Sample VBAC Birth Plan
BIRTH PREFERENCES*
PREADMISSION/ADMISSION
We request:
- to have as much required paperwork as possible competed during a preadmission visit to eliminate
interruption during relaxation for labor
- to consider natural means of induction if pregnancy reaches 42 weeks or there appears to be a
medical need for delivery
- to wait for labor to start naturally after SROM
- to remain at home as long as possible before coming to the hospital
- to decide whether to use a wheelchair or walk to my room
- to return home if I am not dilated at least 4cm
- no IV upon admission; instead, I would like a heplock in place
- To have the following persons present during my birthing: husband and doula
- To use my iPod to listen to music/meditation
- No discussion on pain tolerance and pain levels; I would prefer to have my comfort level assessed as
needed.
- No telephone calls in my room
DURING LABOR AND BIRTH
We request
- The opportunity to experience the most natural, intervention-free birth experience possible
- To use wireless telemetry monitors instead of being hooked up to stationary monitors
- Only necessary staff or observers in room. We ask the staff to honor our need for quiet
- To have staff refrain from references to “pain,” “hurt,” or “hard labor”; instead inquiring about
“comfort level” as needed
- To have my doula, _____, as well as my husband present at all times
- No offer or suggestion of anesthetics or analgesics or labor enhancing procedures unless requested
- Fluids during labor including juices, herbal teas, broth, ice chips and popsicles
- To be free of blood pressure cuff between readings
- To assume labor positions of choice including the choice to walk and move or not walk and move
during labor
- Minimal number of vaginal exams
- To allow labor to take its natural course without references to “moving things along.”
- To use natural oxytocin (nipple) stimulation in the even of a stalled or slowed labor
- No rupture of membranes
- To use tub, shower and birthing ball as desired
- Use of Hypnobirthing breathing down techniques for birthing
- To birth in an atmosphere for gentle encouragement – calm, low tones only- during final pushing
stage without loud coaching.
- To assume the birthing position of choice that will least likely require an episiotomy
- To take pictures during birth
- Use mirror if desired to see crowning and birth
- To delay cord clamping until it stops pulsing
- To have baby placed on my chest following birth
- To have baby assessed while on my chest
- To have father cut the cord
- To allow natural delivery of placenta without pitocin
- To have our daughter come shortly after birth
We would like to discuss:
Methods of natural induction/augmentation of labor
Perineal massage/warm perineal compress
Episiotomy
Vacuum extractor/forceps
CESAREAN DELIVERY
We request
- to avoid a cesarean delivery unless the baby’s life is in imminent danger
- to have at least 1 arm free/not strapped down to table
- To be placed at a slightly raised angle
- for anesthesia to be monitored/adjusted to prevent feelings of suffocation
- To have screen lowered during baby’s birth
- to see the baby immediately following delivery in order for us to announce the sex
- to have baby placed on my chest immediately following birth
FOLLOWING BIRTH
- lower bright lights temporarily at the moment of birth and until baby is on my chest
- allow vernix to be absorbed into baby’s skin; avoid vigorous rubbing and delay cleaning
- Baby should remain with me and my husband
- We do NOT consent to erythromycin or other medication in baby’s eyes
- We do NOT consent to CIRCUMCISION
- We do NOT consent to the HEP B vaccine
- We will decide after birth whether to administer vitamin K
- Immediate and exclusive breastfeeding- no bottles, formula, pacifiers, etc unless medically indicated
and after discussion with us
- In the event that I need to pump, I would like the baby to be fed with a medicine cup or dropper.
IN THE EVENT OF A STILLBIRTH OR NEONATAL DEATH
We request:
- time alone with our baby
- to have pictures taken
- to have footprints taken
Knowing that hospitals and their staff are quite busy, I wrote up a 1-page "abridged"
version of my birth plan to the hospital:
BIRTH PREFERENCES
PREADMISSION/ADMISSION
We request:
- to return home if I am not dilated at least 4cm
- Heplock instead of IV
- No telephone calls in my room
DURING LABOR AND BIRTH
We request
- To experience the most natural, intervention-free birth experience possible
- To use wireless telemetry monitors
- Only necessary staff or observers in room. We ask the staff to honor our need for quiet
- To have our doula, _____, present
- No references to “pain,” “hurt,” or “hard labor”; instead inquiring about “comfort level” as needed
- No offer or suggestion of anesthetics or analgesics or labor enhancing procedures unless requested
- No blood pressure cuff between readings
- Minimal number of vaginal exams
- To use natural oxytocin (nipple) stimulation in the even of a stalled or slowed labor
- No AROM
- To use tub, shower and birthing ball as desired
- To use Hypnobirthing breathing down techniques for birthing
- No loud coaching during birth. Please use calm, gentle tones
- Use mirror to see crowning and birth
- To delay cord clamping until it stops pulsing
- To have baby placed on my chest following birth
- To have baby assessed while on my chest
- To have father cut the cord
- To allow natural delivery of placenta without pitocin
CESAREAN DELIVERY
We request
- to avoid a cesarean delivery unless the baby’s life is in imminent danger
- to have at least 1 arm free/not strapped down to table
- To be placed at a slightly raised angle
- for anesthesia to be monitored/adjusted to prevent feelings of suffocation
- To have screen lowered during baby’s birth
- to see the baby immediately following delivery in order for us to announce the sex
- to have baby placed on my chest immediately following birth
- To have baby in recovery with us
FOLLOWING BIRTH
- allow vernix to be absorbed into baby’s skin; avoid vigorous rubbing and delay cleaning
- We do NOT consent to erythromycin or other medication in baby’s eyes
- We do NOT consent to CIRCUMCISION
- We do NOT consent to the HEP B vaccine
- We will decide after birth whether to administer vitamin K
- Immediate and exclusive breastfeeding
* This birth plan is based off of the "birth preferences" sheet given out during the HypnoBirthing class
at Hunterdon Medical Center in Flemington, NJ