Online Birth Plan

First Name

MI

Last Name

Due Date

Name of Health Care Provider/Physician

After a conversation with my physician/nurse midwife, I'd like the following people present during labor and/or birth.

Partner

Friend

Relative

Doula

Children

I would like

Music

Dim lighting

Peace and quiet

Wear my own clothes

Minimal vaginal exams

I'd like the option of returning home if I'm not in active labor and it is deemed medically safe to do so.

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