My Birth Plan | School of Antenatal

top of page

चित्र 1.jpg

अंतर्राष्ट्रीय प्रशिक्षण प्रदाता

My Birth Plan

First name

Email

Partners/Fathers First name

Last name

Due Date

My partners Email

I know the sex of my baby

No

Yes

My baby is a

girl

boy

Twins

Rather not say

I would like to Birth at home?

No

Yes

I would like to Birth in Hospital

No

Yes

I would like a water birth

No

Yes

I am undecided!

No

Yes

Notes for the Midwife

Pain Relief Options Chosen

I would like an epidural

No

Yes

I would like Gas & Air

No

Yes

I would like a Opioids

No

Yes

I would like no pain relief

No

Yes

Notes for the Midwife

Birth Support

I would like my partner present

No

Yes

My Doula will be present

No

Yes

Notes for Midwife

Birth

Baby to have Vitamin K ?

No

Yes

I would like Skin to skin

No

Yes

Delayed Cord Clamping

No

Yes

I would like to Breastfeed

No

Yes

My partner wants Skin to skin

No

Yes

Myy partner wants to cut the cord

No

Yes

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

स्कूल ऑफ एंटेनाटल लिमिटेड
पंजीकृत: 14260658
निर्देशक: डॉन रोज़वियर - मैथ्यू पीयर्स
पंजीकृत पता: सूट 1 -पोलॉक्स गेट FY8 1BG

bottom of page