BirthPlan

KG Hypnobirthing is a complete in-depth antenatal training programme designed to release fear and build confidence during birth.

Birth Plan Template

To be focussed on a calm and natural KGHypnobirthing birth, take time in your pregnancy to identify what is important to you.

Birth can sometimes be unpredictable, so be flexible and accept that things may not go to plan and each woman’s experience is personal. The course of labour can vary according to the health needs of you and your baby and you can be prepared by understanding your options and asking for full information at the time.

Look at various stages so that you are clear on the experience you would like, what is acceptable to you and how you want to consider your options if presented with them.

Complete this birth proposal and discuss it with your medical care-givers, as it will need to be right for your particular circumstances.

Below is an interactive birth plan

Click on the boxes to choose your preferences and use the free form box to add your own requests. Leave the boxes blank if the statement is not relevant, it will then not populate onto your birth plan. Once you have filled out the form click on 'create your birth plan' and you will be able to print out your personalised birth plan.

Full Name

Email Address

Name of husband/birth partner/support person

Place of birth

Your date of birth (mother)

Greeting

Introduction

General

I / we would like

I / we would prefer not to have

Respect and support for our hypnobirthing

clear selection

I / we would like

I / we would prefer not to have

A midwife who is supportive of KGHypnobirthing

clear selection

I / we would like

I / we would prefer not to have

Any conversation to be with dad / partner in the first instance (Respect the fact that conversation with mother disturbs the neocortex and stimulates the production of adrenalin which inhibits the production of oxytocin)

clear selection

I / we would like

I / we would prefer not to have

Private time to discuss any procedure proposed

clear selection

I / we would like

I / we would prefer not to have

clear selection

I / we would like

I / we would prefer not to have

clear selection

I / we would like

I / we would prefer not to have

clear selection

I / we would like

I / we would prefer not to have

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Induction / augmentation

I / we would like

I / we would prefer not to have

Induction by membrane sweep

clear selection

I / we would like

I / we would prefer not to have

Monitoring after 42 weeks rather than induction of labour

clear selection

I / we would like

I / we would prefer not to have

Induction for post-dates

clear selection

I / we would like

I / we would prefer not to have

Induction if labour does not start after the release of membranes

clear selection

I / we would like

I / we would prefer not to have

Augmentation of labour

clear selection

I / we would like

I / we would prefer not to have

Vaginal examinations after the release of membranes at start of labour

clear selection

I / we would like

I / we would prefer not to have

clear selection

I / we would like

I / we would prefer not to have

clear selection

I / we would like

I / we would prefer not to have

clear selection

I / we would like

I / we would prefer not to have

clear selection

+ Add another row

Environment during labour

I / we would like

I / we would prefer not to have

A calm, safe and natural place of birth

clear selection

I / we would like

I / we would prefer not to have

Peace and tranquillity in my room

clear selection

I / we would like

I / we would prefer not to have

Soft lighting

clear selection

I / we would like

I / we would prefer not to have

Facility to play relaxing music and KGHypnobirthing audio

clear selection

I / we would like

I / we would prefer not to have

My birth partner to remain with me throughout labour and birth and after the birth

clear selection

I / we would like

I / we would prefer not to have

Use of the pool during labour and birth (As hypnobirthing births can be quicker than other births please make sure the pool is filled in good time)

clear selection

I / we would like

I / we would prefer not to have

The use of the word 'pain' in labour

clear selection

I / we would like

I / we would prefer not to have

Conversation in my room throughout labour

clear selection

I / we would like

I / we would prefer not to have

clear selection

I / we would like

I / we would prefer not to have

clear selection

I / we would like

I / we would prefer not to have

clear selection

I / we would like

I / we would prefer not to have

clear selection

+ Add another row

Monitoring

I / we would like

I / we would prefer not to have

One vaginal examination at the beginning of labour

clear selection

I / we would like

I / we would prefer not to have

Vaginal examinations in labour

clear selection

I / we would like

I / we would prefer not to have

clear selection

I / we would like

I / we would prefer not to have

clear selection

I / we would like

I / we would prefer not to have

clear selection

I / we would like

I / we would prefer not to have

clear selection

+ Add another row

Labour and birth

I / we would like

I / we would prefer not to have

I would like to have a birth pool available

clear selection

I / we would like

I / we would prefer not to have

Artificial rupture of membranes in labour

clear selection

I / we would like

I / we would prefer not to have

Coaching during the second stage of labour

clear selection

I / we would like

I / we would prefer not to have

Natural expulsion of placenta

clear selection

I / we would like

I / we would prefer not to have

clear selection

I / we would like

I / we would prefer not to have

clear selection

I / we would like

I / we would prefer not to have

clear selection

I / we would like

I / we would prefer not to have

clear selection

+ Add another row

Baby care

I / we would like

I / we would prefer not to have

Dad / birth partner to cut the cord

clear selection

I / we would like

I / we would prefer not to have

Facilitate my baby to initiate breast feeding at or soon after birth

clear selection

I / we would like

I / we would prefer not to have

Infant feeding supplements (cows milk formula) to be given to my baby

clear selection

I / we would like

I / we would prefer not to have

Baby to receive vitamin K by injection

clear selection

I / we would like

I / we would prefer not to have

Baby to receive vitamin K orally

clear selection

I / we would like

I / we would prefer not to have

clear selection

I / we would like

I / we would prefer not to have

clear selection

I / we would like

I / we would prefer not to have

clear selection

I / we would like

I / we would prefer not to have

clear selection

+ Add another row

Environment after birth

I / we would like

I / we would prefer not to have

Optimal cord clamping and cutting (after pulsation has stopped)

clear selection

I / we would like

I / we would prefer not to have

To hold our baby undisturbed for at least one hour after birth

clear selection

I / we would like

I / we would prefer not to have

An injection of synthetic oxytocin

clear selection

I / we would like

I / we would prefer not to have

To hold baby skin to skin

clear selection

I / we would like

I / we would prefer not to have

clear selection

I / we would like

I / we would prefer not to have

clear selection

I / we would like

I / we would prefer not to have

clear selection

I / we would like

I / we would prefer not to have

clear selection

+ Add another row

KGHypnobirthing will not be retaining any of your decisions on the form as once it has been saved as a PDF by you, it will be deleted from our system.

KGHypnobirthing run face-to-face and online parents courses – to find out more, please tick the box

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