Birth plan
**General Information**
Name : Bridgette Mansfield
Partner's name : Scott Cotton
Health care provider : Cindy (Midwife)
Due date : 8th April 09
** Location Of Birth **
Birth Center, Womens and Childrens Hospital Adelaide
** Special Notes **
My blood type is Rhesus Negative.
** General Comments **
I would like all staff to discuss all procedures with my partner/coach and myself before they are performed.
I would like to be able to vocalize during labor and birth without criticism or comment.
I would like permission to see my chart and the baby's chart.
** Environment **
I would like the room to be quiet during labor.
I would like it if non-essential personnel, including interns and students were not present.
I would like a private birthing room.
I would like my partner to be present at all times.
I would like to wear my own choice of clothes.
I would like my supporters to be able to take photographs of the labor and delivery.
I would like my supporters to be able to video the labor and delivery.
I would like to listen to my choice of music during the labor.
I would like the lights to be dimmed during the labor.
I would like to use aromatherapy during labor.
I would like to have massages during labor.
I would like people to respect my privacy by knocking before entering the room.
** During The Labor **
I would like vaginal examinations to be kept to a minimum.
I would prefer to avoid an IV unless it is necessary.
I would like to deliver in whatever position is comfortable for me.
I would like to be able to walk around during the labor.
I would like to be able to drink fluids during the labor.
I would like to be able to eat light foods during labor.
I would like a mirror so if i want I can see the baby’s head during delivery.
** Monitoring **
I do not wish to have continuous fetal monitoring unless it is necessary.
I prefer external monitoring to internal monitoring.
I would prefer to be monitored using Doppler.
** Pain Relief **
I would like to give birth naturally without medication and use the following methods.
I would like to use a birthing tub/ shower for pain relief.
Heat pack
Massage
I would like to give birth naturally but would like the following medication to be available should I require it.
Pethidine (small dose as I am easily effected by pain relief)
Entonox (gas and air)
** Induction **
I would like to avoid induction unless there are signs of fetal distress.
Before induction, I would like to try the following natural methods to progress labor.
Relaxation
Nipple stimulation
(And whatever else comes to mind)
If induction is necessary, I prefer the following methods.
Prostaglandin Gel
Sweeping of the membranes
Breaking of the waters
As a last resort: Pitocin
** Episiotomy **
I would prefer to avoid an episiotomy, even if minor tearing is possible.
If severe tearing is iminent then an episiotomy is to be done
** Delivery Of The Placenta **
I would like medication to aid the delivery of the placenta.
** Caesareans **
I would like to avoid a caesarean unless it is absolutely necessary.
I would like a second opinion before having a caesarean.
I would like the following anesthesia for a caesarean.
Epidural
I would like my partner/coach to be present during the caesarean.
I would like my partner/coach to take photographs during the caesarean.
I would like my partner/coach to video the caesarean.
I would like the screen lowered so I can view the birth.
I would like to touch the baby as soon as possible.
I would like my partner/coach to cut the cord.
** After The Birth **
I would like the baby handed to me immediately it is born, unless there are signs of fetal distress.
I would like to have the baby evaluated in my presence.
I would like the umbilical cord to stop pulsating before it is cut.
I would like my partnerto cut the cord.
I would like my baby to be kept with me at all times.
** Feeding **
I would like to breast feed my baby.
Please do not give the baby supplements, pacifiers or glucose solution without consulting me.
** In The Event The Baby Is Sick **
I would like to breastfeed where possible.
I would like unlimited visits for the parents.
I would like to hold the baby where possible.
If it is necessary to transfer the baby to another facility, I would like to follow as soon as possible.
** Circumcision **
No circumcision is to be performed.
** Eye Care **
I would like to delay eye care until after I have bonded with the baby.
I would prefer erythromycin eye treatment to silver nitrate for my baby.
** Vitamin K **
I would like vitamin K to be administered to my baby.
I would like vitamin K to be given orally.
Name : Bridgette Mansfield
Partner's name : Scott Cotton
Health care provider : Cindy (Midwife)
Due date : 8th April 09
** Location Of Birth **
Birth Center, Womens and Childrens Hospital Adelaide
** Special Notes **
My blood type is Rhesus Negative.
** General Comments **
I would like all staff to discuss all procedures with my partner/coach and myself before they are performed.
I would like to be able to vocalize during labor and birth without criticism or comment.
I would like permission to see my chart and the baby's chart.
** Environment **
I would like the room to be quiet during labor.
I would like it if non-essential personnel, including interns and students were not present.
I would like a private birthing room.
I would like my partner to be present at all times.
I would like to wear my own choice of clothes.
I would like my supporters to be able to take photographs of the labor and delivery.
I would like my supporters to be able to video the labor and delivery.
I would like to listen to my choice of music during the labor.
I would like the lights to be dimmed during the labor.
I would like to use aromatherapy during labor.
I would like to have massages during labor.
I would like people to respect my privacy by knocking before entering the room.
** During The Labor **
I would like vaginal examinations to be kept to a minimum.
I would prefer to avoid an IV unless it is necessary.
I would like to deliver in whatever position is comfortable for me.
I would like to be able to walk around during the labor.
I would like to be able to drink fluids during the labor.
I would like to be able to eat light foods during labor.
I would like a mirror so if i want I can see the baby’s head during delivery.
** Monitoring **
I do not wish to have continuous fetal monitoring unless it is necessary.
I prefer external monitoring to internal monitoring.
I would prefer to be monitored using Doppler.
** Pain Relief **
I would like to give birth naturally without medication and use the following methods.
I would like to use a birthing tub/ shower for pain relief.
Heat pack
Massage
I would like to give birth naturally but would like the following medication to be available should I require it.
Pethidine (small dose as I am easily effected by pain relief)
Entonox (gas and air)
** Induction **
I would like to avoid induction unless there are signs of fetal distress.
Before induction, I would like to try the following natural methods to progress labor.
Relaxation
Nipple stimulation
(And whatever else comes to mind)
If induction is necessary, I prefer the following methods.
Prostaglandin Gel
Sweeping of the membranes
Breaking of the waters
As a last resort: Pitocin
** Episiotomy **
I would prefer to avoid an episiotomy, even if minor tearing is possible.
If severe tearing is iminent then an episiotomy is to be done
** Delivery Of The Placenta **
I would like medication to aid the delivery of the placenta.
** Caesareans **
I would like to avoid a caesarean unless it is absolutely necessary.
I would like a second opinion before having a caesarean.
I would like the following anesthesia for a caesarean.
Epidural
I would like my partner/coach to be present during the caesarean.
I would like my partner/coach to take photographs during the caesarean.
I would like my partner/coach to video the caesarean.
I would like the screen lowered so I can view the birth.
I would like to touch the baby as soon as possible.
I would like my partner/coach to cut the cord.
** After The Birth **
I would like the baby handed to me immediately it is born, unless there are signs of fetal distress.
I would like to have the baby evaluated in my presence.
I would like the umbilical cord to stop pulsating before it is cut.
I would like my partnerto cut the cord.
I would like my baby to be kept with me at all times.
** Feeding **
I would like to breast feed my baby.
Please do not give the baby supplements, pacifiers or glucose solution without consulting me.
** In The Event The Baby Is Sick **
I would like to breastfeed where possible.
I would like unlimited visits for the parents.
I would like to hold the baby where possible.
If it is necessary to transfer the baby to another facility, I would like to follow as soon as possible.
** Circumcision **
No circumcision is to be performed.
** Eye Care **
I would like to delay eye care until after I have bonded with the baby.
I would prefer erythromycin eye treatment to silver nitrate for my baby.
** Vitamin K **
I would like vitamin K to be administered to my baby.
I would like vitamin K to be given orally.