Download Baptist Health Louisville`s birthplan

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.