Birth plan Creator

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Birth plan Creator

Email *

Your Name:

Estimated Due Date:

YYYY

Hospital/Birth Center:

Healthcare Provider:

Support Person(s):

Labor and Delivery Preferences

Birthing Environment

Dim Lighting

Music (provide my own)

Essential Oils/ Diffuser

Limited Visitors

Pain Management

Breathing techniques

Massage (by support person)

Hydrotherapy (shower)

Epidural

IV pain medication

Labor Positions

Walk around freely

Use a birthing ball

Stay in bed

Birthing Stools

Fetal Monitoring

Intermittent

Continuous

I have no preference

Labor Augmentation

Medical interventions as necessary

Open to Pitocin if needed

I trust my medical team to make the best decisions

Birthing Preferences

Coached pushing

Spontaneous pushing

Avoid episiotomy unless necessary

Discuss the use of forceps/vacuum if necessary

Open to interventions if needed for safety

Cesarean Birth (if applicable)

My partner/support person to be present if possible

Gentle cesarean (immediate skin-to-skin if possible

Support person to stay with baby if the baby has to leave

PostPartum Preferences (if applicable)

Delayed cord clamping

Immediate cord cutting

My partner/support person will cut the cord

Skin-to-Skin Contact immediately after birth

Skin-to-skin contact after initial medical checks

Breastfeeding

Formula feeding

Combination feeding

Newborn Care (if applicable)

Vitamin K shot

Erythromycin eye ointment

Hepatitis B vaccine

Newborn screenings

First bath in the hospital

Yes circumcision

No circumcision

Special Considerations

Cultural or Religious Preferences:

Allergies, Medical Conditions, or Past Birth Trauma:

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