Preparing For Birth – A sample low-intervention birth plan

A birth plan is a tool to express your desires and needs for birth and initial postpartum, as well as, to make sure that you and your provider are on the same page.  Your birth plan should be brief (no more than one page) and only have the bullet point information that is specific to your care and desire or not usually done by your care provider or birth location.

Discuss with your care provider prior to labor and bring a copy with you to your birth location.  Remember it is not a legal document that your location of delivery or care provider must adhere to.

Here is a sample plan for an out of the home birth:

Birth Needs and Desires for: _______________________. Care Provider:____________________________________.

Estimated Due Date: ____________________________.

Labor

I am planning on a no to low-intervention natural birth.  I plan on being mobile, lightly snacking, drinking orally, and having ___________ present.   I understand that intermittent monitoring of me and my baby will be necessary.  I want to be fully consented for any procedure that may come up and fully participate in the medical care for myself and my baby.  I understand that there is pain management available to me, I will ask for it if I so desire.

  • I plan on wearing my own clothing. I will ask for a gown if I change my mind.
  • I would like a saline lock in lieu of an IV
  • In the event of an induction and/or augmentation is medically necessitated-
    • Ripening – Foley Catheter instead of Cytotec (misoprostol)
    • Pitocin – A very slowly increased dosage
    • AROM – will only consent to if an internal fetal monitor is a must.
  • Delayed cord clamping for at least 5 minutes (baby can receive oxygen or other helps while still attached to me).

Postpartum and Baby Care

  • Request that my baby is on my belly or chest for assessments and warmth (even oxygen can be given on me)
  • Delayed bathing
  • Delaying vaccinations including eye ointment and vitamin k.
  • Exclusive breastfeeding, no pacifiers, sugar water, or formula
  • No separation from me unless absolutely medically necessary not just protocol.

Cesarean: In the event a cesarean becomes necessary and is not a true emergency requiring general anesthesia.  I would like to keep the spirit of my plan A to plan C so the delivery can be as family centered and intimate as possible.

  • Only essential lighting
  • Only essential conversation related to the surgery and delivery
  • Lower sterile drape or have a mirror present so I may see my baby emerge
  • Only one arm strapped down so I may touch my baby
  • Pictures and video
  • Aromatherapy as I desire for comfort, abate nausea and to mask surgical odors
  • Baby to stay with me continuously in OR and recovery
  • If baby must leave OR for treatment, my partner/spouse goes with baby and I would like my ____________ to stay with me so I am never alone.
  • Breastfeed in OR and/or recovery
  • Delayed immunizations
  • Delayed washing and dressing of baby
  • No separation from me except what is absolutely medically necessary

2 Responses to “Preparing For Birth – A sample low-intervention birth plan”

  1. Sheridan says:

    I like this. The cesarean one is nice.

  2. Kim Evans says:

    This is great!

    I know when John and I were putting our birth plan together we were wishing for samples to look at. There are surprisingly very few to reference on the internet and the only ones we had to refer to were from our class.

    Knowing that one has to be as concise as possible but still make their desires known presents its own challenges. Having samples to reference tends to help take the mystery out of it.

    Kim