Birth Plan for Me These are our wishes for childbirth. We realize there are many unknowns and that this plan does not prepare us for every possible situation. If there are unusual situations that come up, we are more than willing to hear the benefits, risks, and alternatives of any changes made to this birth plan and are open to making changes as indicated to ensure a safe delivery for mom and baby. Labor I wish to be able to move around and change positions during labor I would like to be able to have fluids by mouth regularly in early labor. Please keep the number of vaginal exams to a minimum. I do not want an IV unless I am dehydrated or unless GBS + (than please cap off between doses). I would prefer to try natural methods to stimulate labor before pitocin is administered. I realize many pain medications exist-I will happily ask for them if I need them. Monitoring I do not want to have continuous fetal monitoring unless it is required by the condition of Insert Name. I do not want an internal monitor unless Insert Name shows some sign of distress. Episiotomy I would prefer not to have an episiotomy unless absolutely required for the baby’s safety. I will accept any assistance given in my quest to avoid an episiotomy including coached pushing, perineal massage, or other suggestions/interventions. Delivery I would like to be allowed to choose the position in which I give birth, and prefer no stirrups. I would like my husband Insert Name, and my support people to support me and my legs during the pushing stage. I would like my son Insert name to be placed skin to skin immediately after delivery if he is doing ok. I would prefer to have a warm blanket on top of us if there is any need to warm baby up. After Delivery I would like to wait until the cord has stopped pulsating to cut or clamp the cord and would like my husband Insert Name to cut the cord. I would appreciate if any evaluations of Insert Name could be done while he is having his skin to skin mommy time-unless there is unusual situation. Please do not administer eye drops for at least 30 minutes to allow time for feeding and bonding with my baby. I would like to donate the umbilical cord blood if possible. Breastfeeding-I plan to breastfeed Insert Name and would like to begin nursing very shortly after birth. Please only give formula via a syringe or cup if it is needed. We will provide Insert Name a pacifier if he needs one. This birth plan has been reviewed by my caregivers: Julie King, C.N.M. ________________________________________________________________ Dr. Roger W. Lewis, M.D., F.A.C.O.G. ________________________________________________ Dr. McCauley, M.D., F.A.C.O.G. _____________________________________________________