Any recommendation whatelse to write in birthplan?
**MY Birth Plan **
Due Date: 06/14/05
Patient of Dr. Wong
Scheduled to deliver at JFK.
05/05/05
Dear Dr. Doctor and the staff of My Hospital.
I look forward to sharing my upcoming birth with you. I have created the following birth plan to help you understand my preferences for my upcoming labor and delivery. I fully understand that in certain circumstances these guidelines may not be followed, but it is my hope that you will assist me in making this the experience I hope for. If you have any questions or suggestions, please let me know.
Sincerely,
ILOVEMYBABY
Labor
I would like to be free to walk around during labor.
I wish to be able to move around and change position at will throughout labor.
I would like to be able to have fluids by mouth throughout the first stage of labor.
I would like the environment to be kept as quiet as possible.
Labor Augmentation/Induction
I do not wish to have the amniotic membrane ruptured artificially unless signs of fetal distress require internal monitoring.
If labor is not progressing, I would like to have the amniotic membrane ruptured before other methods are used to augment labor.
I would prefer to be allowed to try changing position and other natural methods (walking, nipple stimulation) before pitocin is administered.
Anesthesia/Pain Medication
I would like to have a walking epidural.
Cesarean
Unless absolutely necessary, I would like to avoid a Cesarean.
If a Cesarean delivery is indicated, I would like to be fully informed and to participate in the decision-making process.
I would like My Husband present at all times if My baby requires a Cesarean delivery.
If My baby is not in distress, My baby should be given to (blank) immediately after birth.
Episiotomy
I would prefer not to have an episiotomy unless absolutely required for the baby’s safety.
I am hoping to protect the perineum. I am practicing ahead of time by squatting, doing Kegel exercises, and perineal massage.
I would appreciate guidance in when to push and when to stop pushing so the perineum can stretch.
If possible, I would like to use perineal massage to help avoid the need for an episiotomy.
I would prefer an episiotomy rather than a tear.
I would like a local anesthetic to repair a tear or an episiotomy.
Delivery
I would like My Husband and/or nurses to support me and my legs as necessary during the pushing stage.
I would like a mirror available so I can see My baby’s head when it crowns.
I would appreciate having the room as quiet as possible when My baby is born.
I would like to have My baby placed on my stomach/chest immediately after delivery.
Immediately After Delivery
My Husband does not wish to cut the cord.
I would prefer that the umbilical cord stop pulsating before it is cut.
I would like to hold My baby while I deliver the placenta and any tissue repairs are made.
I would like to hold My baby for at least fifteen minutes before (he/she) is photographed, examined, etc.
I would like to have My baby evaluated and bathed in my presence.
I plan to keep My baby near me following birth and would appreciate if the evaluation of My baby can be done with My baby on my abdomen, with both of us covered by a warm blanket, unless there is an unusual situation.
If My baby must be taken from me to receive medical treatment, My Husband or some other person I designate will accompany My baby at all times.
Postpartum
I would like a private room, if available.
Unless required for health reasons, I do not wish to be separated from My baby.
I would like with me during the day but in the nursery at night, but brought to me for breastfeeding.
Breastfeeding
I plan to breastfeed My baby and would like to begin nursing very shortly after birth.
Unless medically necessary, I do not wish to have any bottles given to My baby (including glucose water or plain water).
I do not want My baby to be given a pacifier.
I would like more information about breastfeeding.
I would like to meet with a Lactation Consultant.
Circumcision
If I have baby boy please circumcised him in present of my husband.
Other
My support people are MY husband and my Mom and I would like them to be present during labor and/or delivery.
I would prefer that no students, interns, residents or non-essential personnel be present during my labor or the birth.
I WANT ONLY FEMALE NURSES AND DOCTORS present at time of labour and/or delivery.