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Our Family Birth Plan
Name of Mother:
Anticipated Birth Date:
Mother's Support During Labor/Delivery:
M.D. Name:
A family birth plan allows parents- to- be the opportunity to plan and anticipate their birth experience. Every effort will be made to
honor the requests of parents-to-be throughout the childbirth experience. If the unexpected occurs,
rest assured that the MUSC
Women and Infant Services Team will work to provide the
best care available to the new mother and infant. Should emergency
complications
arise, components of the birth plan may not be available. We will work to ensure
you are informed should this occur.
Labor
Y/N (Check to indicate yes)
I would like to be free to walk around during early labor.
I wish to be able to move around and change position at will throughout
labor.
I will be bringing my own music to play during labor.
I would like the environment to be kept as quiet as possible.
I would like the lights in the room to be kept low during my labor.
I would prefer to keep the number of vaginal exams to a minimum.
Comments:
Anesthesia/Pain Medication
(Your nurse and an anesthesiologist will be able to answer question about medication
during labor and delivery)
Y/N (Check to indicate yes)
I would like to be asked if I would like to have narcotic pain relief.
I would like to have a standard epidural.
Comments:
Cesaeran
Y/N (Check to indicate yes)
If a Cesarean delivery is indicated, I would like to be fully informed and to
participate in the decision-making process.
I would like to (coach) present at all times if the baby requires a Cesarean
delivery.
Comments:
Epistotomy
Y/N (Check to indicate yes)
I would prefer not to have an episiotomy unless absolutely required for the
baby’s safety.