Birth Plan

Full Name *
Full Name
Partner's Name
Partner's Name
if applicable
Today's Date *
Today's Date
Due Date/Induction Date *
Due Date/Induction Date
Due Date/Induction Date *
Please note that I:
My delivery is planned as:
I'd like the people I specify below present:
During labour, I'd like:
I’d like to spend the first stage of labor:
I'm not interested in:
A heparin or saline lock
I’d like fetal monitoring to be:
I’d like labour augmentation:
For pain relief, I’d like to use:
During delivery, I would like to:
As the baby is delivered, I would like to:
I would like an episiotomy:
Immediately after delivery, I would like:
If a C-section is necessary, I would like:
I would like to hold baby:
I would like to breastfeed:
I would like the members of my family who I specify below:
I’d like baby’s medical exam and procedures:
Please don’t give baby:
I’d like baby’s first bath given:
I’d like to feed baby:
I’d like baby to stay in my room:
I’d like my partner:
If we have a boy, circumcision should:
As needed post-delivery, please give me:
After birth, I’d like to stay in the hospital:
If baby is not well, I’d like:
Jewish options: