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Welcome to Baptist Health Louisville Mother-Baby Care We care about your needs and want to take excellent care of you and your family. The nurses that will be taking care of you in Labor and Delivery and Mother-Baby want to welcome you to Baptist Health Louisville! In order to understand your preferences during your birth experience, the following birth plan addresses common processes that you will experience. You can make your choices and then discuss with your obstetrician. At the time of admission to Labor and Delivery, present this plan to your labor and delivery room nurse. Insert information on this side Personal Information Your name: Your due date: Name of your doctor: Name of your baby’s doctor: (commonly referred to as a pediatrician) Primary Support Person: Labor Coach and/or doula: (doula is a labor coach hired by the patient) Breathing and relaxation exercises (I have attended or plan to attend Lamaze or Bradley classes) Breathing and relaxation exercises (I have not attended either Lamaze or Bradley classes) * Walking (Some MDs do not allow you to walk after your water is Pain relief during labor: (Please check what you are interested in for your pain relief.) To monitor your baby during labor, a fetal monitor in placed around your abdomen. With your doctor’s order, you may have the monitors off for short periods of time. broken) ________MD initials Dim Lights Birthing Ball Music-bring your own Water therapy (shower) Wear your own gown (must be open in the back) Intravenous medication Epidural Please do not offer medication or epidural to me in labor Continuous monitoring (standard practice for most patients; required if labor is being induced) *Intermittent monitoring (requires MD order) ______MD initials An IV (intravenous line) is placed upon admission in case you need medication or to place fluid in your body since you will have only ice chips or popsicles during labor. Your doctor can order to have your IV line disconnected for short periods of time. (called a Saline Lock) IV, continuously infusing *Saline lock only (requires MD order) __________MD initials Do you want a mirror for pushing and/or delivery? Yes No I would like my MD to allow natural stretching. I am aware Decisions regarding episiotomy there is a possibility that the skin and tissue might tear. I want my MD to cut an episiotomy if needed. Welcome to Baptist Health Louisville Mother-Baby Care We care about your needs and want to take excellent care of you and your family. Would you like your support person to cut the cord? Yes No Do you want the baby to go to Kangaroo care immediately after the delivery—the baby will be placed on your chest skin to skin? Yes No How do you plan on feeding your baby while you are in the hospital? Breast Bottle My baby can have a pacifier? Yes No Other Requests Standard care of our newborns include eye ointment within 1 hour of birth, a Vitamin K injection (used to prevent Vitamin K deficiency bleeding) and all of our pediatricians order an injection of Hepatitis vaccine. If you have questions regarding any of these medications/vaccines, please discuss with your pediatrician prior to delivery. Please note during your labor and delivery, you are allowed 3 visitors at a time in your room. Your visitors include your primary support person. This is to protect not only you and your family but in respect to all of the patients experiencing the birth of a new baby. For everyone’s privacy, all visitors must wait in the waiting room and not in any hallway. Rooming in is encouraged at all times on the Mother/Baby unit. I understand that this plan may be altered due to changes in my condition or the baby’s condition. Signature of Mother___________________________________________ Signature of Mother’s doctor____________________________________ We look forward to seeing you for delivery! Sincerely, The Staff in Labor and Delivery and Mother-Baby If you have any questions when completing this birth plan, please call Labor & Delivery at (502) 897-8251 and ask to speak to one of the labor and delivery nurses. Any item with an * should be discussed with your obstetrician during one of your prenatal visits.