Sample Birth Plan Template

As needed post-delivery, please give me:
Extra-strength acetaminophen
Percoset
Stool softener
Laxative
After birth, I’d like to stay in the hospital:
As long as possible
As briefly as possible
If baby is not well, I’d like:
My partner and I to accompany it to the
NICU or another facility
To breastfeed or provide pumped
breastmilk
To hold him or her whenever possible
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birth plan
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Sample Birth Plan Template PDF

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