My Natural BabyBirth – Birth Plan
Names: ________________________
Doctor: ________________________
This birth plan aims to help our providers understand and know what to expect from us about the
kind of care we hope to experience with our childbirth. We’ve chosen our doctor for reasons that he
respects our decision for a natural birth, with desire for low-intervention, and that he communicates
well with us. We know that our doctor will seek our judgment and wishes on all issues regarding our
birth situation and anything that may vary from this plan. Our desire is for a birth as natural as
possible that does not use unnecessary procedures and treatments.
We know that we cannot completely control our birth experience, however we would like to lead
decision making and help direct actions toward it. When we feel respected about our chosen birth
plan, we will be more understanding about deviating for necessary changes. Please let us know
immediately if you think we need to change any decisions regarding our plan and why those changes
may be needed. We want to be consulted and have our consent given before any medical procedures
are conducted.
We fully realize that emergencies do happen in some cases and we trust that our health care team will
make the best decisions for the health of our family. Thank you for all your help and support.
Individuals Present
 It is vital for us to remain together during the entire labor and delivery, whether it be vaginal or
cesarean.
 We highly value our privacy and wish only the necessary personnel be present.
 Any visitors requesting access to our labor and delivery rooms that did not arrive with us
originally, please have them wait until we are ready to see them.
Preparation
 (List here any allergies you may have)
 No routine prep procedures such as enema or shaving.
 No attached IV line unless deemed necessary.
 Do not want the bag of waters broken prematurely unless requested.
Labor
Environment
 Have the lights dimmed when possible.
 Personnel to keep their voices quiet and respectful.
 Prefer to be able to document our birth with cameras.
 Want to have ice chips and popsicles available, even hard candies when desired.
 Prefer to walk to the bathroom when needed.
 If having a catheter becomes necessary, we’d like it removed immediately after the bladder is
void.
Fetal Monitoring
 Only as much as required to determine the condition of the baby.
 Do not want internal monitoring unless it is specifially needed medically.
 Cervical exams only for initial determination, when labor changes, or by request.
Pain Relief
 Want a variety of natural methods: relaxation techniques, breathing, massage, changing
position, water in the tub or shower.
 No pain medication or epidural are to be offered to us unless it is requested.
 If possible, we would like to have available a squatting bar, birthing stool, rocking chair, and
birthing ball.
 Want to choose any positions and movement levels that provide more comfort.
 Desire to walk around as much as possible in order to help labor progression.
 As long as no issues with the baby are present, we do not want the labor augmented.
Pushing & Delivery
Episiotomy
 We want to try for an intact perineum, but a small tear is preferable to a large incision.
 Local anesthetic is fine for performing and repairing a necessary episiotomy.
 Desire for the incision to align vertically and not go through the rectal opening.
Expulsion Methods
 Personnel desired time limits are not to be considered if the baby is doing fine.
 Would like self-directed pushing using (your chosen methods here, ie Lamaze, Bradley)
techniques.
 If pushing isn’t progressing efficiently, please remind us about changing positions to better
help: squatting, on hands and knees, side lying. Flat on back is NOT an option.
 Perfer kiwi cap vacuum if necessary.
 Mother/Father would like to catch the baby if conditions allow it.
Pain Relief
 Want a variety of natural methods: relaxation techniques, breathing, massage, changing
position, water in the tub or shower.
 No pain medication or epidural are to be offered to us unless it is requested.
 If possible, we would like to have available a squatting bar, birthing stool, rocking chair, and
birthing ball.
Baby’s Arrival
 Want the baby placed upon mother’s chest immediately after delivery.
 DO NOT want the cord clamped or cut until a pulse is no longer present.
 Father wants to cut the cord.
 Mother wants to nurse immediately after birth if possible.
 Prefer to post pone routine newborn procedures until we’ve had a chance to bond with our
baby.
After Birth
 Prefer natural placenta separation from nursing stimulation rather than inducing.
 If blood flow is heavy, pitocin may be used to help control the loss.
 Mother prefers to do fundal massage and pressure herself after being instructed how.
 Desire to walk after the delivery to recovery room for freedom of movement.
Recovery
 Please hold all phone calls and visitors until instructed.
 Want to breastfeed on demand with assistance only when requested.
 Want to be discharged as soon as possible once practitioner has approved.
 Access to ice packs, Tucks pads, peri-bottles for washing, and a heating pad for comfort.
 Please provide the mother with nutritious food and drink as soon as possible.
Baby Care
 Breastfeeding only—NO supplementation of any kind.
 Want all routine procedures done in our room if possible.
 When the mother cannot accompany the baby, we want the father to be present with the baby
at all times.
 Bathing the baby is permitted after the natural vernix has been absorbed.
CONTIGENCY PLAN
Cesarean Delivery
 A c-section is only desired when the life of the mother or baby are at stake.
 Please keep all communication open as much as possible about procedures and when things
occur.
 We want to be together at all times, with the mother awake and aware of the birth if possible.
 Want a low-transverse incision.
 Want to hold and nurse the baby as soon as possible after delivery.
Premature/Ill Baby
 We want to accompany the baby at all times during necessary transport.
 Desire to breastfeed exclusively and have unlimited visitation and holding of our baby.
 Have all procedures explained before/as they are performed when our baby’s condition
permits.
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