BIRTH PLAN – HAVING A BABY IN CANBERRA Name: Date: Ob

BIRTH PLAN – HAV ING A BA BY I N C AN BE RR A

Name: ___________________________________

Date: ____________________________________

Ob/Midwife: ______________________________

Partner’s Name: ___________________________

Due Date: ________________________________

Hospital: _________________________________

Please note that I have:

 Group B Streptococcus

 I am RhD negative

 Have gestational diabetes

I am planning a:

 Vaginal delivery

 Caesarean birth

 VBAC

 Water birth

During labour and birth, I would like to be kept informed of how things are progressing and the health and

wellbeing of my baby. I would like to be informed and involved in any decisions made about any

interventions or procedures that may be required. If I am unable to make an informed decision or give my

informed consent I would like my partner/support person to do so on my behalf.

I’d like the following people present during my labour and birth:

_________________________________________________________________________________________

During labour, I would like:

 The lights dimmed

 Music playing

 My partner to be present always

 To move around freely

 To use the bath and/or shower

 As few vaginal exams as possible

 Foetal monitoring only as required

I plan to manage pain using:

 Breathing techniques

 Acupressure

 Cold/heat packs

 Massage

 Water immersion

 Warm shower

 Meditation

 TENS

 Walking / movement / active birth

techniques

 Nitrous oxide

 Pethidine

 Epidural anaesthesia

I would like pharmacological pain relief;

 Only when I request it

 Offered to me by my care providers as required

 Never

I would like an episiotomy:

 Only as a last resort

 Performed rather than risk a tear

 If deemed necessary by my

doctor/midwife

 Never

During the birth of my baby I would like to:

 Push spontaneously

 Push as directed

 Avoid forceps or vacuum assistance if possible

 Be given injection of synthetic oxytocin to help deliver the placenta

After my baby is born I would like:

 Skin to skin contact immediately

 Delay clamping of umbilical cord

 My partner to cut the umbilical cord

 To keep the cord blood

 To keep the placenta

 To stay with my baby at all times if

possible

 My partner to stay with baby if I

cannot

I plan to:

 Exclusively breastfeed

 Formula feed

 Combined feeding

 Feed on demand

 Feed on schedule

I agree to the following medical exams and procedures;

 Vitamin K at birth

 Hepatitis B vaccine

 Newborn Screening test

 Newborn Hearing Screen

If my baby is not well, I would like:

 My partner and/or I to accompany him/her to NICU or other facility

 To breastfeed or provide expressed breastmilk

 To hold him/her whenever possible

 Be informed and involved in decision making regarding his/her condition

Comments:

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