my birth planflipbooks.leedsth.nhs.uk/ln004582.pdf · the midwife my birth partner me this is the...
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Leeds Maternity Care
The Leeds Teaching Hospitals
n
NHS Trust
Easy Read
My birth planInformation for patients
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This is an easy guide to help you plan the birth of your baby.
Please mark the boxes to show your choice.
Who I want with me during my labour and birth:
my partner
my friend
a member of my family
my support worker
someone of my choice:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Someone of my choice
Support Worker
Family
Friend
Who you want with you during your labour and birth:
my partner
my friend
a member of my family
my support worker
someone of my choice:
. . . . . . . . . . . . . . . . . . . . . . . .
Partner
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Massage
Birth ball
Moving around
Things you would like to help during your labour and birth:
beanbags
moving around
birth ball
massage
Beanbag
Who I want with me during my labour and birth
my partner
my friend.
a member of my family.
my support worker.
or someone of my choice.
Things I would like to help me during my labour and birth
beanbags.
moving around.
birth ball.
massage.
TENS.
my own music.
baths or showers.
encouragement and support.
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TENS
my own music
baths or showers
support and
encouragement
Support
Bath or shower
My own music
TENS
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Low lights / bright lights
Too warm / cold
Too many people
Things you may not like during my labour and birth:
loud voices
too many people
too warm / cold
low lights or bright lights. etc.
Loud voices
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Pain relief you are thinking about during your labour and birth:
water pool
paracetamol
gas and air (entonox)
diamorphine
epidural
Epidural
Diamorphine
Gas and air
Paracetamol
Water pool
DiamorphineHydrochloride
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Injection
Naturally
This is your placenta.
How would you like to give birth to it?
naturally
with an injection
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The midwife
My birth partner
Me
This is the umbilical cord.
Who do you want to cut the cord?
me
my birth partner
the midwife
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By mouth
Injection
This is vitamin K. This can help your baby.
Do you want your baby to have vitamin K?
Yes
No
How would you like your baby to have vitamin K?
injection
by mouth
What is vitamin K and do I want my baby to have it?
do I want my baby to have vitamin K & if so by
injection.
orally.
How I would like to feed my baby
breastfeeding bottle feeding
mixed feeding
We help all mum’s to have skin to skin contact with their baby.
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Skin to skin contact
Mixed feeding
Bottle feeding
Breastfeed
How would you like to feed your baby:
breastfeed
bottle feeding
mixed feeding
We help all mum’s to have skin to skin contact with their baby.
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Important things you want us to know about you and your choices:
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Other information:
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LN004582Publication date
10/2019Review date
10/2021
© The Leeds Teaching Hospitals NHS Trust • 1st edition (Ver 1)Developed by: Laura Walton, Lead Midwife Maternity Strategy
Produced by: Medical Illustration Services • MID code: 20190516_001/BP