Should we include anything else or should I take out anything?

Our Birth Plan

Name of Mother: *****

Anticipated Birth Date: 08/18/19

Mother's Support During Labor/Delivery:(Spouse)

O.B. Name: ****

Pediatrician: ****

My Delivery is planned as: Vaginal

Please Note That I Am: GBS Positive

During Labor

• I would like to be free to walk around during early labor.

• I wish to be able to move around and change position at will throughout

labor.

• I will be bringing my own music to play during labor

• I would like the environment to be kept as quiet as possible.

• I would like the lights in the room to be kept low.

• I would prefer to keep the number of vaginal exams to a minimum as I am GBS positive.

• I would like my husband to film and take pictures

• I would like hospital staff limited to my own doctor and nurses. Please no students, interns or residents present

• Please avoid using forceps and/or vacuum extraction per my OB.

Fetal Monitoring

• I would like to walk around during labor while monitor is on my belly.

• I prefer continuous monitoring of my baby’s heart rate

Anesthesia/Pain Medication

• I do not want any narcotic pain relief.

• If I decide I want pain relief, I'd prefer an epidural

Cesaeran

• If a Cesarean delivery is indicated, I would like to be fully informed and to

participate in the decision-making process.

• I would like my husband present at all times if the baby requires a Cesarean

delivery.

• I would like to have video or photos taken.

• I would like my support person to cut the cord.

• I would like to breastfeed as soon as possible in the recovery room

Epistotomy

• I would prefer not to have an episiotomy unless absolutely required for the

baby’s safety.

Delivery of Baby

• I would appreciate having the room lights turned low for the actual

delivery.

• I would like to have the baby placed on my stomach/chest immediately

after delivery.

After Delivery of Baby

• I would like to wait to have the cord cut until the baby receives all the blood from the placenta.

• I would like to donate the umbilical cord blood.

• I would like all routine tests, shots, and procedures for my newborn.

• I would like to hold the baby while I deliver the placenta and any tissue

repairs are made.

• I would like to have the baby evaluated and bathed in my presence, if possible.

Breastfeeding

• I plan to breastfeed the baby and would like to begin nursing very shortly

after birth.

• I do not want the baby to be given a pacifier.

Circumcision

• I do not want my son circumcised in the hospital.