Model Letter for Hospital Births - Avoiding Invasive Procedures*For those who are planning a hospital birth but want to evade invasive routine post natal procedures such as a Hep B shot, vitamin K injection or the application of silver nitrate in the newborn’s eyes, a very specific birthing plan must be submitted to the hospital in advance of the birth. Hospital staff must be informed, in advance, of your needs, wants and desires where your baby and birthing experience are concerned. The following letter was provided to the local hospital by VacLib members in advance of the birth of their child. This letter can be used as a model letter for others who are planning a hospital birth but want their babies spared from being subjected to certain routine postnatal procedures. ____________________________________ |
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(Date)
To (Name of hospital) OB-GYN-NBN Staff:
RE: Patient Jane Doe, DOB 00/00/00. Dr. (Name), Due date – 00/00/00
INSTRUCTIONS FOLLOWING BIRTH:
As requested by (Nurse’s name), Nurse Manager OB-GYN-NBN, we are expressing our wishes in writing concerning the treatment of our baby once born. We trust that our wishes will be carried out by all staff members.
We would like to hold and allow the baby to breastfeed immediately after birth. When the baby and we are comfortable, the staff may take the baby to the warmer, check him/her, and put his/her ID tags on the ankle. When getting the footprints, please use as little ink as possible and do not scrub over zealously to remove the ink. [Another VacLib member was able to keep her baby from being taken from her the whole time she was in the hospital.]
We prefer that the baby is bathed and measured in the labor/delivery room. If this is absolutely impossible, the support will escort the baby to the nursery.
UNDER NO CIRCUMSTANCES is the baby to receive the antibiotic drops in the eyes and UNDER NO CIRCUMSTANCES is the baby to receive the Vitamin K shot. (Nurse’s name) assured me this would not be a problem and it would be noted in my chart and posted in the nursery.
We will discuss vaccination with the baby's regular pediatrician
UNDER NO CIRCUMSTANCES is the baby to be given the PKU Test.
There is no family history to warrant the test.
We would like the baby to be brought to the post-partum room as soon as possible and we anticipate a rooming in situation.
We appreciate your cooperation and understanding and thank you for your help in delivering and caring for our baby.
Sincerely,
Mrs. Jane Doe
Mr. John Doe
To (Name of hospital) OB-GYN-NBN Staff:
RE: Patient Jane Doe, DOB 00/00/00. Dr. (Name), Due date – 00/00/00
INSTRUCTIONS FOLLOWING BIRTH:
As requested by (Nurse’s name), Nurse Manager OB-GYN-NBN, we are expressing our wishes in writing concerning the treatment of our baby once born. We trust that our wishes will be carried out by all staff members.
We would like to hold and allow the baby to breastfeed immediately after birth. When the baby and we are comfortable, the staff may take the baby to the warmer, check him/her, and put his/her ID tags on the ankle. When getting the footprints, please use as little ink as possible and do not scrub over zealously to remove the ink. [Another VacLib member was able to keep her baby from being taken from her the whole time she was in the hospital.]
We prefer that the baby is bathed and measured in the labor/delivery room. If this is absolutely impossible, the support will escort the baby to the nursery.
UNDER NO CIRCUMSTANCES is the baby to receive the antibiotic drops in the eyes and UNDER NO CIRCUMSTANCES is the baby to receive the Vitamin K shot. (Nurse’s name) assured me this would not be a problem and it would be noted in my chart and posted in the nursery.
- No Antibiotic drops: The mother does not have any sexually transmitted diseases or active infection in the birth canal and is therefore unlikely to infect the eyes of the newborn. (Especially since it will be a C-Section)
- No Vitamin K to the newborn: The baby is at little risk for cerebral hemorrhage. The mother is a vegetarian who consistently eats large quantities of dark leafy green vegetables, therefore unlikely that mother or child is vitamin K deficient.
We will discuss vaccination with the baby's regular pediatrician
UNDER NO CIRCUMSTANCES is the baby to be given the PKU Test.
There is no family history to warrant the test.
We would like the baby to be brought to the post-partum room as soon as possible and we anticipate a rooming in situation.
We appreciate your cooperation and understanding and thank you for your help in delivering and caring for our baby.
Sincerely,
Mrs. Jane Doe
Mr. John Doe
More sample birth plan letters
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