Birth Plan for the Flax Family

Birth Plan

Obstetrician: name Doula: name Hospital: name

My husband, _____ _____, and the doula, _____ _____, should be present with me throughout labor and
delivery.

Corrective Lenses: I need to wear contact lenses or glasses at all times when conscious, as my vision is so bad that
being without corrective lenses is unbearably disorienting. This should not be a problem, as my contact lenses take
very little time to remove in the event of an emergency, and furthermore are extended wear, so there would be no
problem if they were left in my eyes for an extended period of time, up to a week, including periods of sleep. My
husband will have my glasses in case I need to remove my lenses.

External Fetal Monitoring: We do not wish to have continuous fetal monitoring unless required by the condition of
the baby. We expect that there will be a period of being monitored by the external fetal monitoring upon first
arriving at the hospital, and afterwards monitoring will be intermittent as long as everything looks ok.

Prep: I would prefer to avoid an enema or extensive shaving of pubic hair.

Free Movement: I wish to be able to move around and change position at will throughout labor. I would like to be
allowed to choose the position in which I give birth, including squatting.

IV: I do not want an IV unless I become dehydrated. If necessary, I will accept having a device (heparin lock?)
inserted into a vein so that an IV can be started up quickly when needed, but without the IV being connected until
it is needed.

Artificial Rupture of Amniotic Membrane: I do not wish to have the amniotic membrane ruptured artificially before
the birth unless signs of fetal distress require an internal monitor. I do not want the internal monitor unless the baby
has already shown some sign of distress.

Fluids by mouth throughout first stage of labor.

Anesthesia and Pitocin: I do not wish to use any anesthesia unless I request it during labor. I will want local
anesthesia for repair of tears or of episiotomy, of course. I do not want routine pitocin to be used; we should be
allowed to try position changes and nipple stimulation before pitocin is used.

Episiotomy: I do not wish an episiotomy unless required to avoid an extensive tear. I would prefer a medium-sized
tear to an episiotomy, although I imagine that it may be hard to judge how much tearing will occur. I intend to take
all possible measures to avoid the need for an episiotomy.

Birth: I would like to be allowed to hold the child immediately after birth. We would prefer that the cord not be cut
immediately, but given a few minutes to cease functioning first.

Caesarian: If a caesarian is necessary, I wish to have an epidural for anesthesia, and to have my husband and, if
possible, [the doula's name] present for the birth. The child, if he is not in distress, should be given to my husband.

Circumcision: We do not wish to have circumcision performed in the hospital. (Better to go to a specialist who
uses local anesthesia, if you want this done.)

Breastfeeding: I intend to breastfeed the infant and do not wish to have any bottles given to him, including glucose
water. [This was not followed, which caused big troubles!!!]

Rooming-in: We would like to have the baby remain with us in our room. We do not want the baby to be taken
away from us unless he requires medical treatment, or unless we request to have him taken to the nursery. We
would like to have the baby examined in our presence.