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Birth Plan Checklist

Birthing Equipment

Birthing bed
Birthing stool
Birthing chair
Birthing pool/tub
Beanbag chair
Squatting bar
Other
I would like a mirror available so I can see the baby's head crown
I would like to touch my baby's head as it crowns
I would like to have the baby placed on my stomach/chest immediately after birth
Room as quiet as possible

Pushing

Spontaneous
Directed

Extraction Devices

None unless baby's health at risk
Vacuum extraction
Forceps

Cesarean

Partner present at all times during the operation
I'd like to be conscious
Screen lowered so I can see the baby coming out
One hand free to touch the baby
Immediate contact with the baby

Placenta

Cord Blood collection
Injection of Pitocin to aid with delivery
Spontaneous
Encourage with breast stimulation, baby suckling
Manual extraction
I'd like to see it
Use of placental tissue by the hospital

Cord-cutting

Partner cuts cord
I would like to cut the cord
Neither
Other family member

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