Birth Plan Template for A Better Birth To Share With Your Birth Team

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Here is a sample birth plan we used for the birth of our last baby. Use this birth plan template to write your own to go over with your birth team.

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 birth 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.

birth plan template. 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. That's why using a birth plan template is so great.

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?!

4 Things to Include When Writing a Birth Plan

1. List Your Support People

Make sure you list the people who you would like to be in the room during your labor and their contact information.

If there is anyone you don't want in the room, list this as well.

2. Important Medical History

Make sure to list any medications you are taking, conditions you may be being treated for, and information on past pregnancies and deliveries. Write it all out even if you think it's in a chart somewhere.

3. The Room Environment

This is where you should make a note if you want certain music or guided meditations to be played. If you would prefer the room to be as quiet as possible, make sure that’s clearly written.

4. Pain Management Preferences

Make sure if you want an epidural that it is clearly stated because there is a window when it will be too late for an epidural to be administered. If you would like to utilize other pain management techniques make note of that in your birth plan. Also, if you had trouble with pain management during previous deliveries, make sure to add that information to your birth plan.

Let's take a look at what your birth plan might look like using this birth plan template.

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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  1. 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 🙂

    1. 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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