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Birth Plan & Preferences Guide

Desiree Marie Dozier has outlined her birth preferences, indicating a plan for a vaginal birth with the use of a standard labor epidural and IV pain medication. She has specified preferences for newborn care, including skin-to-skin contact and breastfeeding, and has indicated her desire to avoid induction medications unless necessary. The document includes details about her care team, allergies, and authorized support people during labor.

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42 views3 pages

Birth Plan & Preferences Guide

Desiree Marie Dozier has outlined her birth preferences, indicating a plan for a vaginal birth with the use of a standard labor epidural and IV pain medication. She has specified preferences for newborn care, including skin-to-skin contact and breastfeeding, and has indicated her desire to avoid induction medications unless necessary. The document includes details about her care team, allergies, and authorized support people during labor.

Uploaded by

evandozier7c
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Birth Preferences for: Desiree Marie Dozier (Ihde)

MY CARE TEAM ALLERGIES

NSAIDs Drugs (ex: Advil)


Support People:
Sulfa Drugs
Evan Dozier (Husband):
Azithromycin
Phone : 240-390-7353
Latex
Tammy Gonzalez (Mother):
Glutens
Phone : 424-435-8969
Oats
Obstetrician:
Pears
Dr. Cheryl Sanders
Phone : 310-376-2716
Fax : 310-374-9163
Fetal Specialist: AUTHORIZED PEOPLE DURING LABOR
Dr. Rachel Gutkin
Phone : 310-944-9094
Fax : 310-944-9095
Primary Care: Evan Dozier (Husband)
Dr. Shih-Fan Sun
Phone : 310-303-3953 Tammy Gonzalez (Mother)
Fax : 310-303-7903
Pediatrician: Christina Fernandez (Cousin)
Dr. Elaine Gutierrez
Phone : 310-326-4670 Brenda Escobar (Friend)
Fax : 310-326-4672

LABOR PREFERENCES

I am planning a vaginal birth. I plan Ambulation: I would like to move


throughout labor (if no epidural is in
on laboring with:
A standard labor epidural place).

IV pain medication Yes

Unmedicated comfort techniques: No


Support person(s)
Massage
Birthing ball Do you want intermittent fetal
Peanut ball monitoring (if medically
Music appropriate)?
Aromatherapy
Yes
Other:
No
Birth Preferences for: Desiree Marie Dozier (Ihde)

In case of an emergency cesarean: Nutrition: I would like to eat and


drink throughout my labor.
In the operating room, I plan on
using:
Yes
Music
No
Window drape

I prefer a saline lock for my IV. Are you donating your placenta?

Yes Yes
No No

BIRTH PREFERENCES

Do you want to take your placenta


I would like the cord clamped:
home?

30 seconds after birth Yes


10-15 minutes after birth No

Do you want your cord blood


Do you want to avoid an episiotomy?
collected for storage?

Yes Yes
No No

Do you want a warm compress to the Do you want the golden hour with my
perineum? newborn right after birth?

Yes Yes
No No
Birth Preferences for: Desiree Marie Dozier (Ihde)

NEWBORN CARE

Do you want the recommended


Skin-to-skin right after birth:
newborn medications?
Yes Vitamin K
No Antibiotic Eye Ointment
Hepatitis B Vaccine

How do you plan on feeding your Do you want your baby bathed after
baby? 24 hours of age?

Breast only (if able) Yes


Formula only No
Both breast and formula

Something we missed? Any other birth preferences: No use of Pitocin or any other
induction medication unless absolutely necessary. Use of Pitocin or other medication to
stop hemorrhaging is okay. Epidural will be requested if needed, or any other pain
management medication.

It is important that all members of your care team know and understand your choices.

I have reviewed my birth choices with my obstetrician or midwife during an office visit.
I am bringing this copy to share with my care team.

For physician use only

I have reviewed the birth plan with the patient and I agree with the above.

Physician Signature:

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