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Template for Making Your Own Birth Plan

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Birth plans seem to be a somewhat new idea. But why wouldn’t you make a list of what you want to happen during your birth to make sure everyone is on the same page? It makes sense to me. Depending on where you live, the size of the hospital, and how long you labor before delivery, you could have several nurses and doctors over the course of your labor.

I think we had 3 nurses while I labored with my first child. I was so glad we had our birth plan available. With our second, we had 2 nurses, and I had never met the doctor who delivered our oldest son. We just tweaked the birth plan a bit to include a birth photographer. Our third was a little easier, I was wheeled into the birthing room, somehow climbed up on the bed and he was born while my husband was still parking the car. Ha! The birth plan allowed everyone who came into the room to know our wishes for our births. I have found that typically if you give your birth plan to your provider at one of your last appointments, make sure the nursing staff have your birth plan at the hospital and have an extra in your bag to keep in your room, the staff tries to follow your plan. That has been our experience anyway.

Pregnant woman looking at ultrasound image and writing birth plan

A quick search of the internet provides several different websites that simply allow you to fill in the blanks. You can also search for birth plans and pick and choose what best fits your birthing philosophy. There is no one size fits all birth plan. While some people can watch television during labor or listen to music, that’s not me. I need quiet. Some music is okay, but if it has words, it’s over. I get so irritated with music that contains words while I’m laboring. Isn’t that crazy?!

Birth Plan Template

Mother-to-be: Whitney   Partner: 
Support Person(s): GC   Due Date: 03/19/2014
Practitioner: Midwives   Place of Birth: Charlotte NC 

This birth plan is intended to express the preference and desires we have for the birth of our baby. It is not intended to be a script. We fully realize that situations may arise such that our plan cannot and should not be followed. However, we hope that barring any extenuating circumstances, you will be able to keep us informed and aware of our options. Thank you.

First Stage (Labor):

  • Dim lights.
  • Peace and Quiet.
  • Would prefer to keep vaginal exams to a minimum.
  • Birthing room with a tub.
  • Maintain mobility (Walking, rocking, up to bathroom, etc.)
  • Eat and drink to comfort.
  • Intermittent Monitoring (ACOG Standards) with an external monitor.
  • Please do not offer me pain medications, I will ask for them if I want them.
  • Relaxation techniques (breathing, focusing, etc.).
  • Positioning as desired.
  • Water (Shower or Tub).
  • Heat or Cold packs.
  • Massage (back, foot, counter pressure, etc.).
  • Acupressure
  • Photos to be taken without the flash


  • I would prefer to use natural methods to start labor.
  • Herbs and essential oils before using Pitocin to induce.


  • I would prefer to walk and use natural remedies to speed labor.

Second Stage (Birth):

  • Choice of position
  • Spontaneous Bearing Down
  • I would prefer no episiotomy, but please use compresses, massage, and positioning.

Baby Care:

  • Delay the cord cutting
  • Prefer partner to cut the cord.
  • Delay the eye medication
  • Breastfeeding only
  • No pacifiers or glucose water
  • delay the first bath
  • no vaccinations in the hospital

Cesarean Birth (should one be deemed necessary):

  • Spinal/epidural anesthesia
  • Partner present
  • Doula present
  • Video/Pictures taken
  • Screen lowered to view the birth or mirror
  • Explain the surgery as it’s happening
  • Free one hand to touch the baby
  • Partner to cut the cord
  • Breastfeeding in recovery room

Should baby need to be transferred to the NICU:

  • Breastfeeding as soon as possible
  • Unlimited visitation for parents
  • Handling the baby (Kangaroo care, holding, care of, etc.)

Childbirth Baby Pregnancy

Have you created a birth plan for labor and delivery? How did you go about writing it out? Were you able to follow it?

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Monday 10th of March 2014

I love this! I made a birth plan and I found it to be so helpful. I thought the hospital would be 'annoyed' by it, but the nurses actually seemed to welcome my wishes! I followed it for the most part :)

Whitney at Beauty in the Mess

Monday 10th of March 2014

I thought the same thing! But they were super gracious about the whole thing. Granted they've all been pretty basic birth plans, but you never know. It also helped to keep me focused on what I did want and didn't want since I made it when I was thinking clearly. I definitely don't think that clearly in the midst of contractions. Thanks for stopping by!

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