Free Birth Plan Template 26Free Birth Plan Template 26
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My Mercy Birth Plan
Expectant Mother’s Name __________________________________ Birthdate __________
Expectant Mother’s Physician_________________________________________________________
Baby’s Physician _____________________________________Baby’s Due Date__________
My Labor Support Team • I plan to have the following people with me during my labor and birth:
Partner______________________________________Relationship______________________
Doula _____________________________________________________________________________
Other visitor___________________________________Relationship_____________________
Other visitor___________________________________Relationship_____________________
Other visitor___________________________________Relationship_____________________
Comfort Measures • I plan to try these additional
comfort measures (check all that are desired):
¨ Walking, squatting and using a birth ball
¨ Labor in water using a shower or tub
¨ Listening to music (please bring your own)
¨ Ma