Our Birth Plan

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Our Birth Plan

Congratulations! This form can be used to help formulate your desired birth plan. Mark your choices for each of the categories. You will receive the filled out form after you submit the form. You can then create a document with just your choices or simply use this for your plan. Best wishes for a safe and amazing birth!

Email *

Full Name *

Due Date

YYYY

Members of My Birth Team

Before Labor Begins

As long as baby and I are healthy, I would like to go at least 10 to 14 days over my due date

As long as the baby and I are healthy, I would like to have no time restrictions on the length of my pregnancy

I would like to discuss laboring at home as long as possible

I trust that my practitioner will seek out my opinion concerning all the issues directly affecting my birth before deviating from my plan.

If nonstress test observation becomes necessary after my due date, I am flexible and support this procedure.

I would like to discuss induction before my due date.

If I go past my due date and the baby and I are fine, I prefer to go into labor naturally rather than be induced.

Please obtain my permission before stripping my membranes during a vaginal exam.

I prefer to have no vaginal exams unil I go into labor

I prefer to have only one vaginal exam on or around my due date

During a vaginal exam, I prefer not to have my membranes broken unless there is an emergency situation.

I prefer minimal internal vaginal exams

If I am less than four centimeters dilated, I would like to discuss with my healthcare provider the option of going home.

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