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    My Birth Plan: Preparation

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    isapatrick8126
    The document is a birth plan for an expecting mother's third vaginal childbirth at Arlington, VA Hospital. She lists her preferences for labor and delivery including wanting an epidural if needed for pain management, taking a shower after her water breaks, and holding her baby skin-to-skin immediately after birth. She also outlines her wishes for care of the newborn after delivery including vaccinations, circumcision if a boy, and exclusively breastfeeding while in the hospital room.

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    My Birth Plan: Preparation

    Uploaded by

    isapatrick8126
    117 views2 pages
    The document is a birth plan for an expecting mother's third vaginal childbirth at Arlington, VA Hospital. She lists her preferences for labor and delivery including wanting an epidural if needed for pain management, taking a shower after her water breaks, and holding her baby skin-to-skin immediately after birth. She also outlines her wishes for care of the newborn after delivery including vaccinations, circumcision if a boy, and exclusively breastfeeding while in the hospital room.

    Original Description:

    BIRTH PLAN

    Original Title

    My Birth Plan

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    The document is a birth plan for an expecting mother's third vaginal childbirth at Arlington, VA Hospital. She lists her preferences for labor and delivery including wanting an epidural if needed for pain management, taking a shower after her water breaks, and holding her baby skin-to-skin immediately after birth. She also outlines her wishes for care of the newborn after delivery including vaccinations, circumcision if a boy, and exclusively breastfeeding while in the hospital room.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    117 views2 pages

    My Birth Plan: Preparation

    Uploaded by

    isapatrick8126
    The document is a birth plan for an expecting mother's third vaginal childbirth at Arlington, VA Hospital. She lists her preferences for labor and delivery including wanting an epidural if needed for pain management, taking a shower after her water breaks, and holding her baby skin-to-skin immediately after birth. She also outlines her wishes for care of the newborn after delivery including vaccinations, circumcision if a boy, and exclusively breastfeeding while in the hospital room.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    My Birth Plan

    Date: ____Name: I________want to express my birth wishes to the care givers at Arlington,
    VA. Hospital where I have completed childbirth classes I expecting a boy. He will be my
    third vaginal childbirth. I am flexible to the decisions of healthcare team that could
    make in behalf of my newborn and myself as long I have been informed previously and I
    consent.

    HUSBAND NAME: _____ DUE DATE: ______INSURANCE #_______MD. NAME (CELL): ________

    PREPARATION: I WILL WEAR MY NURSING BRA, GOWN, GLASSES, IV SALINE LOCK ON LEFT FOREARM. I AM SHAVING MY
    GENITAL HAIR AT HOME. I PREFER TO WALK AROUND WHEN OUT OF BED WITH PORTABLE INTERMITTENT MONITORING.

    As MD discretion, artificial IV induction: ____ If possible no C


    section_____ No forceps use_____
    Pain management: No narcotics use_____ Epidural IV drip when active
    labor, if needed_____ PM

    COMFORT LABOR & DELIVERY: FAMILY CENTERED CARE ROOM


    Ice chips, clear chicken soup, flavored gelatin, water ___ Coached push,
    breathing exercises____
    Room w/environment: soft water river sounds___Room temp.73 F__ Vaginal
    exams MD___
    I want to take a warm shower after my water breaks____ Aromatherapy
    lavender scent_______
    Episiotomy if necessary ___No pictures, visitors labor and delivery_____
    I prefer Squat for delivery___
    I authorize in our behalf EBP interventions medically recommended to
    preserve our lives____
    After childbirth and placenta delivery:
    I prefer to hold my baby dried off, skin to skin dry placed matching ID
    bands (3) immediately ____
    I will donate my baby cord blood____. I would like to eat, have a clean
    bed, a warm shower and clean post maternity dress, rest with dim lights
    at room_____
    I plan exclusively breastfeeding my baby while at my room_____
    I want all hospital newborn evaluation and procedures at the first 3
    hours after delivery such as: measurements, weight___ Height__ Abnormal
    newborn reflex (to be notified) ___ Vit. K___
    Hepatitis vaccine___ eye ointment____ babys first bath ____.
    Birth certificate before discharge____ I want my baby circumcised at the
    hospital _____
    Appointments and follow up care for me and newborn instructions verbally
    & written_____
    I plan exclusively breastfeeding my baby while at my room ____
    After, I want Wi- Fi signal to face time and pray with my mother and take
    family pictures____.
    signature________ print name _______ witnessed by _______
    Date______

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