1 2 0% Create your own birth plan A birth plan is a simple, clear, flexible plan expressing the birth mother’s preferences during birth. The plan is not a medical guide or definitive declaration of how the birth will go, but it does give everyone involved an idea of the pregnant woman’s wishes. More importantly, you must be flexible about your birthing expectations. Check each choice as best as you can IV (intravenous) * I have no preference If possible, no IV please I leave that option up to the doctor/midwife It depends on the need Artificial rupture of fetal membranes (AROM) * I have no preference If possible, no AROM I leave that option up to the doctor/midwife It depends on the need Cesarean delivery * I am OK having a cesarean if needed If possible, I try for a vaginal delivery I definitely do not want a cesarean delivery Circumcision * I have no preference if it's a boy No circumcision if a boy Circumcision if it's a boy It's a girl!! Cord blood donation * Public donation OK Private donation I have not decided yet Eating in labor * I have no preference I want to eat in labor I leave that option up to the hospital policy It depends on the need Episiotomy * I have no preference No routine episiomy I leave that option up to the doctor/midwife Fetal monitoring * I have no preference If possible, no fetal monitoring Doppler only I leave that option up to the doctor/midwife It depends on the need Internal vaginal examinations * I have no preference If possible, as few exams as possible I leave that option up to the doctor/midwife I prefer to not have any vaginal examinations Oxytocin * I have no preference If possible, no oxytocin I leave that option up to the doctor/midwife Pain relief * I have no preference If possible, no epidural Epidural please when I ask for it I will let you know when I am ready Shaving or enema * I have no preference If possible, no shaving or enema I leave that option up to the doctor/midwife It depends on the need Students or residents * I have no preference If possible, no residents or students to examine me I will let you know this is an issue Urinary catheter * I have no preference If possible, no catheter I leave that option up to the doctor/midwife When the baby is out * I want to hold the baby I want my partner to hod the baby I want the baby to get a Vitamin K injection I want the baby to get eye drops I want delayed cord clamping Any comments? You have finished your questionnaire. Please leave us any comments (optional)