pushing, and positions to promote perineal stretching.
  • Episiotomy – I would prefer to tear naturally and not have an episiotomy.
  • Forceps/Vacuum extraction – I do not want these used unless my baby’s life is threatened.
  • C-section – A last resort and only to be considered if my life or baby’s life is threatened.
  • Time – As long as baby is tolerating labor well, I would like to labor at my own pace without time constraints or labor augmentation.

 After Birth:

  • Baby – To be laid directly on mother’s chest after birth and allowed to breastfeed in skin-to-skin contact.  Any observations or measurements should be done while baby is on my chest.  Please allow baby to be laid on mom even through delivery of placenta and any repair work.  I would like to be present for all newborn procedures.
  • Cord – Please allow cord to stop pulsating before it is clamped.  Please do not milk the cord to speed the process.  Please do not clamp the cord early.  If possible, I would like to leave cord attached until placenta is delivered.
  • Placenta – Please allow the placenta to be expelled on its own, with no pulling or tugging.  I do not want to be given Pitocin unless fundal massage to control bleeding is not effective.
  • Temperature – I would like to hold baby skin-to-skin during the first hours to help regulate baby’s body temperature.

 Baby Care:

  • Rooming In – To begin immediately.  All necessary examinations should be performed w/us present.
  • Breastfeeding – The baby will be breastfed exclusively.  Please do not give baby a pacifier, bottled water, glucose water, formula, etc.
  • NO lab work is to be drawn, no injections or medications of any kind are to be given without our prior consent.

Alternate Plans:

  • Should a C-section be necessary, I would like my husband to hold baby in skin-to-skin contact immediately following birth until I am able to hold baby.
  • Should baby need special care after delivery, my husband or I would like to be present in the NICU or elsewhere.

Click here to download a .pdf of this sample birth plan.

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