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Template: Natural Birth Plan

Example Natural Birth Preference Plan

More articles like this and support at www.thematernitynetwork.co.uk

Birth plan for………………………………

I am planning a vaginal, natural water birth without intervention but, should circumstances change I am willing to consider other options so long as I am fully informed of the advantages and disadvantages.

Attending: I would like my husband / partner / doula / friend / children to be present.

1^st Stage:

I would like to remain at home for as long as I feel comfortable. If possible I would like to be attended by the community midwife at home

The atmosphere:

I would like my partner to be able to join me in the pool if I choose at the time / I wish to remain on my own in the pool with my birth supporters outside the pool.

I wish to have music playing.

I wish for health care providers to keep non-essential talk to a minimum

I wish for any hand over’s between midwife shift changes to be done outside the room so that I can continue labouring uninterrupted

We wish to use HypnoBirthing/Natal Hypnotherapy with my husband / partner / doula / friend guiding me through it.

I would like to have the lighting kept low and subtle at all times whenever possible

Monitoring: I would like monitoring of the baby to be kept to a minimum unless there is cause for concern.

Medication:

Should the need arise for intervention I would like it all to be explained and discussed first.

I would like information about any proposed medication before receiving it, including the purpose, potential side effects on me and the baby

Pain Relief

I would like to cope without pain relief / I would like to use gas and air / TENS machine / homeopathic remedies

I would like to have massage by my partner/doula

I would like to use the birth pool for relaxation and to progress labour, I know that it is best used at 5-7 centimetres dilated when labour is established.

I would like to remain as active as possible, finding the best positions for me and changing these as I wish / I wish to have positions suggested which could encourage an active birth

Transition: I would like to be guided through this stage / I wish to be left alone during this stage

2nd Stage – pushing your baby into the world

I would rather not be told how to push, or guided in the second stage, unless there is a particular reason to suppose that I need assistance, or unless I ask for assistance.

I would like to deliver my baby in water / I wish to exit the pool and deliver my baby on the beanbag / floor / bed / couch / other

I would like to find my own comfortable position for pushing. This is likely to be ……………..

I wish to know / do not wish to know when the head is crowning

I wish to feel the baby’s head / see it in a mirror / I do not wish to know when the baby is crowing

I would like talk to be kept low and relaxed at this time / I wish to have a cheerleading team encouraging me

I would like guidance at this time to prevent too quick a delivery to prevent tearing

I do not wish to have an episiotomy unless vital / I prefer an episiotomy to tearing

I wish the baby to be delivered onto my chest / I wish to hold my baby straight away / I wish to pick my own baby up. I would like the midwife to observe and to be on hand in case of emergency, but otherwise I want to be left to give birth entirely under my own guidance.

We would like to discover the sex of our baby ourselves

Please do not suction mucus from the baby's nose and mouth 'just in case' - only suction if necessary.

3rd Stage – delivering the placenta

I would like to have a physiological third stage / I wish to have an actively managed 3rd stage.

If I give birth in the pool, I would like to get out /stay in the water for the third stage.

I wish to exit the pool to deliver the placenta / I wish to stay in the pool to deliver the placenta

I wish our baby to breastfeed help deliver the placenta

We do/do not wish to keep the placenta / We are interested to have the placenta shown to us and explained

Please save our placenta, we are having the placenta encapsulated

The cord:

We are planning a Lotus Birth and do not wish for the cord to be cut

I would like the cord to stop pulsating before it is cut

My partner would like to cut the cord / My partner would like to opportunity offered to cut the cord / my partner does not want to cut the cord

Our Baby:

We do not want our baby to be given any artificial milk, we wish to be given the support to breastfeed, even if this is not immediately possible after birth. Under no circumstances is my baby to be bottle-fed as this could lead to nipple confusion and prevent breastfeeding. If formula is necessary, please have my partner/doula give it by spoon or open cup

We would like our baby to stay with one of us at all times.

We would like to be left alone with our baby.

We would like to be consulted if our baby needs to go to special care.

We want our baby to have the vitamin K injection / we have decided we do not want our baby to receive vitamin K injection

Stitches

If one occurs I would prefer not to be stitched unless it is essential to healing / I prefer to be stitched

If stitching is necessary I do want a local anaesthetic to be well administered prior to stitching / I would like Gas and Air on hand for when I have stitches.

Emergencies and transferring from a homebirth to hospital

My partner and I would like all the information to be able to discuss all eventualities as they arise.

Please share any concerns about the labour or my baby with us as soon as they arise.

In the event that assisted delivery is necessary I prefer ventouse suction to forceps.

In the event that a caesarean section is necessary I would like to have a spinal / epidural / general anaesthetic.

If transfer by ambulance becomes necessary, I would prefer to be on my side, to make contractions easier to deal with and continue an active labour

Please do not offer Pethidine as I am concerned about its possible effect on my state of mind in labour, and on my baby's health / I would like to keep an open mind about my pain relief options; please suggest anything you think would be appropriate.

I am very keen to avoid a caesarean section if it is at all possible, I would like to allow my labour to take it’s time when I arrive in hospital as it may slow down due to the transfer. Please encourage me to keep going and try changes of position or movements which might help. Please do not offer a caesarean unless my baby is in danger.

If a caesarean section becomes necessary, I would prefer to remain awake with epidural or spinal block anaesthesia. I would like my partner to stay with me at all times, and would like my partner to have skin-to-skin. I would also like to breastfeed as soon as possible.

If I have trouble breastfeeding, I would greatly appreciate the help of a midwife who is fully supportive of breastfeeding, and would also like to be given contact details for local breastfeeding counsellors.

In The Post-Natal Ward

We do not want our baby to be given any artificial milk.

I intend to breastfeed on demand OR I intend to bottle feed on demand.

I would like our baby with me at all times unless I request otherwise.

CranioSacral Therapy for babies. For birth trauma