Birth Plan Worksheet 3
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HEALTHY BIRTH YOUR WAY

Birth Planning Worksheet
Name: ________________________________________

Date: ___________________________

I have prepared myself for a birth that is as safe and healthy as possible and prefer that interventions be used as a last resort, if
at all. I plan to be actively involved in all decisions related to my labor and birth and request clear and open communication
between myself and all medical support staff. While I know that I may need to respond to unexpected situations, this birth
plan reflects my current intentions. Thank you for helping me have a safe, healthy, and satisfying birth.
I would like my labor to begin on its own, unless there is a medical reason why induction would be safer.
I plan to walk, move around, and change positions throughout my labor.
Other comfort techniques I would like to use:

I plan to have continuous labor support from a loved one, friend, or doula.
Names and roles of people I would like to have at my labor:
I would like my la