Page 31 - The Doula Hub - Flip book_Neat

E X A M P L E B I R T H P R E F E R E N C E S

– Physiological Birth Doula – Mary-Anne 07973496092
Partner – Bill 07496029683

Thank you for taking the time to read our birth plan.

About me Labour & Birth Monitoring of Baby

Name – Ameillia Smith I would like to be free to walk around during labour. I would prefer Electronic Foetal Monitoring kept
Hospital # - I wish to be able to move around and change position at will to a minimum.
throughout labour. I would prefer the use of hand held Doppler.
Husband/Partner - Bill I would prefer to keep the number of vaginal exams to a
Doula - Mary-Anne minimum.
st
1 birth – unplanned c-section I would like to be able to eat and drink as I wish.
I suffer from anxiety attacks, but have this under control We would like the Mother/Father to discover the sex of baby.
with Citalopram 0.5mg per day
I have an aversion to needles so please use ‘magic’ cream if
needed

Pain Management & Environment Acceleration Unplanned Caesarean birth

If I feel the need for pain management other than what is I would like the amniotic membranes to release We would like our baby skin-to-skin immediately.
listed below, I will ask for it. Please do not offer it to me. spontaneously. We would like delayed cord clamping as per
Massage I would like labour to be allowed to take its natural cause. latest NICE guidelines.
TENS Machine We would like the room kept quiet and the lights
Music and aromatherapy dimmed.
Water We would like a family centred caesarean.
Gas & Air I would like heart monitor pads put on my back.
I would like the environment to be kept as quiet as possible. Cannula placed in less dominant hand and arm
I would like the lights in the room to be kept low during my left out of gown.
labour.
I’m using Hypnotherapy

After the birth Third Stage Other

I would like my baby to be delivered onto my tummy and I would prefer that the umbilical cord stops pulsating before We would like to be kept fully informed of all
have skin to skin. it is cut. developments and share in any discussions and
I intend to breastfeed/formula feed I am planning a physiological third stage. decisions.
I would like the Paediatrician to examine my baby in our I would like to see my placenta. We do/do not mind students being present.
presence. I’m keeping my placenta and have a cool box for it.
We would like to be left alone after birth for bonding. Father/mother would like to cut the cord.
We would prefer our baby to have Vitamin K orally/injected