[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-351348-105":3,"detail-sidebar-cat-1-en-105":81,"doc-detail-351348-en":126},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","birth-plan-worksheet-hospital-labor-and-delivery-preferences","Birth Plan Worksheet - Hospital Labor and Delivery Preferences","","Birth Plan Worksheet is a structured questionnaire that helps outline a patient’s preferences for labor, birth, postpartum care, and discharge. It covers attendants, desired amenities, hospital admission options, and specific procedures such as monitoring, hydration, walking, and intervention thresholds. It also records choices for pain relief, pushing positions, vaginal birth support, and C-section preferences, plus cord blood banking, feeding plans, circumcision decisions, and newborn postpartum routines.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/template/forms/","Forms",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/template/birth-plan-worksheet-hospital-labor-and-delivery-preferences/351348/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/birth-plan-worksheet-hospital-labor-and-delivery-preferences/351348.png","ImageObject",442,249,{"name":42,"@type":43},"Finn","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-23","2026-09-22",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",12,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What preferences can be set for hospital admission and procedures?","Question",{"text":63,"@type":64},"The worksheet allows choices about returning home if not in active labor, who may stay during admission, whether the participant can wear contact lenses, eat if desired, stay hydrated without an IV, have a heparin or saline lock, and walk freely.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What options are provided for pain relief and pushing?",{"text":68,"@type":64},"It lists pain-management techniques to try, including non-medicinal methods and options for medication if requested, while also noting a preference not to be offered pain medication automatically. For pushing, it asks whether to push instinctively or be coached, and it lists preferred pushing and birth positions.",{"name":70,"@type":61,"acceptedAnswer":71},"What postpartum, feeding, and discharge decisions does the worksheet collect?",{"text":72,"@type":64},"It captures preferences for newborn procedures during presence, rooming-in arrangements, partner involvement, and whether to breastfeed early. It also records feeding plans and items to avoid, circumcision wishes, cord blood banking intentions, and preferred timing for hospital discharge.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},351348,1791328847,{"code":4,"msg":82,"data":83},"success",[84,89,93,98,103,108,112,117,122],{"id":85,"doc_module":22,"doc_module_name":25,"category_name":86,"show_sort_weight":87,"slug":88},11,"Presentations",90,"presentations",{"id":55,"doc_module":22,"doc_module_name":25,"category_name":90,"show_sort_weight":91,"slug":92},"Resumes",80,"resumes",{"id":94,"doc_module":22,"doc_module_name":25,"category_name":95,"show_sort_weight":96,"slug":97},14,"Invoices",70,"invoices",{"id":99,"doc_module":22,"doc_module_name":25,"category_name":100,"show_sort_weight":101,"slug":102},15,"Posters",60,"posters",{"id":104,"doc_module":22,"doc_module_name":25,"category_name":105,"show_sort_weight":106,"slug":107},16,"Social Media",50,"social-media",{"id":109,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":110,"slug":111},17,40,"forms",{"id":113,"doc_module":22,"doc_module_name":25,"category_name":114,"show_sort_weight":115,"slug":116},18,"Letters",30,"letters",{"id":118,"doc_module":22,"doc_module_name":25,"category_name":119,"show_sort_weight":120,"slug":121},21,"Paper Templates",5,"papers-templates",{"id":123,"doc_module":22,"doc_module_name":25,"category_name":124,"show_sort_weight":4,"slug":125},158,"General","general-158",{"code":4,"msg":82,"data":127},{"doc_id":79,"user_id":128,"nickname":42,"user_avatar":129,"doc_module":22,"category_id":109,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":33,"language":135,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":12,"update_tm":139,"read_time":26},34359740700684,"https://ap-avatar.wpscdn.com/avatar/1f400023980c374ae676?_k=1777273430885731487","Birth Plan Worksheet  \nNAME:  \n______________________________________________________________________  \nATTENDANTS  \nI'd like the following people to be present during labor and/or birth:  \nPartner:    Friend/s:   Relative/s:   Doula:   Children:    \nAMENITIES  \nI'd like to:  \n bring music  \n dim the lights  \n wear my own clothes during labor and delivery  \n take pictures and/or video during labor and delivery  \nHOSPITAL ADMISSION & PROCEDURES  \n I'd like the option of returning home if I'm not in active labor.  \nOnce I'm admitted, I'd like:  \n my partner to be allowed to stay with me at all times  \n only my practitioner, nurse, and guests to be present (i.e., no residents, medical students, or other hospital personnel)  \n to wear my contact lenses, as long as I don't need a c-section  \n to eat if I wish to  \n to try to stay hydrated by drinking clear fluids instead of having an IV  \n to have a heparin or saline lock  \n to walk and move around as I choose  \nOTHER INTERVENTIONS  \nAs long as the baby and I are doing fine, I'd like to:  \n have intermittent rather than continuous electronic fetal monitoring  \n be allowed to progress free of stringent time limits and have my labor augmented only if necessary  \nLABOR PROPS  \nIf available, I'd like to try a:  \n birthing stool  \n birthing chair  \n squatting bar  \n birthing pool/tub  \nI'd like to bring the following equipment with me:  \nbirthing stool beanbag chair birthing pool/tub  \nother:    \nPAIN RELIEF  \nI'd like to try the following pain-management techniques:  \nacupressure  \nbath/shower  \nbreathing techniques/distraction  \nhot/cold therapy  \nself-hypnosis  \nmassage  \nmedication  \nother:    Please don't offer me pain medication. I'll request it if I need it.  \nIf I decide I want medicinal pain relief, I'd prefer:  \n regional analgesia (an epidural and/or spinal block)  \n systemic medication  \nPUSHING  \nWhen it's time to push, I'd like to:  \n do so instinctively  \n be coached on when to push and for how long  \n be allowed to progress free of stringent time limits as long as my baby and I are doing fine  \nI'd like to try the following positions for pushing (and birth):  \n semi-reclining  \n side-lying position  \n squatting  \n hands and knees  \n whatever feels right at the time  \nVAGINAL BIRTH  \nDuring delivery, I'd like:  \nto view the birth using a mirror  \nto touch my baby's head as it crowns  \nthe room to be as quiet as possible  \nto give birth without an episiotomy  \nmy partner to help \"catch\" our baby  \nAfter birth, I'd like:  \n to hold my baby right away, putting off any procedures that aren't urgent  \n to breastfeed as soon as possible  \n not to get oxytocin (Pitocin) after I deliver the placenta unless it's necessary  \n to wait until the umbilical cord stops pulsating before it's clamped and cut  \n my partner to cut the umbilical cord  \nC-SECTION  \nIf I have a c-section, I'd like:  \n my partner present at all times during the operation  \n the screen lowered a bit so I can see my baby being delivered  \n the baby to be given to my partner as soon as he's dried, if appropriate  \n to breastfeed my baby in the recovery room  \nCORD BLOOD BANKING  \nI'm planning to:  \n donate cord blood to a public bank  \n bank cord blood privately  \n neither  \nPOSTPARTUM  \nAfter delivery, I'd like:  \n all newborn procedures to take place in my presence  \n my partner to stay with the baby at all times if I can't be there  \n to stay in a private room  \n to have a cot provided for my partner  \nI'd like:  \n 24-hour rooming-in with my baby  \n my baby to room-in with me only when I'm awake  \n my baby brought to me for feedings only  \n to make my decision later depending on how I'm feeling  \n my other children brought in to see me and meet the new baby as soon as possible after the birth.  \nFEEDING ISSUES  \nI plan to:  \n breastfeed exclusively  \n combine breastfeeding and formula-feeding  \n formula-feed exclusively  \nDo not offer my baby:  \n formula  \n sugar water  \n a pacifier  \nCIRCUMCISION  \nIf my baby'","cbCaioWec9ANFD1f","https://ap.wps.com/l/cbCaioWec9ANFD1f","pdf",138466,"English","# Attendants and Amenities\n# Hospital Admission & Procedures\n## Other Interventions\n# Labor Props and Pain Relief\n# Pushing and Positions\n# Vaginal Birth Preferences\n# C-Section Preferences\n# Cord Blood Banking and Postpartum\n# Feeding Issues and Circumcision\n# Discharge Preferences","[{\"question\":\"What preferences can be set for hospital admission and procedures?\",\"answer\":\"The worksheet allows choices about returning home if not in active labor, who may stay during admission, whether the participant can wear contact lenses, eat if desired, stay hydrated without an IV, have a heparin or saline lock, and walk freely.\"},{\"question\":\"What options are provided for pain relief and pushing?\",\"answer\":\"It lists pain-management techniques to try, including non-medicinal methods and options for medication if requested, while also noting a preference not to be offered pain medication automatically. For pushing, it asks whether to push instinctively or be coached, and it lists preferred pushing and birth positions.\"},{\"question\":\"What postpartum, feeding, and discharge decisions does the worksheet collect?\",\"answer\":\"It captures preferences for newborn procedures during presence, rooming-in arrangements, partner involvement, and whether to breastfeed early. It also records feeding plans and items to avoid, circumcision wishes, cord blood banking intentions, and preferred timing for hospital discharge.\"}]","Birth Plan Worksheet - Hospital Labor and Delivery Preferences | PDF",1790093682]