We would highly recommend that you prepare a birth plan well in advance of your due date to give to your doctors and hospital staff – preferably prior to the delivery. This can be a starting point for discussion, as well as help make your wishes known.
Here is just one example. Please modify it for your wishes.
Birth Plan For _______________________________ and their child ____________________________________
____________ weeks into our pregnancy we were devastated to learn that our child was diagnosed with______________________________________. We chose to continue his life, even though we have been told by our doctors that our child would not live long after birth.
It is our wish that for his birth, and during his short life, _____________ be surrounded by a loving and caring environment.
We also ask that ________________ , our nurse-midwife, be given the respect and the right to do her job as our caretaker. She has been our main support and caretaker through this whole ordeal.
We ask not to be judged and that each member of the medical team that cares for us and our son provide us with excellent medical care and the compassion to allow us, as much as you are capable, privacy to celebrate _____________’s life with close family and friends. It is our belief that precious time with our baby is the only thing that will soothe the pain of those that love him.
_______________ will be induced on _____________ (date), unless of course she delivers early.
Our goal is for ______________ to be born alive. We would like all measures taken to ensure this.
Each of you can assist during this difficult time by understanding and respecting the wishes we have outlined below:
To be treated as a normal albeit induced labor and delivery- by Prostaglandin gel. We ask that more natural methods be used to start labor, before Pitocin is given.
To be allowed to walk, shower, move around, eat, etc during early labor. To be supported in using natural childbirth techniques, and only offered pain relief if asked for.
If pain relief is needed we would like every option explained to us and the lowest dose used. The mother wants and needs to be alert during and after the birth.
Permission for immediate family (grandparents, aunts, uncles, siblings etc.) to visit during early stages of labor .
That ___________ and ___________’s mothers be allowed to be present for the delivery.
To have a nurse or social worker update the waiting family in the last stages of labor and delivery.
To be told of any change in ___________’s condition, in a kind and respectful way.
Cesarean Section has been discussed, and is agreed upon only for the safety of the mother’s or child’s health.
That all decisions concerning the mother’s and child’s care be made only by our nurse-midwife, or someone designated by her or the parents.
Permission to video-record parts of early labor and all of the delivery. We want this record only for personal reasons, to have in the future as a momento of our baby’s birth.
We ask that ___________ be allowed to cut the umbilical cord, unless he otherwise designates someone else.
We ask that a person designated by us, be allowed to give _____________ a name and a blessing, immediately after emerging from the birth canal.
We do not want any extra-ordinary means to be taken to prolong his life other than any routine care that would be provided to any normal newborn. Unless ________’s condition is found to be better than expected (kidney function, fully formed, working lungs etc.)
Since we don’t know how long ________ will live, we want to spend as much time with him as possible after delivery and delay any procedures that can be put off until later. ________ should be quickly cleaned off, wrapped in a blanket and handed to _________, after his condition is quickly accessed.
If any procedures must be done immediately, we would like to accompany ___________, and videotape anything done.
If ____________ has fully formed lungs and is able to suck, ________ would like to breastfeed him as soon as possible.
We ask that all family members waiting, be allowed in to see ________ as soon as possible. And that we be given the privacy and respect we need in those first and most likely last moments of our baby’s life.
_____________ would like to give _________ his first bath and dress him, whether that be before or after his death.
That we be allowed to accompany _____________ for any mandatory tests.
If ________________ is suffering, we ask that all options for pain relief be explained to us, and the method of our choice be given to alleviate his pain.
We would like to keep _____________ with us as long as possible, whether that be alive or not.
We want __________ to feel of the love his family has for him, and so would ask that we be holding and loving him at the time of his death.
We ask that _____________ be allowed to stay with us through the night, and if he is still living we beg that he be allowed to room in with us.
We would like to have the following items as keepsakes:
- Bassinet cards
- Hats and hospital clothing
- Any photographs taken by the hospital
- Hospital ID bracelets
- Foot and hand prints
- Lock of hair
We appreciate your compassion during this difficult time.
Thank you for helping us celebrate our child’s short life in a way that is meaningful to us.