Making Your Birth Plan

Download Template

Click to download the FREE Word document template to edit and fill as you like.

There’s no one way to write a birth plan. Some plans only cover the basics, while others are highly detailed. Every expectant parent is different—not only in what they’d like out of their birth experience, but also their pregnancy profile and history—so your birth plan should be customized to reflect and fit you.

Basic Birth Plan Info

Putting together your birth plan will help you feel more prepared for labor and delivery and it will empower you to express your preferences with your delivery team and healthcare provider. 

Your plan should include your preferences for: 

  • Before Labor
  • During Active Labor
  • Medical Interventions
  • Pain Relief
  • During Delivery
  • Newborn Care

The Bottom Line 

Keep in mind: your birth plan is a written understanding—not a binding contract—between you and your practitioner. Chances are, your plan will be followed, but there is always a possibility it won’t, and your birth plan might need to change in the moment. 

The most important part of a good birth plan is flexibility. Childbirth is unpredictable! The best-laid plans don’t always go, well, according to plan. 

Consent & Your Rights during Childbirth

You have the right to choose and/or refuse procedures during and after birth.
For more information on your rights as a child-bearing person, visit childbirthconnection.org.

Starter Birth Plan Template

This template will help you craft a personalized plan. Simply check the options you’d like and cross out the ones you don’t. Don’t forget to include your and your partner’s names at the top, as well as that of your doctor and hospital or birthing center.

Remember: Although chances are very good that your plan can be carried out the way you wrote it, there’s always the possibility that it won’t and that your birth plan might need to change in the moment.

Basic Information

  • Name: 
  • My Support Person: 
  • Hospital/Birth Center: 
  • Due Date/Induction Date: 
  • Practitioner’s Name: 

Before Labor

  • My health factors include: 
  • My planned delivery is: 
  • My birth team includes: 

During Labor

If medically possible, I would like to:

  • Eat and drink during labor if my practitioner allows it
  • Be out of bed (walking or sitting up) during labor
  • Labor in water
  • Play music, dim lighting, use incense or aromatherapy
  • Have partner or birth photographer take photos or videos
  • Labor with an exercise ball, in-room shower or birthing tub
  • Use specific birthing positions:
  • Other:

Medical Interventions

Check all that apply; make a note beside any you want to avoid.

I would prefer:

  • Artificial rupture of the membranes
  • Leave membranes intact for as long as possible
  • External and internal electronic fetal monitoring
  • Intermittent fetal monitoring
  • Doppler fetal monitoring only
  • Use of an IV or catheter or enema
  • Use of oxytocin to induce or augment labor contractions
  • Episiotomy
  • Natural tearing only
  • Vacuum extraction or forceps to assist in the birth 
  • Other:

Pain Relief

Check all that apply; make a note beside any you want to avoid.

I would prefer:

  • Standard epidural 
  • Walking epidural
  • Acupuncture
  • Acupressure
  • Breathing exercises
  • Massage
  • Meditation
  • Reflexology 
  • Other:

During Delivery

Check all that apply; make a note beside any you want to avoid.

I would like to:

  • Use mirror to see baby crown
  • Have my partner help catch our baby
  • Allow my partner to suction
  • Allow my partner to cut umbilical cord
  • Wait to cut umbilical cord

In case of C-Section, if medically possible, I would prefer: 

  • To be conscious
  • Clear drapes be set up so I can watch as my baby emerges
  • One arm to be left free of cuffs, monitors and IVs so I can hold the baby for skin-to-skin contact
  • To nurse/chest/breastfeed as soon as possible

Newborn Care

Check all that apply; make a note beside any you want to avoid.

I would like to:

  • Hold my baby immediately after birth, allow baby time to creep from belly to breast
  • Nurse/Chest/Breastfeed immediately
  • Have a lactation consultant help me breastfeed
  • Bank the cord blood 
  • Donate the cord blood
  • Keep the placenta to take home
  • Give my baby formula
  • Give my baby breast milk only
  • Offer my baby a pacifier
  • Room-in with baby
  • Let my baby sleep in the nursery
  • Have circumcision performed (if baby is a boy)
  • Give my baby vitamin K
  • Give my baby antibiotic eye treatment
  • Other:

 

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