BIRTH PLAN
This comfort care plan/birth plan is for you and your family to discuss with your doctor prior to the birth of your baby. It will help you to think through each step as you prepare to meet your baby.
(Your Baby’s Name) Birth Plan
As (parent’s names), it is our greatest wish to be able to cherish every moment we have with our baby, in a loving and caring environment. We have compiled this list of requests and wishes regarding her care in order to make this experience as easy as possible for all involved. Please do not hesitate to ask us for clarification if it is needed. Please don’t mind if we change our wishes at any time. Our wishes all revolve around our need to spend as much precious time with (baby’s name) as possible and to prevent her from suffering during that time. Our wishes are as follows:
- We DO wish to have a sign placed on our door that designates what type of situation (Baby’s name) birth is.
- We DO NOT wish to have extraneous staff entering our room without speaking to our nurse first (i.e. housekeeping, dietary).
- We DO wish to have continuous fetal monitoring during labor and delivery.
- We DO wish to have an emergency cesarean section in the event that (Baby’s name) heart tones are undetectable or decreased.
- We DO wish to have routine care for any newborn such as having her mouth and nose suctioned with a bulb at the perineum and drying her/him quickly.
- In the event that (baby name) is born apneic, with or without a heartbeat, we want any efforts to revive her, including, but not limited to, positive pressure ventilation, oxygen delivery, intubation, medications, or chest compressions.
- As long as it is safe for (mom’s name), we want her to be able to hold (baby name) immediately following delivery. If (mom’s name) is unable to hold (baby name) we would like her to be handed to (dad’s name).
- We wish to cherish all the time we have with her. Every second counts.
- We DO ask that you give us privacy, without abandoning us. Encourage us to do whatever feels right.
- We DO NOT want (baby’s name) to be taken from the delivery room at any time, by any person, for any reason, before talking to us about what the reason is that she will be leaving the room.
- We DO NOT wish to have any routine admission medications given, such as erythromycin ointment, Vitamin K or Hepatitis B shot. These medications can be given, if needed at 24 hours of age or upon discharge home.
- We want her blood sugar monitored on an as needed basis.
- We DO NOT wish to have a nasogastric tube inserted in order to feed (baby’s name), within the first 6-12 hours of life. If (baby’s name)is stable we would like to talk about an NG or OG tube for feeding, if she isn’t tolerating breast or bottle feeding.
- (Mom’s name) will decide if she wants to nurse (baby’s name) after she is born, and if she is able.
- In the event that (baby’s name) does not die immediately, or soon after birth, we want to consider having an IV inserted and buff-capped for the administration of pain medication, such as fentanyl. We wish to make (baby’s name) time on earth as pain-free and comfortable as possible.
- In the event that (baby’s name) is experiencing severe seizures and seems uncomfortable or in pain, we wish to consider the administration of anti-seizure medication.
- We DO wish to keep (baby’s name) warm with the use of kangaroo skin-to-skin care, warm blankets, hats, or the radiant warmer.
- We DO wish to have (baby’s name) baptized and dedicated to the Lord.
- We DO want the nursing staff to weigh and measure (baby’s name) when we request it. Should we forget to request it, please do it prior to her leaving the hospital.
- We DO request that mom and dad be allowed to give (baby’s name) her first bath.
- We DO request that mom or dad be allowed to dress (baby’s name) in her own clothes.
- We DO NOT want these clothes to be removed at any point or by any other person than her parents. (baby’s name) is to be wearing these clothes when she/he goes to the mortuary.
- We realize that (baby’s name) may look different physically. We hope that everyone can see her for what she is, our beautiful little baby. She will be greatly missed and never forgotten.
- Any keepsakes that mom or dad leave with (baby’s name), such as blankets, lovies, and jewelry, are to remain with her at all times, even when she is taken by the mortuary personnel.
- We DO NOT want (baby’s name) to go to the morgue at any time.
- We have made prior arrangements with a funeral home. The funeral home can be contacted at:
- We DO request that the hospital contact Funeral Home directly when we are ready to say goodbye to (baby’s name)
- We wish for her to be picked up directly from us or the nursing staff and be taken by a staff person from Funeral Home.
- We have contacted Now I Lay Me Down to Sleep and arranged for a photographer to come to the hospital and take photos. We ask that you accommodate them in anyway that is helpful. The number for the area coordinator is,
- We DO wish to allow our family members to visit, as we deem appropriate. We have family that lives in the area and would like them to be able to come visit. Please DO NOT allow anyone in our room without talking to us first.
- We DO wish to have the option to bring other family and friends to the hospital to meet (baby’s name) and spend time with her. We ask your assistance in keeping them updated as we request it.
- We DO wish to be with (baby’s name) and holding her at the time of her death.
- If any caregiver has a suggestion or an idea that you think may be helpful, please share it with us, as there are many things we haven’t thought of.
- If any nurse, doctor, or other caregiver on our team is uncomfortable with any of this, please excuse yourself from our care if possible.
- We DO wish to have as many keepsakes and mementos as possible. Please save the following items for us to take home:
- The bassinet card
- Hats
- Baby blanket
- Any photographs taken by the hospital
- Hospital ID bracelet and cord clamp
- Hand and footprints (we also wish to have footprints put in books we have brought with us)
- Mold of hands and feet (we have kits with us)
- Lock of hair if possible
- Clothing (baby’s name) may have worn
- And any other things you think we may wish to have
Thank you for being a partner in our baby’s birth. Please be patient with us. We don’t know how to do this sad thing and are learning as we go.
Signed,