Setting your location helps us to show you nearby providers and locations based on your healthcare needs.
Your Location is set to Change My Location
Cone Health wants to help you get well and stay well. This section provides tools and information to achieve good health and maintain your well-being.
Learn what community resources are available to help you get well and stay well.
View health and wellness news you can use from Cone Health providers on
View Advanced Search OptionsView All Doctors
View All Locations
Home > Patient & Family Resources > Health Library > My Birth Plan
COVID-19 Info: Please help us slow the spread of coronavirus - Wear a Mask, Wash Your Hands & Wait 6 Feet Apart! Visitor Policies and Precautions | COVID-19 Testing| Vaccine information | Commitment to Safety | Current Numbers
Name: ___________________________________. Partner's name: _____________________________.
Doctor or midwife's name: __________________________. Today's date: _____________________.
This birth plan is a guide for my labor and delivery. Since childbirth does not always go as planned, some of this birth plan may change.
I would like to deliver my baby:
__ In a hospital: _______________________________________(name, phone number).
__ In a birthing center: _______________________________________(name, phone number).
__ At home.
I would like my baby to be delivered by:
__ My family doctor: _________________________________________(name).
__ My obstetrician: ________________________________________________.
__ My midwife: ____________________________________________________.
__ My perinatologist: _______________________________________________.
I'd like these people to be with me during labor and birth:
__ Partner: ________________________________________________(name).
__ Friend(s): _____________________________________________________.
__ Family: _______________________________________________________.
__ Doula: ________________________________________________________.
__ I'd like to be able to go back home if I'm not in active labor.
After I've been admitted, I'd prefer:
__ To eat if I wish to.
__ To drink clear fluids instead of having an IV.
__ To walk and move around if I can.
I'd like to try:
__ A birthing chair.
__ A birthing stool.
__ A squatting bar.
__ A birthing tub or pool.
When the time comes to push, I'd like to:
__ Be coached on when to push and for how long.
__ Push when I feel I need to (instinctively).
I'd prefer to use the following position(s):
__ Half lying down (semi-reclining).
__ Lying on my side.
__ Whatever feels best at the time.
I'd like to use the following for pain management:
__ Breathing techniques
__ Other: _______________________________________________________________.
__ Please do not offer me pain medicine. I'll ask for it if I need it.
If I decide to use medicine for pain, I prefer:
__ Epidural anesthesia.
__ Local anesthesia.
__ Pudendal or paracervical block.
__ An opioid.
I would like to:
__ Take all possible steps to avoid an episiotomy.
__ View the birth using a mirror.
After the birth, I'd like to:
__ Hold my baby right away, before any procedures that are not urgent.
__ Breastfeed as soon as possible.
__ Have my partner cut the umbilical cord.
If I have a C-section, I:
__ Would like to see my baby coming out.
__ Would like my partner present during the operation.
After delivering the baby, I'd like to:
__ Have my partner be with the baby whenever I can't be.
__ Stay in a private room.
__ Have my partner stay with me in my room.
__ Breastfeed only.
__ Bottle-feed with formula only.
Please offer my baby:
__ Nothing without my permission.
I'd like my baby to be:
__ In my room 24 hours a day.
__ In my room only when I'm awake.
__ With me only for feeding.
__ With me based on how well I feel at the time.
If I have a baby boy:
__ I'd like him circumcised at the hospital.
__ I'll have him circumcised later.
__ I will not have him circumcised.
__ I'll decide about circumcision later.
Current as of: February 11, 2020
Author: Healthwise StaffMedical Review: Kathleen Romito, MD - Family MedicineAdam Husney, MD - Family MedicineKirtly Jones, MD - Obstetrics and Gynecology, Reproductive Endocrinology
Current as of: February 11, 2020
Author: Healthwise Staff
Medical Review:Kathleen Romito, MD - Family Medicine & Adam Husney, MD - Family Medicine & Kirtly Jones, MD - Obstetrics and Gynecology, Reproductive Endocrinology
To learn more about Healthwise, visit Healthwise.org.
© 1995-2020 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.
Subscribe to our Wellness Matters e-newsletter, a monthly snapshot of the some of great wellness content from Cone Health providers.