Birth Experience Questionnaire & Plan Builder

Birth Experience Questionnaire

For expecting mothers and their birth support team. Answer at your own pace, one question at a time.

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Question 1 of 11

Mother's Information

Please enter your name to personalize your birth plan.

GBS (Group B Streptococcus) Status

What is your GBS test result?

Positive
Negative
Unknown/Not tested

Support Persons During Birth

Who will be supporting you during labor and delivery?

Labor Environment & Atmosphere

What kind of environment would help you feel most comfortable during labor?

Dim lighting
Quiet atmosphere
Music playing
Essential oils/diffuser
Personal items from home

Pain Management Preferences

What are your preferences for managing pain during labor?

Breathing techniques
Movement & positioning
Massage & counterpressure
Hydrotherapy (shower/tub)
Epidural (when requested)
Nitrous oxide (laughing gas)

Labor & Delivery Interventions

What are your preferences regarding common interventions?

Intermittent fetal monitoring
Continuous fetal monitoring
Avoid induction unless medically necessary
Avoid episiotomy
Warm compresses perineal support
Delayed cord clamping

Delivery & Immediate Postpartum

What are your preferences for the delivery moment and immediate postpartum period?

Spontaneous pushing
Mirror to see birth
Partner to help catch baby
Immediate skin-to-skin
Delayed weighing & measurements
Breastfeed as soon as possible

Newborn Procedures & Care

What are your preferences for your baby's initial care and procedures?

Vitamin K injection
Erythromycin eye ointment
Hepatitis B vaccine
Delayed procedures after bonding
Bath delayed (at least 24 hours)
Baby rooming in with me

Feeding Preferences

What are your preferences for feeding your baby?

Exclusive breastfeeding
Combination feeding
Formula feeding
Lactation consultation support
No pacifiers initially

Unexpected Situations

What are your preferences if unexpected situations arise?

Discuss all options before decisions
Partner present at all times
Gentle/family-centered cesarean if needed
Skin-to-skin in OR if possible
Clear explanations of procedures

Postpartum Recovery & Support

What are your preferences for your postpartum recovery period?

Partner stays overnight
Minimal interruptions for sleep
Help with breastfeeding positioning
Pain management options discussed
Emotional support check-ins
Resources provided before discharge

Personalized Birth Plan

Created on

This birth plan reflects your preferences. Please discuss with your healthcare provider and remember that flexibility is important as birth can be unpredictable.

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