BIRTH PLAN

Our birth plan outlines your preferences for your labor and birth. It helps communicate your wishes to you birth team, ensuring that we understand your goals and priorities. Keeping an open mind is important as birth can be unpredictable. We go over this birth plan below at your 36 week appointment, and input everything directly into your chart. There is no need to print and fill in. It’s pretty short as a lot of preferences such as movement in labor, eating and delayed cord clamping is our standard of care. We do recommend that you make your own birth plan to keep if there is a change of plans and you need to give birth in the hospital. We’ll include some of those prompts as well.

PLANNED BIRTH CENTER OR HOME BIRTH

Birth Center or Home:

Student Involvement:

Family/Friends:

Labor Support: (Doula)

Photographer:

Chiropractor:

BIRTH SPECIFICS/OBJECTIONS:

RELIGIOUS/CULTURAL BELIEFS and/or PRACTICES:

CATCHING: (dad, mom, midwife, etc)

CORD: (who’s cutting)

PLACENTA: (encapsulating, keeping it to plant a tree with, dispose, etc)

CHILDCARE or PET CARE in LABOR:

CHILDCARE/POSTPARTUM HELP:

BLOOD WORK IN LABOR: Declined, Consent signed at intake (these labs are done at 36 weeks)

VIT K: (regular is included in your care, preservative free is an extra fee)

ERYTHROMYCIN:

NEWBORN ABO: (baby’s blood type; we use cord blood so we don’t have to draw it directly from the baby $25)

DRUG ALLERGIES:

BLOOD TYPE: (it’s ok if you don’t know it!)

EXPECTANT/ ACTIVE Management of 3rd Stage: (injection of Pitocin to avoid a hemorrhage is active management / expectant is treat with antihemorrhagic medication only if needed)

HOSPITAL (NON-EMERGENT):

HOSPITAL (EMERGENT): (Baylor if you’re at the birth center / closest hospital with L&D if at home)

Hospitalist HOSPITAL (BABY): (Baylor if you’re at the birth center or Children’s if baby needs specialty care. Closest if at home)

Baylor PEDIATRICIAN/FAMILY PHYSICIAN:

PLANNED OR UNPLANNED HOSPITAL BIRTH

Name:

Due Date:

Baby’s name and gender if you know or want to share:

Partners Name and Phone Number:

Environment: Preferences such as dim lighting, music or quiet space

Movement: (Consider asking for wireless monitors here, birth ball, peanut ball or access to shower/tub if available)

Positions for Labor: Any specific positions you prefer for laboring or during the pushing stage

Pain Management: (If you are transferring for pain management think of if you would like an epidural or IV narcotics first. Are there any medications you do not want offered unless medically indicated?)

Induction Methods: (This is something to think about if you need a planned hospital birth and need to be induced. We will talk about all the options it’s just good to write them down if you have a strong desire to try one method over another.)

Augmentation: (Speeding up labor. Natural vs medicated. Starting slow if consenting to pitocin, etc)

Episiotomy: (Unless medically necessary this practice tends to be outdated but it is still good to address)

Pushing: (If unmedicated do you want to listen to your body or do you desire to be coached?)

Assisted delivery: (How do you feel about the use of forceps or vacuum? Medically indicated only or if the OB feels the need to move things along sooner?)

Cesarean: (Non-emergent who would you like in the room with you, would you like music, would you like it quiet or do you want to know step by step what is happening, are clear drops if available, photos, skin to skin immediately. Emergent who do you want waiting for you in recovery, can you give a camera to the nurse for immediate photos)

Newborn Procedures: (Vitamin K, Erythromycin, or Hep B vaccine)

Feeding: (breastfeeding, bottle feeding, use of pacifiers)

Circumcision: (if applicable)

Baby leaving the room: (if you desire to have someone accompany baby if they leave your room at any time add it to your birth plan)

Pediatrician: