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Birthworks: Birth Plan for a Homebirth www.birthworks.co.uk
Birthworks Birthing Pools: support 7 days a week: 0333 240 9710 (call charged at local rates)
Name: ………………………………………………………………..
Due Date:…………………………………………………………..
In an emergency contact:…………………………………………........
On:………………………………………………………………………………….
Birth Partner:
Who will be your birth partner?
Contact number for birth partner:
Do you want them with you all the time?
What relationship are they to you?
Details of other birth partners or doula:
Name:
Contact number:
What role have you planned for them?
Special needs:
Do you have any special requirements?
(dietary, religious, disabilities etc.)
Homebirth:
Are you planning a homebirth?
What room in your home do you plan to
labour and deliver in?
Will you have other children present at the
birth?
Do you have pets? Have you considered
whether you need to make special
arrangements for them?