This Birth Plan Worksheet is designed for use by expectant parents all over the United States. It has a variety of options listed to stimulate research regarding what is available in your community. It is not designed to be printed in its entirity, rather to be used to discuss options with your careprovider.

Need one to print? Click here to print a Birth Worksheet to take to you care provider once you have completed this worksheet!

Birth Place

Hospital	Labor & Delivery Area
Birthing Room (LDR or LDRP)	Birthing Center
Home

Care Provider

Physician	Obstetrician
Family Practice Physician	Midwife
Certified Nurse Midwife	Lay Midwife

Childbirth Education

Classes at the Hospital	Independent Educator
Educator affiliated with physician	Lamaze method
Bradley method	ICEA
Hypnosis/Hypnobirthing	other

Types of Classes

Childbirth Preparation	Breastfeeding
Parenting	Child Care
Infant/child CPR	Sibling Preparation
VBAC (vaginal birth after a cesarean)	Cesarean
Teen Childbirth Preparation	Teen Breastfeeding

Pregnancy/Birth Support

Husband/partner	Sibling of baby
Family members (how many?)_____	Friends
Certified doula/labor support professional

Labor

Oral fluids	IV
Saline/Heparin Lock	Perineal shave
Enema

Comfort Measures

Upright positioning	Hydrotherapy (labor tub or shower)
Massage/effleurage	Music Therapy
Aromatherapy	Breathing Techniques
Active relaxation techniques	Heat/cold therapy
Therapeutic touch	Reiki
Guided Imagery	Acupressure
Squatting	Hands/knees position
Birthing Ball

Assessment of Baby via Heart Beat

Intermittent Auscultation with Stethoscope of Baby's Heart Beat	Electronic Fetal Monitoring External Intermittent Continuous Telemetry
Internal Telemetry IUPC (intrauterine pressure catheter)

Medication

None	Relaxants
Local infiltration	Regional anesthetics
Epidural	Spinal
Paracervical	Pudendal
Spinal Narcotic	Walking Epidural

Induction

None	Cervical Ripening Gel
Pitocin	Amniotomy
Stripping of Membranes	Foley Catheter
Laminaria Tents

Birth Positions

Squat/using squat bar	Hands/knees
Semi-sitting or "C"	Sidelying
Sitting with feet in stirrup supports	Birthing stool

Procedures

Forceps	Vaccum Extraction
Perineal Massage (no or minimal episiotomy)	Episiotomy

Immediately after birth

Partner cut cord	Leboyer birth
Immediate skin-to-skin on mother's abdomen	Bonding - skin-to-skin
Breastfeeding	Delay of eye ointment

During hospital stay

Rooming-in	Breastfeeding
Breastfeeding without bottles, nipples or pacifiers	Breast/bottlefeeding
Bottlefeeding	Visit from Lactation Consultant
Circumcision	Sibling visitation

Going Home

Parent Answer Line	Home Care Visit
Lactation Consultant Visit	LaLeche League Information

VBAC/Cesarean

Husband/partner support	Husband/partner present during procedure
Anesthesia Options	Parent bonding afterwards
Breastfeeding immediately after