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What is a birth plan? 
A birth plan is a document that tells your midwife your preferences for such things as how to manage labour pain. Of course, you can't control every aspect of labour and delivery, and you'll need to stay flexible in case something comes up that requires your midwife to depart from your plan. But a printed document gives you a place to make your wishes clear when you have a choice. The information can help guide you in a discussion with the midwife about your preferences when you face choices along the way.

How do you write a birth plan?
To help you write a birth plan, we have provided a fill-in-the-blanks worksheet below which lets you know what your options might be when you give birth. Use it to prepare yourself for delivery and communicate your wants and needs with us. After you have filled in the form, click on ‘send’, which automatically sends a copy to our email address.

Discussing your birth plan 
The discussion can be the basis for a birth plan, if you decide to create one. Please ask for a longer appointment when you have filled in the form, so that we have enough time to discus your preferences.  


(*) = compulsory

vraagteken = more information

  1. Your data

  2. Your name(*)
    Mandatory field
  3. Date of birth(*)
    Mandatory field
  4. Phone number(*)
    Mandatory field
  5. E-mail address(*)
    Mandatory field
  6. Your partners name(*)
    Mandatory field
  7. Post natal maternity care (kraamzorg)(*)
    Mandatory field
  8. Due date(*)
    Mandatory field
  9. Support and location

    Good support during your delivery is very important. Who would you like to support you during the birth of your child?

  10. Ongeldige invoer
  11. Ongeldige invoer
  12. Where would you like to give birth?(*)

    Mandatory field

    If there are no medical problems your pregnancy is deemed low risk and you may choose between a home birth or a hospital birth (in Dutch called "poliklinisch bevalling"). The midwife will help you during your delivery in either situation. In case you're not sure which you want to choose, your definite decision may even be differed up until labour begins. During a normal labour, and regardless of where you want to give birth, the first half of the labour process will happen at home during which time we will check on you at regular intervals. At about 4-6 cm's dilation, we will either go with you to the hospital or stay with you at home until the baby is born. We will let you know when it’s necessary to call the post natal maternity care.

    During labour, even if you have planned for a home birth, there can be reasons to transfer you to the hospital and into second-line care. Less than 4% of women who plan to give birth at home, are rushed to hospital in an emergency situation. The majority of women required to transfer to the hospital do so in a calm a controlled manor, using their own transport. The midwife continually assesses the progress of your labour. Safety for mother and child are our top priority and we will take no unnecessary risks! If we feel the situation is unsafe, we will refer you to the gynaecologist. Having said this, we must stress that giving birth at home is just as safe as in the hospital. You should deliver where you feel most comfortable.

    If a hospital birth is for a medical reason (i.e. you have been referred to second-line care during pregnancy or labour), your medical insurance company will normally cover the total costs. Choosing a hospital birth when there is no medical indication incurs a personal contribution of €336.08 (as of 2014). Some medical insurance policies cover these costs – check your own medical insurance to establish exactly which costs are covered. Please be aware that the midwife is responsible for all the emergencies and deliveries during her shift. It could be possible that she needs to answer the phone while assisting you during your delivery.

  13. Options for both home or hospital births:

  14. May an intern be present during your delivery?(*)
    Mandatory field
  15. Do you want pictures/film taken during your delivery?(*)
    Mandatory field
    If so, let us know as specifically as possible when you would like pictures to be taken and more importantly, when not! Also decide who you would like to take them. Please be aware that filming in the hospital requires consent.
  16. Any other wishes with regard to support or location?
    Ongeldige invoer
  17. Ways of giving birth

  18. Did you follow a prenatal course which you would like to use?(*)

    Mandatory field
  19. Ongeldige invoer
  20. Which position would you prefer to take during your contractions and delivery?

    Ongeldige invoer
    More information about different positions can be read in de folder ‘Houdingen tijdens de baring’ (pop-up) which you received from us. Please be aware that we may suggest a different position if it will improve the dilation or for any other medical reason.
  21. Mandatory field
  22. Note: The midwife always has a birthing stool with her.
  23. Any other comments about the way you want to deliver?
    Ongeldige invoer
  24. Pain

    During the delivery there are a couple of methods you can use to handle the pain of the contractions: breathing techniques, relaxation exercises, massage, taking a warm shower or bath or using a hot water bottle. Together we will try to see which options help you the most. Some women experience relief using a birth TENS, which can be hired or bought.

  25. Do you want to receive pain medication at the onset of your delivery? (only possible in the hospital)(*)
    Mandatory field
    Information about pain management can be found in the booklet ‘How do you deal with pain?’ (pop-up) which you received from us. When you have asked for medical pain relief, please note that it takes about 45-75 minutes before the treatment is effective. It takes time to travel to the hospital, a CTG must first be made to asses the condition of your child and the anaesthesiologist must be available to place the epidural. When you have received pain medication it is no longer possible to get out of bed. In some cases the delivery progresses so quickly, that there is no time to administer any treatment. Any form of medical treatment has it's advantages and disadvantages, any possible side effects can be read about in the booklet mentioned above.
  26. Which type of medicine would you prefer?(*)

    Mandatory field
  27. Other comments about medication
    Mandatory field
  28. Medical help

    During a low-risk birth there is usually little reason to intervene with the natural process. However, sometimes the delivery doesn't progress as expected. If the delivery takes longer than expected or there are any signs of danger for the wellbeing of mother or child, it may be necessary to receive medical treatment. This can vary between needing an IV line to receive extra hormones, monitoring the foetal heartbeat, a vacuum extraction if labour isn't progressing when pushing or a caesarean section. The doctors and midwives working in the hospital will discuss and explain all interventions as clearly as possible, so you and your partner can understand the choices that are being made.

  29. Do you prefer to explicitly give permission for medical interventions?
    Ongeldige invoer
  30. Please explain (when needed)
    Ongeldige invoer
  31. Any specific wishes regarding medical interventions
    Mandatory field
  32. The birth

    Do you have any specific wishes concerning the time directly after the birth of your child? If you had a vaginal delivery and you and your baby are both in good condition, we will do our best to take into account all the following wishes.

  33. I would like the baby to be put directly on my abdomen(*)
    Mandatory field
  34. I would like the umbilical cord to be cut by
    Ongeldige invoer
  35. I would like to see the placenta(*)
    Mandatory field
  36. How would you like to feed your baby?(*)

    Mandatory field
    Breastfeeding: In accordance to the advice of the breastfeeding association, we try to help you nurse your baby as soon as possible.
  37. Other wishes concerning the birth of our child
    Ongeldige invoer
  38. Apart from the questions covered above, I have the following specific requests
    Ongeldige invoer
  39. (*)
    Invalid Input

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