Plan, Sample 5
Plan for ___________ and ________ __________
My husband and the doula should be present
with me throughout labor and delivery.
We respectfully request that there be
as little intervention as possible, unless an emergency arises.
We would like to be part of the decision-making
to be consulted with and asked for our consent
before any medical procedure is performed.
We would prefer NOT to have the routine
IV (please use heparin lock if
Frequent electronic fetal monitoring
Medications for pain
Pitocin for Labor augmentation
Artificial Rupture of Membranes
Frequent vaginal exams
We would like to have freedom of motion
and a choice of laboring positions
Induction/Augmentation of Labor:
I would like for my labor to proceed at its own natural pace,
and would therefore like to avoid measures such as amniotomy,
stripping of membranes, and/or pitocin unless a specific medical
*Unless there is excessive bleeding, we
prefer not to have routine pitocin administered after the birth.
I would like to push spontaneously with the urge, not directed
I would like perineal massage done during the birthing process.
We would like to avoid an episiotomy; if one is deemed absolutely
necessary, we would like to try for a pressure episiotomy when
the baby's head is crowning.
I would like rooming in 24 hours a day.
I would like the baby to be handed to my husband after the newborn
procedures have been performed.
I would like to Breastfeed as soon as the baby and I are ready.
I would like to request that s/he not be given artificial nipples
of any kind, including bottles (formula or water) or pacifiers.
In the case that a cesarean section needs to be performed, we
would prefer not to have general anesthesia, allowing the mother
to be awake and alert for the birth and the father and doula
to be present.
If the baby should need special
care, we want to be involved in that care as much as possible
and want the baby breast-fed or given expressed mother's milk
from a bottle.