Birth Plan Worksheet 2Birth Plan Worksheet 2Birth Plan Worksheet 2
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Birth Plan Worksheet
Basic Information
Name: __________________________________________
Partner’s Name: ___________________________________
Doctor/Midwife’s Name(s): __________________________
Other Birth Attendants (doula, friends, etc.): ________________________________________________
Children and Helpers, if attending: ________________________________________________________
Baby’s pediatrician, if known: _________________________________
Delivery location: ______________________________________
Estimated Due Date: ___________________________________
Pre-Birth Preferences
___ I prefer to be induced on _____________ (date)
___ I will discuss induction after _____________ (date)
___ I prefer not to be induced unless it becomes medically necessary
___I am having a scheduled c-section on _____________ (dat