Creating a Birth Plan: Template and What to Consider
Complete guide to creating your birth plan with template, options to consider, and tips for discussing with your healthcare team.
A birth plan is a document that communicates your preferences for labor and delivery to your healthcare team. While birth rarely goes exactly according to plan, having one helps ensure your wishes are known and can guide decision-making during labor. Here's everything you need to know about creating an effective birth plan.
What Is a Birth Plan?
A birth plan is a written document that outlines your preferences for:
- Pain management during labor
- Labor positions and movement
- Medical interventions and procedures
- Who you want present during delivery
- Immediate postpartum care preferences
- Newborn care decisions
Keep in Mind
Birth plans should be flexible guidelines, not rigid requirements. The most important goal is a healthy outcome for both you and your baby. Be prepared to adapt if circumstances change during labor.
Birth Plan Template
Basic Information
- Mother's Name: ________________________
- Partner's Name: ________________________
- Due Date: ________________________
- Healthcare Provider: ________________________
- Hospital/Birth Center: ________________________
Labor Environment Preferences
Atmosphere & Support
People I want present:
- Partner ☐
- Doula ☐
- Family members (specify): ________________
- Friends (specify): ________________
Environment preferences:
- Dimmed lighting ☐
- Music playing ☐
- Quiet environment ☐
- Photography/video allowed ☐
Labor Management
Movement & Positioning
- ☐ Freedom to walk and move around
- ☐ Use of birth ball
- ☐ Squatting bar
- ☐ Shower/tub during labor
- ☐ Various labor positions
Comfort Measures
- ☐ Massage
- ☐ Hot/cold therapy
- ☐ Aromatherapy
- ☐ Breathing techniques
- ☐ Meditation/visualization
Pain Management Options
My Pain Management Preference:
☐ Natural/Unmedicated Birth
I prefer to avoid pain medications and would like to be reminded of this preference if I request them during labor.
☐ Open to Pain Medications
I am open to pain relief options and would like to discuss them as needed during labor.
☐ Epidural Preferred
I would like an epidural as soon as it is safe and available.
Specific preferences:
- Nitrous oxide (laughing gas) ☐
- IV pain medications ☐
- TENS unit ☐
- Water birth ☐
Medical Interventions
Please discuss with me before:
- ☐ Induction of labor
- ☐ Breaking my water
- ☐ Continuous fetal monitoring
- ☐ IV fluids
- ☐ Episiotomy
- ☐ Vacuum/forceps delivery
- ☐ Cesarean section
- ☐ Internal monitoring
- ☐ Pitocin augmentation
- ☐ Catheter insertion
Delivery Preferences
During Birth:
- ☐ I want to see the baby crowning with a mirror
- ☐ I want my partner to catch/help deliver the baby
- ☐ I want to touch my baby's head as it crowns
- ☐ Please avoid announcing the baby's gender (we want to discover it)
- ☐ Please announce the baby's gender
- ☐ I want immediate skin-to-skin contact
- ☐ I want to deliver the placenta naturally
Newborn Care
Immediately After Birth:
- ☐ Immediate skin-to-skin contact
- ☐ Delay cord clamping
- ☐ Partner cuts the cord
- ☐ Breastfeeding within first hour
- ☐ Baby stays in room (rooming-in)
Medical Procedures:
- ☐ Vitamin K shot
- ☐ Eye antibiotic
- ☐ Hepatitis B vaccine
- ☐ Circumcision (if boy)
- ☐ PKU and other newborn screening
Feeding Preferences
- ☐ Breastfeeding only - No bottles, pacifiers, or formula unless medically necessary
- ☐ Combination feeding - Breastfeeding with formula supplementation as needed
- ☐ Formula feeding - Please provide bottles and formula
- ☐ Please consult me before giving the baby anything other than breast milk
Tips for Using Your Birth Plan
Before Labor
- Discuss your birth plan with your healthcare provider during prenatal visits
- Bring copies to your hospital bag
- Make sure your partner and support people understand your preferences
- Ask about hospital policies that might affect your choices
- Keep your birth plan to 1-2 pages for easy reading
During Labor
- Give copies to your nursing staff when you arrive
- Communicate with your support person about your current needs
- Stay flexible if medical circumstances change
- Ask questions if recommendations differ from your plan
- Remember that your safety and your baby's safety are the top priorities
Important Reminders
- Birth plans are preferences, not requirements
- Medical emergencies may require changes to your plan
- Every birth is different, even for the same person
- Your healthcare team wants the best outcome for you and your baby
- It's okay to change your mind during labor
Discussing Your Birth Plan
When reviewing your birth plan with your healthcare provider:
- Ask about hospital policies and how they align with your preferences
- Discuss any concerns or questions about your choices
- Understand the circumstances that might require plan changes
- Ask about alternatives if your first choice isn't available
- Make sure your provider supports your overall birth philosophy
Remember that creating a birth plan is about preparing for one of life's most important moments. While you can't control everything that happens during labor, having a thoughtful plan helps ensure your voice is heard and your preferences are considered whenever possible.
The most successful birth plans balance personal preferences with flexibility, allowing you to advocate for yourself while remaining open to the unexpected journey that birth can be.