My Birth Plan

Mother: Becky Ann Turley Rasmussen
Father: Neil James Rasmussen
Mother’s DOB: 12/28/1978
Last Menstrual Cycle: 9/6/2008
Due Date: 06/12/2009
Insurance Provider: Select:Care + ID: 800561011
Birth Team: Mt. Timpanogas Woman’s Health Care/Midwives
Blood Type: O+
Allergies: Penicillin
Group B Strep Test: Positive
Gravida: 8
Full Term: 7

Labor Preferences:

Natural Delivery Without Anesthetic
Availability of Jetted Tub & Birthing Ball

Second Stage Labor Preferences:

Assistance with modesty given the family members in attendance
Reminder Squatting or Kneeling Position for Pushing
Perineal massage if necessary to avoid tearing
Request gloves to feel baby’s descent

Preferences for Baby:

Wavier of Eye Prophylaxis
Wavier of Hepatitis B Vaccination
Wavier of Vitamin K Shot
Delay cord clamping until pulsating discontinues
Immediately breastfeed baby with skin to skin contact
I Would like to nurse & massage the vernix into the baby’s skin immediately following birth

*Notice pertinent information first. If you have allergies or complications related to your pregnancy they should be listed at the top.

Most of your concerns should be addressed in the weeks prior to delivery. As you initiate discussions with your provider you should have a good idea of what to add or subtract from your birth plan. The shorter your birth plan is, the more your birth team will work to accomodate the items listed.