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My Birth Preferences

Birth Preferences

You can’t control every aspect of the labor and delivery process, particularly in the case of a high-risk pregnancy, but having a plan will allow you the opportunity to discuss with your obstetrician your preferences of how you’d like your baby’s birth to be handled. It will not only assist before you go into labor, it will also communicate your wishes to other members of the team such as your labor-and-delivery nurse and your midwife, while you’re in active labor.

Take some time and write your responses to the questions in the following form. Then print out a copy to use as discussion with your healthcare provider at your pre-natal appointment.

Please understand that this form reflects your ideas/suggestions only, and that medical necessity may override your preferences in order to best care for you and your baby.

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Today's Date
Delivery Date
Hospital

My baby's birth is expected to be:


I'd like the following individuals to be present before AND/OR during labor (May be asked to leave the room for privacy questions during admission, epidural placement or during an emergency, if necessary.):



During labor, I'd like:










I’d like to spend the first stage of labor:




For pain relief I'd like to use:









During delivery I would like to:






Immediately after birth, I would like:






If a cesarean is necessary, I would like:





I would like to breastfeed:

I would like baby's medical exam and procedures:



I'd like baby's first bath given:


I would like to feed baby:

I'd like my spouse/partner to:

If we have a boy, a circumcision should:


If baby is not well, I'd like: