Here's an example of my birth plan and a good template for you if you ever need to make one! I obviously left a lot of info blank for safety purposes, but you get the point!
Birth Plan
Patient Info
Name: Kayla Raborn
Husband: Cody Raborn
OB/GYN:
Pediatrician:
Due Date: June 12th 2022
Baby’s Name:
My blood type:
Husband’s blood type:
Allergies:
Please Note that I have:
Scoliosis (please inform anesthesiologist)
Please Note that baby has:
Left Club foot
My Delivery is Planned as:
Natural
During Labor I’d like:
My doctor to deliver if possible
An epidural sooner than later (I have scoliosis)
Everything explained to me
No yelling
My husband in the room at all times
No students or interns
Emergency Plan:
Episiotomy only if necessary
Only use vacuum if entirely necessary
No forceps please
C-Section last resort
Immediately after Delivery:
Delayed cord clamping
Skin-to-skin immediately and delay measurements and bath (for golden hour)
Seen by a lactation consultant
No formula, no sugar water unless emergency
No pacifier
Baby to be kept in room the entire time unless emergency then husband will follow with baby
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