Birthing Plan

By: Nerresa Pearl Beraye

&
Herfel Asteene Lagalagot
 Patient's
Information

Name: Mrs. N. Valera

Spouse's/ Support Person's Name: Chris
Date Today : February 2,2022
Due Date/EDD: March 11,2022
Physician: Dr. Grey Stone
Hospital : Medical City
Where I want to My preferred
give birth? delivery method:

HOSPITAL Vaginal Delivery

Caesarian Section
Midwife-led birth (C-Section)
unit or centre

Vaginal Birth
after Caesarian
At Home
Water Birth
Delivery
To have the following persons

present before or during my

birthing

Partner Relatives

Children Doula

Parents Others: (Specific Name)

 1. During and after the labor I want my husband to be present
2. During the labor I would like to listen to classical music to make
My
me relax a little bit
Req uests 3. The hospital staff present should only be my own doctor and

during
nurses and no students, residents, or interns
4. I would like the staff present during labor to be all women and
labor no males
5. My husband will film and take pictures during labor
6. If I am in pain, I would like to use breathing techniques if it is not
then distractions, if it does not work still then what the doctor
deems appropriate is the next option
7. As the baby is being delivered, I would like some one to direct me
to push
8. If some dangers are encounter during the delivery, I would trust
my doctor’s decision of what to do as necessary
I would like to breastfeed: I'd like to feed the baby:

Immediately after the delivery Only with breastmilk

After being wiped clean and swaddled Only with formula milk
Before eye drops/ointments are given On demand
After suctioning On schedule
After weighing With the help of lactation specialist
As soon as possible after delivery
Pain Relief I'd like to
use during labor:

Breathing techniques Walking, moving or changing

Acupuncture position
Acupressure Epidural block
Hypnosis Spinal block
Continous labor support Nitrous oxide
Touch or massage Any pain relief suggested at

Applying ice packs or heat to

the time (prescribed by

back or other parts of body Doctor)

 1. If the doctor deemed that I need to undergo episiotomy

then I would consent but there should be anesthesia

My
2. The umbilical cord would be cut if pulsation stops
Requests
3. I would like to hold my baby immediately when the baby

is delivered after
4. I would like to breastfeed the baby if the doctor says
labor
that it is fine
5. I’d like to feed the baby with breastmilk if possible
6. I want to be with my baby when I am awake
7. My husband can visit me always
8. If the baby is a boy, I want him to be circumcised
9. I want to stay in the hospital as briefly as possible
10. If there is a problem with the baby I would trust the

decision of the doctor on what to do

Thank
u
y !
o !