Your birth plan

I want to limit the number of guests and phone calls I have while I’m in labor by disconnecting my phone and placing a sign on my door.

I would like the hospital staff to help me limit visitors during labor.

I would like the hospital staff to help me limit visitors after labor.

I would like the lights in the room to be dimmed.

I want to be out of bed as much as possible during labor (walking, rocking, etc.)

I want to have intermittent fetal monitoring.

If I need an IV, I’d prefer to have a saline lock.

I prefer that my “waters” (amniotic fluids) break naturally.

I plan to use alternative methods to cope with labor pain. I’ll ask for pain medication if I need it.

I would like more information about pain management during labor.

I want my care team to offer me pain medication if they see that I am uncomfortable.

I want an epidural as soon as possible.

I’m considering having an epidural or pain medication, but will decide for sure when I am in labor.

I want to choose what position I will be in for labor (lying on my back, semi-sitting, squatting, lying on my side, or on my hands and knees).

I would like a mirror available so I can see my baby being born.

I would like to touch my baby’s head as it crowns.

I would like my baby placed on my chest skin-to-skin after delivery so we can start bonding.

I would prefer my baby to be lightly dried off before being placed on my chest.

If possible, I would like the cord to be cut by:

I want to delay newborn procedures (such as bathing, measuring, etc.) during the first hour so I can feed and bond with my baby.

I want all procedures and all medications explained to me before they are carried out.

I want to be there when my baby is bathed and evaluated.

If my baby needs medical treatment, my baby should be accompanied by:

I plan to breastfeed while at the hospital.

I would like additional information and support to help me breastfeed successfully.

I would like to be asked before my baby is given water, formula, sugar water, or a pacifier.

If I have a boy (check one):

I do plan on having him circumcised at Kaiser Permanente.

I do not plan on having him circumcised at Kaiser Permanente.