This plan can help you consider what will make your birth experience meaningful and comfortable for you.
Please discuss this with your doctor or midwife during your pregnancy. Also, please bring a copy with you to
the hospital when your labor begins.
Your name (birth plan for):
Your partner’s name:
Name of your labor support person/doula:
Your due date:
Name of your doctor or midwife:
Name of your baby’s doctor (pediatrician):
Labor and delivery: the environment
role or relationship to
Primary support person
Other people attending the birth
For child visitors:
Would you like the child(ren) present for labor? yes
Should we help you limit visitors?
for delivery? yes
Comfort and mobility
Check all the things you’d like to try during your labor:
music (please bring your own CDs and player)
TV and DVDs (may bring your own DVDs)