Creating a Birth Plan: How to Make It Work For You
A birth plan is not a contract. It is a communication tool. Used well, it is one of the most powerful things you can bring into that room.
The pushback on birth plans usually comes from two places: people who have been disappointed when births did not go to plan, and medical staff who have dealt with rigid, confrontational documents that made everyone's job harder.
Both concerns are valid. Neither is a reason not to write one.
The goal is just a document that clearly communicates your values and preferences while demonstrating that you understand birth is unpredictable. That combination earns you respect in the room.
Keep it short
One page. Two at most. A document that runs to five pages with colour-coded sections will not be read in full during an active labour. A single clear page will be.
Use bullet points or short paragraphs. State preferences clearly without lengthy justifications. The explanation is for your conversations with your midwife antenatally. The document is the summary.
Structure it around the stages
A useful framework is to organise your preferences by stage:
– First stage of labour: your preferences around monitoring, movement, pain relief, environment
– Second stage: pushing positions, coached versus spontaneous pushing, perineal support preferences
– Third stage: management of the placenta, delayed cord clamping, skin-to-skin
– Immediately after birth: cord cutting, vitamin K, newborn checks, feeding
– If a caesarean becomes necessary: skin-to-skin in theatre if possible, your preferences for the experience
Be specific about what matters most
Not everything in birth carries equal weight for every woman. If unmedicated birth matters to you most, say so clearly and explain how you want to be supported if you ask for an epidural under pressure. If early skin-to-skin is the non-negotiable, make that the clearest line in the document.
The things that feel most important to you deserve the most explicit language.
Include a section for possible complications
This is the section most birth plans skip and the one that does the most work. If an emergency caesarean is needed, what matters to you? If your baby needs to go to NICU, who do you want with them? If you need to be separated from your baby, what are your feeding preferences in the interim?
Writing this section forces you to think through scenarios you would rather not think about. It also means you have communicated your values before the situation is urgent.
We had decided ahead of time that if anything urgent was to happen that would require my baby to be taken away, that my partner would go wherever the baby went rather than staying with me.
Share it with your care provider before you go into labour
Your birth plan should be discussed at a prenatal appointment, not introduced for the first time in the delivery room. Your midwife or OB should know what is in it, have had the chance to flag anything that is not feasible, and ideally have a copy in your file.
If any of your preferences meet significant resistance from your care provider, that is worth exploring before you are in labour. Informed refusal is always your right. It is a much calmer conversation at 36 weeks than at 8 centimetres.
Write the plan. Have the conversations. And then hold it loosely, knowing that a birth that needed to change course is not a birth that went wrong.
——
Here is my actual birth plan, feel free to make it your own especially if you’re intending on an unmedicated home birth!
HOME WATER BIRTH IS OUR PRIMARY PREFERENCE
At home
The atmosphere of the room to be calm and quiet.
Dim lighting.
To have relaxation music/tracks playing in the background.
To have the following persons present during my birthing: Stu, Cathy and extra midwife when required
Minimal (if any) vaginal examinations. None if membranes have released.
During Labour
No unnecessary talking – please speak to Stu. As I will be using self-hypnosis, I may not be immediately responsive to questions, especially during surges.
Please do not speak to me or move me during my surges (unless needed), we will be practising our hypnobirthing techniques.
Please do not offer any medication (due to using self-hypnosis I am very open to suggestion) – I will ask if I need it.
In the absence of a medical necessity, only intermittent monitoring of baby's heart with Doppler or manual use of EFM. Freedom of movement is of upmost importance.
To change positions and assume labour/birthing positions of choice in any location.
Please do not inform me of my progression in dilation unless I am complete.
The patience to allow labour to progress naturally without references to "moving things along."
During Birthing
To remain in the water for birthing if possible.
Use the birthing position of choice (preferably more upright/squatting/hands & knees) to allow the pelvis to open & gravity to help with descent of baby.
To allow the expulsive reflex to take place naturally, with mother-directed breathing/bearing down until crowning takes place. No prompts to ‘push’ unless necessary.
A calm, quiet atmosphere during descent.
Perineum – warm compress applied to my perineum during 2 stage of labour if possible/not in pool.
I wish to keep my perineum intact; however, if it comes down to a choice, I would prefer to tear rather than have an episiotomy if possible.
Melissa or Stu to help receive the baby.
Initial exam to be made whilst baby is in my arms.
Allow vernix to be absorbed into baby's skin; delay "cleaning or rubbing"; use of soft cloth when rubbing is appropriate but please retain as much vernix as possible.
We appreciate your patience in allowing up to 60 minutes for natural placenta delivery (or as long as required unless medically necessary to intervene).
Delay cord clamping and cutting until after pulsation has ceased and cord is completely white. Stu will cut cord.
Continue the atmosphere of quiet and calm after birth. Lights remaining low. No unnecessary procedures. Baby skin to skin with mother. No hat on baby.
Immediate breastfeeding to assist in natural placenta expulsion.
No cord traction, oxytocin injection, or manual removal of placenta unless there is a medical need and only after discussion.
Allow us at least 1 hour of uninterrupted bonding time together before any weighing/measuring etc.
Injections/immunisations: none at this point. Vitamin K will only be considered if any trauma/bleeding to baby is an immediate risk.
Optional
To video and/or take photos of our birth if safely possible at all /opportunity allows (we’d be so grateful, and also fully recognise this is not what you are here for).
IF HOSPITALISATION REQUIRED
Only consider inducement if there is evidence of medical urgency or if labour is unusually delayed (i.e. more than 14 days past the estimated due date).
To use natural means of inducement first; moving to gels, Syntocinon or other procedures as a last resort.
To be fully apprised and consulted before the introduction of any medical procedure.
No augmentation of labour via synthetic oxytocin, Artificial Rupture of Membranes ARM (amniotomy), or stripping of membranes without discussion and explanation of absolute need.
Use ventouse, rather than forceps if assistance is medically necessary.
If significant perineal trauma is imminent, I would prefer a medio-lateral episiotomy only if 100% required to avoid potential further trauma.
In the case that the oxytocin injection is required after birth for placenta delivery - clamp cord before injection given.
In Case of an Emergency Caesarean
It is my strong wish to give birth vaginally. If it is determined that a caesarean is indicated, we request (health and circumstances permitting):
The option to obtain a second opinion from another obstetrician/doctor if time allows.
The atmosphere of the room kept calm, with no unnecessary chatter.
Delayed cord clamping.
Drapes lowered as baby emerges.
Vaginal swab be taken and smeared over baby (mouth & body) immediately at birth; so baby is exposed to a similar bacteria environment as if born vaginally if possible.
Baby placed on my chest immediately for skin-to-skin contact, for us to stay together during repair and recovery and to breastfeed during the initial recovery period.
Stu to remain with our baby at all times, no matter what.