Birth Plan Generator | Undoctored for Doulas

Document Details

State of delivery

Date of delivery (estimated)

Hospital or birth center name

Attending provider

Doula name

Parents / Guardians

Parent / Guardian 1 — full name

Parent / Guardian 2 — full name (if applicable)

Baby's name (or "Baby [Last Name]")

Is birthing parent Rh-negative?

Labor & Delivery

Freedom of movement and positioning throughout labor

Intermittent fetal monitoring preferred over continuous electronic fetal monitoring

Unless clinically indicated

Doula present at all times, including any surgical procedure

No students, residents, or interns without explicit verbal consent for each

No augmentation or induction without full informed consent discussion and written agreement

No photographs or video for teaching, records, or social media without written consent

Birth Trauma — Birthing Person

Document refusal of interventions known to cause or contribute to birth trauma. These are assertions of bodily autonomy, not emergency refusals.

No episiotomy without explicit consent in the moment — not general consent at admission

Routine episiotomy is not evidence-based; we consent only if we are informed and agree in real time

No forceps or vacuum-assisted delivery without explicit informed consent discussion and agreement

Alternatives and risks to be explained before proceeding

No physical restraint, holding down, or directed pushing against our will

We will labor and push in positions that feel right to us

No vaginal examinations without verbal consent for each individual examination

We have the right to pause or stop any examination at any time

Support person and doula are not to be removed from the room during any procedure without our consent

We expect respectful communication — no threats, ultimatums, fear language, or condescension

Informed consent requires a calm, pressure-free environment

No pressure toward cesarean without a clear clinical indication and full informed consent discussion including alternatives

Birth Trauma — Newborn

The transition from womb to world is the most neurologically significant event of a human life. These preferences protect that transition.

No routine bulb syringe or deep suctioning unless clinically indicated (meconium aspiration risk or respiratory distress)

Routine oropharyngeal suctioning is not evidence-based for healthy newborns

Gentle, unhurried handling — no rough stimulation or vigorous toweling for a breathing newborn

Dimmed lighting and reduced noise immediately following birth — the transition environment matters

No separation from birthing parent except for a genuine, named medical emergency — not for routine assessments

All weight, measurements, and assessments to be performed on our chest or within our sight

If emergency separation is required, support person must be notified immediately and accompanies the baby

Vernix to remain on baby's skin — do not wipe or wash off

Antimicrobial, thermoregulatory, and moisturizing — designed to be absorbed

Cord & Placenta

Cord clamping

No controlled cord traction — allow placenta to deliver physiologically

We wish to keep the placenta

Newborn Procedures

Select your preference for each. Declining items will generate legally grounded informed refusal language in the document.

Erythromycin Eye Ointment

Decline — informed refusal

Legal in all 50 states. Not mandated.

Accept

Vitamin K

Decline — informed refusal with monitoring plan

Decline injection — compounded oral alternative arranged

No FDA-approved oral formulation exists in the US; must be compounded

Accept — preservative-free formulation only

Request Amphastar or Cipla USA formulation (no benzyl alcohol)

Accept injection

Hepatitis B Vaccine

Decline — informed refusal

Defer — will discuss timing with pediatrician

Not legally mandated at birth in any US state

Accept at birth

Newborn Metabolic Screening (Heel Prick)

Decline — religious / philosophical exemption

Select your state above for specific form and statute

Document religious objection (no exemption available in this state)

For NE and SD only — acknowledges mandate while recording objection

Accept

Nebraska and South Dakota have absolute mandates with no exemption pathway. Nebraska has enforced compliance through emergency custody orders (In re Anaya, Nebraska Supreme Court, 2008). We strongly recommend consulting a healthcare rights attorney before delivery if you intend to decline in these states.

Other Newborn Screens

Decline pulse oximetry screening

Decline newborn hearing screen

Rh Immunoglobulin (Rhogam)

Not legally mandated anywhere in the US. The decision depends on paternal Rh status, future pregnancy plans, and current sensitization status.

2024 guideline update: SMFM (Feb 2024) and ACOG (Dec 2024) both state Rhogam is no longer recommended after pregnancy loss before 12 weeks — miscarriage, medication abortion, or aspiration. This was never a law. The right to decline has always existed.

Father / co-parent Rh status (if known)

28-Week Antenatal Dose

Decline — informed refusal

Accept

Postpartum Dose

Decline — informed refusal

Accept (if baby is Rh-positive)

Reason for declining (optional — strengthens documentation)

Newborn Care

Immediate uninterrupted skin-to-skin — minimum two hours before any non-emergency procedure

Delayed bathing — minimum 24 hours

Vernix protection and temperature regulation

No formula, glucose water, or supplemental feeds without explicit consent

No pacifiers or artificial nipples without explicit consent

Baby remains with parents at all times — no nursery without consent

No additional blood draws beyond agreed screening without specific consent for each

Feeding

Breastfeeding is our intention — lactation support requested within 24 hours

No cord blood banking solicitation

Anything not covered above

Additional preferences, specific concerns, or anything specific to your situation that the form didn't ask

This will appear as its own section in the generated document.