Birth Plan – Relearning the process

Yet another thing that I couldn’t find good information for online when searching was for a Surrogate friendly birth plan. All sites showed a full birth plan which extends to the baby’s first care, nursing, skin to skin, and other preferences that might not be applicable depending on your journey and the IP’s wishes as expressed in your contract. I have included the bare bones of my birth plan below to help others searching for a surrogate friendly birth plan. My birth plan is centered around the Bradley Method so it may not be the right plan for you. But you can always use this birth plan as a starting point and fine tune it to your wishes. Just remember to reference your contract, you make decisions for your own body, and that, unless discussed with your IP’s, all of baby’s care is their decision upon birth.

Birth Plan:

Full name: _________________ – Surrogate

Partner’s name: _________________

Today’s date: _____________________

Due date: _________________

Doctor’s name:  _________________

Hospital name:  _________________

__________________________________________________________________

My delivery is planned as: Vaginal un-medicated

I’d like (below)to have the option of being present before AND/OR during labor: Partner: NAME
Intended Parents: NAMES

During labor, I’d like:
Music played
As few vaginal exams as possible
To wear my own clothes
My partner to film take pictures
My partner to be present the entire time
To eat and drink

I’d like to spend the first stage of labor:
Freedom to walk around and/or get in the shower

I’m NOT interested in:
An enema
Shaving of my pubic area
A urinary catheter
An IV, unless I’m dehydrated (a heparin or saline lock is OK)

I’d like fetal monitoring to be:
Intermittent External

I’d like labor augmentation:
Performed only if baby is in distress
Performed by membrane stripping
Performed with prostaglandin gel
Performed by rupture of the membrane

For pain relief, I’d like to use:
Please only offer pain medications if I ask for them.
Minimal Intervention

During delivery, I would like to:
Squat
Semi-recline
Lie on my side

As the baby is delivered, I would like to:
Push spontaneously
Push without time limits, as long as the baby and I are not at risk
Avoid forceps usage
Avoid vacuum extraction

I would like an episiotomy:
Not performed, even if it means risking a tear

Immediately after delivery, I would like:
My partner to cut the umbilical cord
The umbilical cord to be cut only after it stops pulsating
To deliver the placenta spontaneously and without assistance
Not to be given Pitocin/oxytocin

If a C-section is necessary, I would like:
To make sure all other options have been exhausted
To stay conscious
My partner to remain with me the entire time
The screen lowered so I can watch baby come out
My hands left free so I can touch the baby
The surgery explained as it happens
Intended Parents to hold the baby as soon as possible

I would like to hold baby:
Immediately after delivery

I’d like my partner:
To have unlimited visiting To be able to sleep in my room

As needed post-delivery, please give me:
Extra-strength acetaminophen
Stool Softener

After birth, I’d like to stay in the hospital:
As briefly as possible

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