Download the birth plan that is shown below

BIRTH PLAN OF:
DATE:

When you experience an uncomplicated birth, many things will happen in a quiet atmosphere and there will be enough time to relax after the birth and to respect the new parents’ wishes. However, at times immediate action is needed and sometimes this involves an intervention that does not fit in your, as parents, pre-created idea about the birth. Such interventions will always be clarified by us (in acute situations this explanation might be given at a later time). Still it is important to think about your view on labour and the birth of your child, and about what you would consider to be the ideal conditions . Your birth plan will be discussed with your midwife during one of your next appointments.


Which location has your preference concerning the place of birth?

o   home

o   birth centre

o   hospital, non-medical

o   hospital, I have no choice due to a medical reason

o   I don’t know yet

o   other: _____


Which position(s) seem(s) the most comfortable to you to give birth in, at this moment?

o   lying down on my back

o   in a bath

o   on a birthing stool

o   squatting

o   on all fours

o   other: _____


At this moment, who would you want to be around you while giving birth?

o   just my partner, the midwife and the maternity/obstetric nurse

o   the above + friend(s) and/or mother (in law)

o   other: _____


What kind of atmosphere would you like to be in while giving birth?

o   dim lighting, candles, relaxing music

o   a lot of distraction

o   other: _____


Would you like to have a mirror at hand during the birth so you can watch your baby being born?

o   yes

o   no

o   I don’t know yet


If possible, would you like to seize the baby yourself (or your partner) when it is born?

o   yes

o   no

o   I don’t know yet


Would you like to hold your baby on your belly immediately after birth or would you want us to ‘clean’ the baby first?

o   directly on my belly

o   clean first

o   I don’t know yet


If possible, who will cut the umbilical cord?

o   I will

o   my partner

o   my elder son/daughter

o   the midwife

o   other: _____


What would you like to do with the placenta after we have checked it for completeness?

o   bury it in the garden

o   throw it away with the garbage

o   other: _____


Do you want to offer your baby your breast to drink within 1 hour after birth?

o   yes

o   no, because _____

 

The questions as stated above are the ones we, as midwives, get asked the most. Following, you will find a few more suggestions on topics you can use to write your personal birth plan. Furthermore you will find a few ‘open’ questions we invite you, as parents, to think about.


SUGGESTIONS TO WRITE YOUR PERSONAL BIRTH PLAN:
  • What is your view on rupturing your perineum or having an episiotomy during the birth?
  • What is your view on supplementary feeding for the baby with formula milk, if necessary?
  • In case of a caesarean section, would you like your partner to stay with you or with the baby after it is born?

OPEN QUESTIONS

 

At this moment, are there any issues that are bothering you as upcoming parent(s)?







 

What is your view on medical pain relief, what would, or not be, an option?







Are there any other factors you would like us to take into account or be aware of?