Name __________ Husband/Partner __________ Support Person ___________ 

Overview:

During my labour I will be practicing Gentle birth techniques, breathing, relaxation, and visualizations to assist me in birthing my baby. After much thought and reflection I would like the following to happen/be observed during the birth:

1st Stage

• Maintain a quiet relaxed environment
• Support to move around and try various positions
• Option to use bath, shower, fit ball, mats on floor
• I am aware of what pain relief is available and will ask for medical pain relief if I feel it is required. 
• Vaginal examinations – how often? 
• Continuous fetal monitoring only when absolutely necessary. 
• Induction, when and how?

 2nd Stage

• I would like to be able to move into any position that feels right to birth my baby: stand, squat, on all fours
• Skin to skin contact with baby 

 3rd Stage

• Syntocin injection to be discussed
• Cord to be clamped after the cord has stopped pulsating
• Who is to cut the cord?
• I would like the placenta to be kept for me to look at and perhaps take home

 Care of the baby

• I would like to breastfeed as soon as the baby is ready
• The baby can be weighed and measured some time after
• I would like to keep my baby with me at all times
• Please discuss Hepatitis B and Vitamin K options before administering

 In case of Caesarean Section

• Partner and, if possible, support person to be present
• I would like my partner and baby to be with me at all times, including recovery
• Skin on skin with me in Theatre
• Support to breastfeed as soon as possible
  
  We understand that things don’t always go according to plan! This birth plan is a guide for our ideal birth. We know you will be doing your best to look after us and we will make the necessary decisions along the way together. Thank you for your support and understanding, we appreciate that we are in the most capable of hands.