TWIN GEMS BLOG PREGNANCY BIRTH PLAN 1
TWIN PREGNANCY BIRTH PLAN
Support During Labor and Birth
During by labor I would like to have present
o My partner
o The following support people:
o Birth doula
o Visitors, depending on how I feel at the time
o Personal preference:
During my baby’s birth, I would like to have present
o My partner
o The following support people:
o Birth doula
o Personal preference:
Pain control during labor and birth
In regards to pain control options, I wish:
o To have an unmedicated birth
o In support of the unmedicated birth option periodically remind me of:
 Breathing techniques
 Relaxation
 Position changes
 Birth ball
 Rocking chair
 Massage
 Hydrotherapy
o To have medication if needed for pain relief
o To have an epidural
o Personal preference:
Labor
If medically safe for me and my babies, I would like
o To walk around during early labor
o To use the birthing ball and/or rocking chair
o To use the tub/shower during active labor
o To keep vaginal exams to a minimum
o To allow labor to progress without augmentation
o To listen to music of my choice
o To have the lights dimmed
o To have ice chips/water
o To have ice pops or other clear liquids
o Personal preference:
Birth/Immediately Following Birth
If medically safe for me and my babies, I would like
o To have a mirror available to help me see to push
o To have a choice in the position I choose for pushing
o To not use forceps or suction
o To use forceps only if needed
o To use suction only if needed
o To have my partner cut the cord after delivery
o To have the baby placed on my chest in skin to skin contact immediately after
delivery
o To have my partner with me in the event that I require a cesarean section
o To have my babies cleaned on my chest
o To please delay all routine exams for _____________ (time) to allow for bonding
time
o To perform physical exams and procedures of the babies in the room with myself
and/or my partner
o To avoid that the babies’ eyes be treated with drops or ointment until an hour or
two after birth
Feeding Preferences
o I would like to breastfeed immediately after my babies’ birth
o If one of the babies require NICU care, I would like to initiate breastfeeding or
pumping within 1 to 3 hours of birth
o I would like to see a lactation consultant
o I do not want my babies to receive bottles unless it’s medically necessary
o I would prefer that my babies not be given a pacifier
o I am undecided about breastfeeding and would like more information
o I am planning to bottle feed my baby
o Personal preference:
Circumcision
o I would like my son circumcised
TWIN GEMS BLOG PREGNANCY BIRTH PLAN 3
o Personal preference:
Umbilical cord blood banking
o I would like additional information regarding public cord blood banking
o I would like to donate my babies’ cord blood to the Texas Cord Blood Bank, a
public cord bank
o Personal preference:
NICU Care
o We expect to be a part of any major discussion or permission for any medical
intervention being considered for one or both of our child(ren)
o I would like to initiate breastfeeding as soon as any baby shows signs of interest
or beings to coordinate sucking and swallowing
o If I do not provide enough colostrum or milk for both babies initially, we would
like for our babies to receive donated human milk from a HMBANA-accredited
milk bank
o We would like to initiate skin-to-skin care as soon as possible (as supported by
several NICU-care researchers)
o If both of our babies require NICU care, we would like for them to be co-bedded
in a single crib until both are medically stable
o Personal preference:
Other
o I prefer not to have an episiotomy unless medically necessary
o Personal preference:
Your name:
Due Date:
Partner:
Phone:
Physician/Group:
Phone: