My maternity care plan
Personal care plans help you explore, understand and record your individual choices for pregnancy, labour and birth. Every woman, birthing person and family is different, with individual needs.
Decisions regarding care should be made in partnership with your maternity team and those close to you (such as family and friends). Personal care plans are for everyone, whether it is your first baby or your fifth!
Your midwife and/or doctor can help you to complete or adapt your personal care plans at any point, and you are encouraged to share your plans and preferences with them throughout pregnancy.
Feel free to complete as much of the plan as you like. You can skip a section or wait to discuss with your midwife.
If there is a section you do not want to complete tick this icon at the top of the page.
Throughout this booklet you will find QR codes to scan, for further information and support. The QR codes link to helpful short films and relevant pages of the Suffolk and North East Essex maternity and neonatal website.
About Me
This is me
1. Hello, my name is:
2. Please call me:
3. I identify myself as… (she/her; he/him; they/them)
4. My preferred way to communicate is:
- Sign language
- I like to use pictures
- In my native language
- Makaton
5. Something I would like you to know:
6. Some of the people you may hear me talk about - They mean a lot to
This is my pregnancy
My due date is:
That makes me feel:
- Happy
- Neutral
- Sad
My maternity unit is:
This is my first baby:
- Yes
- No
Baby Number:
My intended place of birth (home, midwife-led unit or obstetric-led unit) is:
I’m not sure yet, I may need further information
My midwife/team contact details are:
My named obstetric consultant is:
My known medical condition/allergies/disabilities are:
My Journey before pregnancy
How I got here
This is my story:
Things that might impact my journey, and areas I may need support:
I don’t mind talking about it
I find it difficult but may be later
I don’t want to talk about it again
My spirituality:
My world now
Whats happening now
My every day looks like:
My family looks like:
My cultural routine
My Religious routine:
Where I seek my support (organisations, groups, family, friends or professionals):
Other things I would like you to know:
My current health
My body mind and health
I have a long term health condition I wish to share:
- Diabetes
- Epilepsy
- Mental health challenges
- High blood pressure
- Asthma
- Hyper/Hypothyroidism
- Sickle Cell disease
- Experiences of trauma/abuse
- Other
- None
I’m taking the following medication/supplements:
- None
It is recommended that folic acid supplements are taken up until 12 weeks of pregnancy and Vitamin D supplement throughout pregnancy
I have discussed my plan with my midwife/doctor:
Midwife/doctor name:
Date:
My worries
Things I'm not so sure about
My concerns about my pregnancy:
- I’m feeling fine, no worries here
What worries me most about labour and birthing my baby:
- I’m feeling fine, no worries here
I would like more information about
My Birth Preferences
I have a plan
The power of a birth plan is not the plan its self, its the process of thinking about your choices and sharing them. Plans change, but here you can write down your hopes and wishes for birth. Please share this each time you see the maternity team.
01 Place of birth
Where I would like to birth my baby:
- At home
- A midwife led unit
- A delivery suite
- I would like to wait and see
- I’m really not sure, can I have more information about my local maternity services and see
Where to birth
My birth supporter/s will be:
The birth partner
Thoughts, feelings, questions
Sometimes student midwives/doctors may be working in the team where I chose to have my baby:
- I am happy for a student midwife/doctor to be present during my labour/birth
- I would prefer not to have any student midwives/doctors to be present during my labour/birth
- I would like to see how I feel nearer the time
- I’m really not sure, please can you tell me more
I have additional requirements
- I will need help from a translator as English is not my first language
- I have allergies/dietary requirements
- I may need adjustments to my care due to learning disabilities
- I would like my religious beliefs/customs to be observed and respected
- I have experienced previous trauma and would like to talk to someone
- I/my partner has additional needs details of my/partners additional needs, how you can support us:
02 Pain management
Pain management during labour and birth - If I am in pain what matters to me
Things I need to cope:
I have considered:
The ways in which I cope are
Pain management
03 Third stage of labour
My plans for after the birth of my baby:
I would like my baby’s cord to be cut by:
I would like to birth my placenta:
- Naturally
- Managed (injection of oxytocin)
- I am unsure and need more information
I would like my baby to receive a vitamin K injection after birth?
- No
- Yes
- I need more information before I make a decision
Third stage of labour
04 Feeding my baby
How I choose to feed my baby
- Breastfeed
- Bottle feed
- I haven’t thought about it yet
- I need more information and support with this
My thoughts, feelings and questions about feeding my baby:
Feeding baby
Health visiting
I would like to talk to a specialist midwife about my birth experience (birth debrief)
- Yes
- No
- Maybe later
- What does this mean? What happens?
Wellbeing after birth
My maternity contacts
My midwife
My maternity unit
