Printable Contracts

   Birth Plan

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BIRTH PLAN

I, {Name}, giving birth to my {number} child on or around {due date} (or: having labor induced on {date}), declare the following birth plan to be my direct wishes for the duration and follow-up of the procedure. I hereby request that my {doctor/midwife/doula}, {Name(s)}, and/or any other medical personnel who assist with the birth consider the following to be morally and legally binding, and that they follow this plan to the best of their ability.

Initial Stages

Environment

Comfort/Pain Management

Delivery

Post-Partum

I understand that my desires and needs during the birthing process may be subject to change, and all requirements above should not be considered over my requests during the birth. Should I be incapacitated or unable to answer questions, please use this document as the primary reference.

IN WITNESS WHEREOF, the party has signed this Agreement as of the date first set forth above.

_______________________________
{Name}

_______________________________
Date

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