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Birth Expectation Plan

We have developed a Birth Expectation Plan to help guide you in some of the options that are available to you during childbirth. This also gives you the opportunity to share what your expectations are for your birth experience so that we can partner together. Please use the Birth Expectation Plan to begin conversations with your healthcare provider(s) about the kind of birth experience that is important to you. We encourage you to research all options, and discuss the effectiveness and risks of those that interest you with your healthcare provider(s).

Click here If you would prefer to download a PDF of this form and submit it manually or by fax.

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** not provided by hospital

 
Patient Information
 
Care Provider
 


 
Environment within the Birthing Suite
 




 
The following are the people I want present in room at time of delivery (You may have up to 4 people and one support person)
 
Pain Management During Labor
 













 
Techniques/Positions to Cope With Back Labor
 





 
Care During Labor
 





 
Delivery Position
 








 
Delivery
 









 
Postpartum
 




 
Our concerns/priorities regarding labor and birth
 
Is there anything else you would like us to know about your preferences, concerns:
 
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