Essential reads & resources

A birth planning guide for your labor and birth plan preferences.

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Creating a birth plan can be simple, once you know what is most important for your labor and delivery preferences. Use this birth plan overview as a guide to the what, when and how of birth planning 101. Here’s what we’ll cover:

Birth Planning Basics

• What is a birth plan?
• Why use a birth plan?

Things to consider when using a birth plan  

• A birth plan is a starting point
• Birth planning with your team

Birth plan essentials for a hospital birth

• Your people/team
• Your needs
• Your birth goals and care preferences

Birth plan preferences

• During Labor
• During Pushing & Birth
• After birth
• For your Newborn

Using your Birth Plan at the Hospital

• Effective birth plan design
• Using your birth plan

Birth Plan Basics

A pregnant person or couple planning for their baby’s arrival has a lot to think about - but actually birth planning? The concept may be new to you if you’ve never had a baby before, but birth planning has become increasingly popular as a plethora of medical interventions, support options and care philosophies about birth have become available.

In the United States, where there are particularly high rates of medical interventions such as Cesarean section and induction, and health outcomes are impacted by systemic racism and economic disparities, planning for your care is important. Birthing people and the people who care for them have developed birth plans as a way of discussing medical choices, asking for labor support, reducing anxiety, boosting patient confidence, and advocating for the best evidence-based practices in busy hospital settings. In this section we will describe this multi-functional tool in more detail and how a birth plan can be used to help you develop your own birth plan.

What is a Birth Plan?

In simplest terms, a birth plan is a document showing a laboring person’s needs and goals related to:

• Support people roles and limitations
• Informed choice and consent
• Medications
• Procedures
• Newborn bonding, care and feeding
• Cultural or religious considerations
• Whatever an empowered experience means to you as a new parent

However, a birth plan is more of a reference guide and tool for informed decision-making than a plan. It is neither a contract nor any kind of legally binding document, but it can be used as a reference tool for you, your support people and your medical team. This can be particularly helpful if you are feeling vulnerable, tired or overwhelmed, because a written birth plan represents what you’ve learned and identified as important ahead of time, and serves as a reminder to slow down, take a breath, and talk to your providers.

Planned physiological birth, or vaginal birth, has a beginning, middle and end, but every birth is a little different. The unexpected does occur, and personal health history, anatomy, lifestyle, prenatal care, genetics, and chance can all play into exactly how a labor unfolds. Knowing about your choices for each stage of the process - and outlining your highest-priority preferences in a clear way - helps you to discuss them during planning, or in the moment - and can help you feel calm, confident and supported in making any changes if needed.

Why use a Birth Plan Template?

A birth plan template is simply a tool for helping you to make your birth plan, and can be used in creating a birth plan document or, in some cases, may itself be used as a birth plan. A template should include the options and preferences available to you at your birth location, and address the different stages and processes of birth and the immediate postpartum period. If you are having your baby at a hospital or birth center, they may provide a birth plan or checklist for you to use. You can download our Seven Starling Birth Plan above, for a downloadable PDF to build your own.

In most cases, a birth plan is a guide from which you can create your own unique plan. Using a current template will ensure that your checklist of considerations includes the most current available options in terms of medication types, facility logistics, and common procedures. With a quality birth plan, you will have a handy starting point for learning about these options ahead of time, which in turn allows you to get additional information, make changes, or submit requests to your medical care team.

Once you start using your birth plan to get clear on your preferences, make notes, and discuss your ideas with your support team and prenatal health care provider, you will have a handy list, from which you can write an organized, easy-to-read and effective birth plan.

Things to Consider When Using a Downloadable Birth Plan

Using a simple birth plan is a way to organize your birth planning and get clear on the areas you may need to discuss with your prenatal health care provider. It can also be used as a direct document, but a birth plan is only as effective as the collaboration of your team in using it.

Below we discuss some of the things to consider in making the most out of any birth plan, and how to leverage this simple tool for what can feel like a complex process.

Let your birth plan be a starting point

Rather than an end goal, your downloadable birth plan template is a way to start identifying your priorities and get your preferences organized. It can also serve as a handy “index” of sorts for keeping track of the questions you’ve asked your doctor, the options you’ve done your own research on, and the areas where you could use more support. When reviewing any birth plan, make notes to mark:

• For which of these birth options do I already know my preference?
• Which of these are unfamiliar to me and require more research?
• For which of these birth options am I feeling unclear or still a “maybe”?

Approached in this way, a birth plan can be used throughout your pregnancy, starting as early as you’d like and in conjunction with any online birth classes, prenatal education, labor prep, or postpartum planning you do. You can even print your birth template, take notes, and then print another copy after you’ve increased your understanding and confidence in your preferences. Remember, this is your birth plan, and there isn’t one way to plan, so print your downloadable birth plan template today or come back to it online as many times as you need to.

Birth planning with your team  

A birth plan is only effective if you, your personal support team, and your medical staff have a chance to review your preferences and goals with you. Consider your birth plan a “living document” that serves both as a source of information and as a reference if any questions come up. For example, a question about who will cut your baby’s umbilical cord after birth may lead to a conversation about delayed cord clamping and cord blood banking.

Make sure your partner or primary support person is well-versed in your birth plan - it’s a great idea to review it together after prenatal appointments, or with your doula if you have one. They should know your level of flexibility on certain aspects, in addition to any contingency plans you might have. To support communication around those instances, it may be helpful to also discuss, separately from your birth plan, the “vibe”, energy or communication style you’d like to use during any potentially stressful moments.

Even in a typical low-risk pregnancy, your plan should be flexible and include discretion and guidance from your provider based on your unique needs - let the plan be a conversation starter with your provider team. Ask your provider what the standard of care is in for each aspect of your birth plan. You can also ask for your area’s or facility’s specific statistics for procedures like an episiotomy or an emergency Cesarean section.

Birth Plan Essentials  

Your birth plan should include some essential elements that are always present, no matter what stage of pregnancy, labor, delivery or postpartum care you are in. A simple birth plan might address these elements directly as categories, or they may be worked into different sections of the document covering the beginning, middle and end of labor and birth.

We’ll break down these essentials of a quality birth plan and some of the different ways you might incorporate them into your birth planning process.

Your birth team

Your birth plan is a tool for you and your birth team, and your birth team includes anyone directly supporting you through the end of pregnancy and the labor process.

• Your first team member is YOU! You are the decider, the leader and the center of the process. Your name, date of birth, and estimated due date should be listed at the top of your birth plan, and your first name might be worked into the sections where you state your preferences.
• The next element of your birth team is anyone close to you, caring for you and helping you to navigate your pregnancy and labor. This could include your partner, a parent or other relative, a best friend, a doula, or a combination of these. These are your trusted companions and support people - if they will be with you at your birth location, you should list their names on the first page of your birth plan as approved visitors/support people. If your partner or co-parent will be attending, they should be identified as the other parent of your baby.
• On the medical side, your birth team includes your primary care providers, any medical specialists you work with, and perhaps most importantly, the staff who are attending you in the moment during your actual labor. You’ll want to write your primary prenatal health care provider’s name  - be they doctor or midwife - at the top of your birth plan, with a phone number if they will be on-call. You may not know your nurse’s name ahead of time but once you meet them you can write it down on the plan itself or on the whiteboard in your hospital room, if one is provided. If you are planning for a home birth, you will still want to list your midwife so they can collaborate with your care team in case of any type of transfer.

Pro Tip: If you are birthing in a hospital or birth center, the most constant medical care person you will likely encounter will be a nurse. Because nurses often work in rolling shifts, and labor can take a long time, you may work with multiple nurses during your clinical stay - and you may need to review your birth plan more than once! If you are birthing at a location that provides doulas, or have already contracted a doula to attend you in birth, they will also be a steady companion, and while they cannot give medical advice or speak on your behalf, a skilled doula can help you to articulate your preferences and ask questions, so it will be good to debrief them on your birth plan ahead of time or early on in the process.

Your needs

There are certain needs that are not flexible, and these should be clearly stated at the beginning of your plan or cued for discussion so that they are easy to understand for any medical staff and support people in attendance. Needs could include considerations such as:

• Any allergies or medication sensitivities that your whole team should be aware of
• Any food allergies or sensitivities that your team should be aware of
• Any complications or conditions that could immediately impact your care, including high blood pressure, hypermobility issues, symphysis pubis dysfunction, gestational diabetes or a heart condition
• Any unique personal needs that might be helpful to share, such as a propensity to faint at the sight of blood, a significant health history or traumatic experience in that facility location, such as the death of a loved one, or a religious or cultural requirement related to privacy or personnel in attendance

More universally, while a birth plan is not a manifesto - it is a tool in response to the need for better communication and teamwork in the American birth process. That being said, all people deserve and benefit from respectful, compassionate care, informed consent in collaborative decision-making processes, and time to consider your options in a non-emergency setting. In the next section, we consider how a birth plan can protect these broader needs for all patients by centering your goals and preferences.

Your birth goals and care preferences

While everyone shares the goal of a healthy baby and birthing person, there are a few different ways to get there, and you are allowed to have preferences around different approaches and philosophies about birth. In addition to robust vital signs, there are many other measures of client satisfaction and health - the purpose of a birth plan is to improve health outcomes by centering you, the birthing person, in the labor and delivery process.

Your sense of safety, calm, confidence and enjoyment are all a part of your experience, just as heightened stress or fear can define a memory for a lifetime. As important as the psychological aspects of feeling supported in your birth, are the physiological consequences of your care. If you are feeling listened to, understood, informed and in charge of your body and your baby, your central nervous system is more likely to be relaxed. If you are relaxed, the part of your brain responsible for the hormones of labor and birth is more easily activated, and the functions of labor are more likely to unfold without complication.

Birth planning supports your birth goals and preferences by creating opportunities to learn, explore and decide some things ahead of time, with the understanding that if anything has to change, you are still the primary decider and deserve a thorough and compassionate collaboration with your medical staff in making the next best choice for you and your baby. Whether you are planning for a vaginal birth, going in for an induction, have a planned Cesarean section, or working towards a vaginal birth after Cesarean, your needs and desires are valid and worthy of serious consideration!

Birth Plan Preferences

Your own individual preferences may shift throughout your pregnancy, but starting to think about the different options you have through the phases of labor can help you to make adjustments feeling informed and empowered. It is okay to change your mind, but recognize that in labor, some things can be added or removed, but rarely can an intervention be “undone”.

As you develop your birth plan, you will likely want to assign certain preferences to the different parts of the process that may involve your medical team. Whether you are birthing at home, in a hospital, or at a birth center, these stages apply to any plan and can be altered for anyone planning a medically indicated Cesarean section.

During labor  

Ambiance: Many people enjoy detailing the types of lighting, music or aromatherapy they would like to use in the space. These are worthy details, just know that you can probably request them or directly change them on the spot, and you may not need to write them into the final version of your birth plan if your document is getting crowded. For planned Cesarean section deliveries, these details may be a primary component of creating a family-centered atmosphere. You might also note if you are okay with photos and videography.‍

Personal Freedoms: Labor & Delivery patients are rarely required to wear a hospital gown if they aren’t getting surgery. You may be more comfortable in your own clothing, as long as it is easy to remove if needed. The ability to move around freely, change positions, and eat and drink at will are also common preferences and are considered evidence-based supportive actions for the progress of labor.‍

Personnel: Early on, you may be choosing between a home, hospital or birth center, as well as an OBGYN, midwife, or other practitioner. How do you feel about having a resident (a medical student who is not yet a medical doctor) provide your labor care? Or student observers? You are the decider for your care, and that includes the right to switch to a different provider or decline to work with medical students. ‍

Protocols & Procedures: Asking ahead of time about the standard admission process to help you to identify protocols specific to your birth location. If you are working with a homebirth midwife, they will go over all the details about what will happen once they arrive at your home and what kind of procedures or monitoring will occur. At a clinical site, you might need to discuss your preferences on:‍

• IV placement and hep-lock upon admission or only as medically indicated
• Frequency of cervical exams and discussion of “progress”
• External intermittent or continuous monitoring of your baby
• Use of medications such as misoprostol (“miso”) for induction of labor‍
• Artificial rupture of your membranes (AROM) for induction or augmentation
• The use of synthetic oxytocin (Pitocin) to cause or increase contractions

Coping strategies for sensation and pain relief, including:

• Hands on support and changes in positions
• Movement, vocalization, breathing techniques
• Hot/cold therapy, bath/shower, hot/cold packs
• TENS unit
• Narcotics (i.e. Fentanyl)
• Epidural Anesthesia
• A preference to not be offered any pain relief unless requested

During pushing and birth  

Ambiance, Personal Freedoms, and Personnel considerations will still apply here, although in a hospital setting, additional staff may be called in to check in on your progress, and pediatric staff will likely be present at birth to check on your newborn’s health. Pushing in different positions is safe and possible as long as you feel good about the position and your practitioner’s skill in supporting you - however, many laboring people in hospitals are asked to get on a bed and you may face some resistance if you want to push in certain positions that limit provider vision or access to your baby.

Laboring Down: This may be offered to people using an epidural depending on their baby’s position. “Laboring down” gives someone more time between full cervical dilation and starting to push. This may give the baby some time to come down lower in the pelvis, which can make pushing more effective and avoid preventable pressure or tearing on the soft tissues of the pelvis and perineum.

Pushing Support: Physiological or “mother-led” pushing is when a birthing person follows their own instinctive urge to bear down at the peak of a contraction, starting some time after full dilation. This is common in home birth settings and becoming more popular in the hospital setting, as opposed to coached pushing, which can lead to overstrain, loss of breath, and perineal trauma. On the other hand, some people really benefit from verbal guidance at this stage.  Learn more about pushing with a childbirth educator, doula, or your practitioner - or join Seven Starling today to learn about this and more in a small group setting with an expert coach.

Protocols & Procedures: It can take some time to get the hang of pushing, and this phase can take anywhere from a few minutes to a few hours, especially for first-time moms. Depending on many factors, your medical team might discuss with you the following tools for assisted delivery, all of which come with their own appropriate uses as well as risks:

• Additional Pitocin
• Vacuum extraction
• Forceps
• Episiotomy

Other Pushing Considerations: You may have a desire to view your baby’s crowning with a mirror, to touch your baby’s head, or for you or your partner to catch or help catch your baby. You might also prefer to have your baby’s biological sex announced - or not! Discuss these options ahead of time as provider and location differences will have varying availability. And for more context, read our guide on the stages of labor.

Surgical Delivery Considerations: If you are planning or anticipating a Cesarean section, you can still make the moment of birth special for your family. You might detail preferences for music, announcing the baby’s sex, whether you view the delivery through a clear drape, and who is by your side when your baby arrives.

After birth

Skin to Skin: Having your baby placed on your bare chest will help you both to recover, as that close contact releases more hormones that help your uterus to shrink back down to size and stop bleeding. This practice also prepares your body to give your baby early breast milk, or colostrum. Most of the time your baby will be placed on your abdomen or chest right away, but they may need some support with their first breaths, and usually that resuscitation can happen in the same room so that your baby is quickly returned to you.

Placenta & Umbilical Cord: Placentas are usually delivered 5-45 minutes after baby, and your care provider may ask to manage that delivery with synthetic hormones or physical maneuvers. Ask them about their methods, any risks involved, and your preferences for passive or active management of this final stage of labor. If you are planning to keep your placenta, you will need to arrange for its storage and transport ahead of time.

Recovery & Repair: Postpartum bleeding is normal to a degree, and impacted by your uterus’ ability to contract down to a smaller size and close off blood vessels - this is a normal physiological part of birth called “involution” that is supported by skin to skin, breastfeeding, warmth and privacy - but these are not always available in a hospital setting, or a medical issue may interrupt the process, leading to excessive bleeding, or hemorrhage. You may be offered medication to manage bleeding, and very often nursing staff will “massage” your abdomen to stimulate the uterus, which can be quite uncomfortable. Ask to be notified of any additional measures recommended for your recovery. If you have any need for external stitches, your provider should notify you and you will be offered a local anesthetic injection.

Goals and preferences for your newborn

Skin to Skin: What’s good for you is good for your baby - skin to skin contact with your shirtless baby helps them to regulate their body temperature, breathing and heart rate, just from being close to you. It also calms their nervous system and helps you both prepare for latching if you are planning to breastfeed. The first hours, days and weeks after birth are considered essential bonding and integration time for your baby’s adjustment and development through skin to skin.

Delayed Cord Clamping: When a baby is born vaginally, they are squeezed through the birth canal and a portion of their blood supply is temporarily accumulated in the placenta. After birth, allowing the umbilical cord to pulse for 1-3 minutes or more, or until it turns white and limp on it’s own, allows the majority of that blood, rich in iron and precious stem cells, to return to your baby. Ask your provider what DCC means in their practice as there are a few different definitions.

Newborn Procedures: Screenings and other procedures may vary slightly state to state and between locations - some may be mandated and most are recommended - others are completely optional. Review these with your care team and expect to sign a waiver if you decline certain procedures in some states.

• Suctioning used to be standard but is no longer considered evidence-based for all babies - your baby can usually clear fluids from their mouth and nose without assistance, which actually helps them to breathe robustly, but some gentle suctioning might be necessary
• Resuscitation: if your newborn does need help breathing, you can request that any support happen with you or your partner in attendance observing your child
• Erythromycin is an antibiotic eye ointment that prevents pink-eye, specifically the worst strains from gonorrhea and chlamydia exposure.
• Vitamin K shot or oral drops are effective for preventing a rare but serious type of bleeding in newborns
• Heel prick blood tests are highly recommended to screen for rare, otherwise undetectable health conditions
• Bathing your baby isn’t typically necessary right away, and many parents prefer to wait until they are at home for their baby’s first bath, but staff might offer to wipe down your baby's hair to avoid dried fluids getting stuck. Some babies are born with a residue on their skin called vernix, which is good for their skin and immune system.
• Infant feeding preferences should be made known so that you can receive lactation support, pumping assistance or supplementation as needed.
• Rooming in is now considered standard but if you have any questions about COVID-19 protocols or how your location handles this, it’s important to discuss your preferences ahead of time.

Using Your Birth Plan at a Hospital  

There is a lot of information that could potentially go into a birth plan, but it may not all be relevant to you - or you may have additional requests not listed here. Overall, the end goal is for you to have a birth plan that prioritizes the things that matter most to you, and is accessible to the people you are receiving care from.

Once you are at your birth location, your birth plan is only effective if it’s legible, made visible to any changing staff, and used during discussions with your providers. We offer some tips for using your birth plan in action, below.

Effective birth plan design

You’ve read this article, perused a downloadable birth plan pdf, made notes and done your research - now what? An effective birth plan is easy to read and flexible. Some recommendations for attaining that goal are:

• Keep it short - 1 page for the birthing person, and 1 separate page for your newborn preferences are enough. There may be overlap or repetition, but this is helpful because a different care team will be involved in your newborn’s care and postpartum recovery than your labor and obstetric care.
• Keep it simple - It’s okay to use concise language, such as “I decline a hep-lock/IV placement unless medically indicated.” Your staff know what these options are and do not need to know the definitions or background to your reasoning.
• Use affirming language - Your medical team works for you, not the other way around. You do not need to ask for “permission” or “to be allowed” to do something, and you can set firm requests while still being respectful. Find a few sentences that work for you and stick with them. Examples:
• I prefer to avoid __________________ unless medically indicated.
• I would like to ___________________________ as much as possible.
• Please do not _________________ without consulting with me first.
• I am committed to _______________________ and will request otherwise if needed.
• Avoid over-formatting or unique symbols. If your birth plan is full of capitalized letters, highlights or symbolic images instead of written sentences, it might be overwhelming, confusing, or misread as rude or unrealistic. Do yourself the favor of making your medical staff’s job easier and stick to simple written language.

Using your printable birth plan

Actually implementing your birth plan is a little easier if you follow these steps:

• Print four copies! One to give to your practitioner ahead of time and to be added to your health records, one to hand over when labor starts, one for you, and one just in case of a staff change or a lost plan.
• Keep it visible. Post it on the whiteboard or lay it on the newborn receiving bed if needed. It won’t be referenced if your staff don’t see it.
• Verbally reference the plan. Not sure if things are going the way you wanted? Feeling uncomfortable? Saying, “This wasn’t part of my plan, and I’d like some time to discuss this change,” or, “Can you help me to understand what’s happening? It wasn’t part of my birth plan,” are good ways to respectfully bring up the need for a “team huddle” on your next steps.
  

Selected Sources

• ‍“Birth plans: the good, the bad, and the future” JOGNN 2006‍
• “Making Childbirth a positive experience” WHO 2018‍
• “A “good birth” goes beyond having a healthy baby” WHO 2018‍
• “Has the medicalisation of childbirth gone too far?” BMJ 2002