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Sample Birth Plans


Birth and Care Plan for ......




We want to be treated like other new parents. Please acknowledge our delivery and especially our child's existence. We want (name of child) to be treated as our beloved daughter. Please see beyond the problems with our child, and provide her with love and tenderness in her care while allowing us time to grieve alone, as well as with family and close friends. Thank you for helping us through this difficult time.

We believe that the following list will help us make the most of our time with our child:

1. Mechanical assistance may be temporarily used immediately after delivery to initiate breathing only, not to maintain breathing. After determining whether or not there is a heartbeat or breathing, we request that the doctors use phrases such "I'm sorry (name of child) didn't make it," or if she is alive, "We have a heartbeat," or "She is breathing."

2. We request that she be quickly wiped, have a dressing applied as recommended by Dr. O, given a cap, wrapped in her blanket, and handed to her father. Mum will be allowed to see baby and hold her as soon as possible.

3. Since we don't know how long our child will live, we want to spend as much time with her as possible after delivery and delay any procedures that can be put off until later. our child should be brought to her mother in the room as soon as possible. Daddy would like to be able to videotape any procedures done in the isolation nursery following delivery.

4. Baby should be offered comfort care to include feeding, bathing, swaddling, holding by her parents or those designated by her parents. Our child is not to be placed on any artificial life support system without the permission of either parents.

5. Our baby should be rooming in at all possible times with mum. If there are any required procedures or care that cannot be performed in the room, the baby will be accompanied by her father or other person designated by her parents.

6. We would like to have the following items as keepsakes:

Signed, the parents (as an example only)




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