Example of Hospital Birth Plan
This is the Birth Plan that I wrote up for if I needed to be transferred to the hospital during my planned home birth. I acknowledge that most births are not medical emergencies, but some can become that, so I wanted to be well-prepared.
These were my wishes, based on my own intensified research, but you can of course edit it to suit your wishes! I hope it helps you!
The following is included: Hospital Birth Plan (Editable!)
HOSPITAL BIRTH PLAN
Baby Estimated Delivery Date:
Mother:
Father:
Midwives / Doctor:
Emergency numbers:
After birth:
• No circumcision (male or female)
• No Hepatitis B vaccine (we have both been tested negative for Hepatitis B in recent blood tests)
• No Vitamin K shot (we will do oral vitamin K with our pediatrician)
• Do not administer antibiotics (I have tested negative for Group B Strep)
• Do not administer Synagis to our child (whether premature or full-term)
• No antibiotic ointment in newborn’s eyes (I have tested negative for all sexually transmitted diseases)
If it is medically necessary for me to give birth in a hospital:
• No Electronic Fetal Monitor unless necessary to save my child’s life
• I do not wish to receive any induction or pain medication (if you must induce, use Pitocin and NOT Cytotec)
• Please do not ask me, in the midst of labor, if I want pain medication, I wish to give birth without medication
• Only test my dilation when I am completely comfortable and ready
• Do not clamp the cord until after I have birthed the placenta and the cord has stopped pulsing
• Do not suction my child unless it is necessary to save his/her life
• Please let my husband announce the sex of our baby
• Please immediately lay the baby on my chest so I may connect with my baby unless unable to do so for the life of the baby – please check baby while on my chest (see below)
• We will take the placenta and cord home with us for proper disposal/burial
If it is necessary to save my or my baby’s life and I need a cesarean section:
• I would like to have a VBAC after this birth, please use a double stitch when repairing my uterine wall and not a single stitch
• Let my husband announce the sex of our baby
• Do not clamp the cord until it stops pulsing
• Do not suction our child unless it is necessary to save his/her life
• Please allow my husband to hold our baby until the placenta has been detached – please check our baby while in his arms
• Please let me have my baby on my chest after the placenta has been detached and delay after-birth procedures (see below)
• We will take the placenta and cord home with us for proper disposal / burial
After vaginal or cesarean birth:
• Please let us hold our baby and delay washing, weighing, stamping our baby so we can be with him/her for those first precious moments
• My blood is NEGATIVE and my husband’s POSITIVE. Please test my baby’s umbilical cord to determine if s/he is a Rh+, to see if I need or do not need Rhogam. (I will request the no mercury Rhogam, BayRoh-D, from Bayer Pharmaceuticals.)
• Do NOT give a Hepatitis B shot
• Do NOT give a Vitamin K shot (we will do oral Vitamin K with our pediatrician)
• Do NOT put antibiotic ointment in his/her eyes (Amy has tested negative for all STDs, to include gonorrhea and chlamydia)
• We do not consent to any Synagis for our baby
• You MAY give our baby a PKU test after several hours of life, while in my arms (after he/she is warm and ready and I may nurse right after)
• Do not wash our baby; I will clean him/her with a damp (NO SOAP) washcloth
• I will be BREASTFEEDING; please do not bottle feed my baby ANY formula or use ANY bottle and DO NOT give a pacifier
• Please leave our baby in our room at ALL TIMES
• Please do not let me sleep when my baby is hungry, I would like to exclusively breastfeed
• Do not take our baby out of my room without my or my husband’s knowledge and/or permission
• Our son will NOT be circumcised; we wish to keep his penis intact
You are one smart cookie! I am going to have my fourth baby soon and I don’t know about a lot of this stuff! Thanks for your lovely comments! I love reading about pregnancy and delivery! I just posted about week 34 today.
Sanz, I am so glad if I could help! I really researched like crazy, so I’m glad to post and help others :) You must be thrilled — I’ll check out your post today :)
My husband and I are learning about all the changes hospitals have taken over the last 30 years when it comes to births. I tried to explain some of the changes to my mom and she told me to stop because she couldn’t keep up. Crazy right?! Thank you for giving an example of a real (natural) birth plan! We will be researching all of our choices as we start our family.
I’m so happy that my research could help you! It is so important to be informed — because as mamas, in the labor state, we are hardly in a condition to express our wishes! These are our babies and we have a right to what happens to them <3
We spent our entire pregnancy in the care of our awesome midwives, only to end up needing an emergency C-section (my sweet, big-headed boy didn’t fit). We transferred to the hospital at 2 am after 28 hours of labor. I wish I had had a printed birth plan, because although my midwife explained our wishes and my husband and I frequently reiterated them, the hospital staff did as they pleased. They bullied us, then simply stopped telling us what they were up to when we stood up to them. My 8 1/2 pound son was hospitalized for 4 days in the NICU alongside preemies for a completely normal bilirubin dip. We still suspect he was taken to the NICU so that they could do what they wanted without fighting us, and because our son’s state-provided insurance would pay out all medical charges without question. All in all, the hospital staff clamped the umbilical early (“because he’ll get too cold”), removed our son from our care, prevented me from breastfeeding, fed our son formula (because “he wasn’t getting enough” from my interrupted feedings), given a pacifier, and finally only released because we declared that we wanted an AMA form to sign, because we were taking our boy home at 6pm no matter what. We didn’t have to sign the AMA- he was magically cleared of the “rare and dangerous” condition they claimed to suspect within 30 minutes of our announcement. Our healthy boy finally went home at one week old.
I will be printing this off and taking it with me next time, and I recommend other women do the same. I found out that it’s not enough to find a midwife you like and trust (because there are just some things they can’t handle), or to have a copy of your wishes in your file, or even to say it aloud over and over. At some hospitals, you need a very large poster. Thank you for this simple but in-depth birth birth plan. I didn’t even know about single and double stitches! I hope it will enable more families to stand up for what should be a beautiful and precious event unmarred by battles with medical professionals.