Thursday, November 27, 2014

Birth Plan - Sample Checklist

Birth Plan - Sample Checklist
OUR BIRTH PLAN (courtesy of HypnoBirthing Malaysia)

IC No:

We have chosen the HypnoBirthing method of quiet, relaxed and natural birth. Below is our Birth Plan. 
We understand that these choices presume a normal pregnancy and birth. Should there be a medical emergency, 
we will give our full cooperation after we have had an opportunity for an explanation of the medical need. 
We wish to have clear and adequate explanations of all procedures, of the progress of labor as it is accessed, and of any possible complications if they occur.

During 1st Stage Labor


·         Quiet room, dimmed lights
·         Drawn drapes/closed door at all times
·         Play own music tapes
·         Allow to take photos of birth
·         Mother wears own gown


·         Change positions for comfort & progress in labor
·         Freedom to walk & move
·         Fluids & light food if labor is prolonged


·         No continuous EFM unless medically necessary


·         No suggestion of anesthetic/analgesics 
unless requested


·         Natural oxytocin stimulation – 
nipple/clitoral stimulation – and to be accorded the uninterrupted privacy to do so
·         No Pitocin/amniotomy without discussion
·         To be fully apprised & consulted 
before introduction of any medical procedure

Vaginal examination

·         Minimal – with permission – to avoid 
premature release of membranes

During 2nd Stage Labor


·         Gentle encouragement during final pushing stage without loud “pushing” prompts


·         Pressure episiotomy if necessary
·         Local anesthesia for repair of tears/episiotomy


·         Use of suction device rather than forceps if medically necessary
·         Mother/father will receive baby if at all possible.
·         Father will announce sex of baby to mother.
·         Wait until cord stops pulsating. Father will cut the cord.
·         immediate skin-to-skin contact, with baby on mother’s stomach. No wrapping of baby.
·         No bulb suction unless medically necessary


·         Spontaneous or encouraged with breast stimulation and nursing baby
·         No cord traction, Pitocin or manual removal of placenta unless there is evidence of excessive postpartum bleeding

For baby

·         Bright lights temporarily removed during birth & until baby is moved to mother’s chest
·         Air-con temporarily turn down/switch off.
·         Allow vernix to be absorbed into baby’s skin; delay cleaning/rubbing
·         Baby to remain with mother & father for the 1st hour after birth.
·         Breastfeeding only. No bottle, formula, pacifier
·         Delay use of Erythromycin or other salve for baby’s eyes to allow optimal sight for bonding.

We thank you in advance for your support & kind attention to our choices. We know you join us in looking forward to a beautiful birth.



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