Birth Plan Template
A calm, comprehensive birth plan template covering labor preferences, pain management, delivery wishes, newborn care, and C-section preferences. Pre-filled with a realistic example for first-time parents.
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A Personal Document
Birth
Plan
Emma & James Callahan
Due Date: April 12, 2025
Riverside Medical Center
Attending Physician: Dr. Sarah Okonkwo
Our preferences for labor, delivery,
and postpartum care.
This birth plan reflects our wishes. We understand that medical circumstances may require adjustments and trust our care team's judgment.
Labor Preferences
Emma & James Callahan · Due April 12, 2025
Environment
- ☑ Dim lighting throughout labor
- ☑ Own music playlist (calm / nature sounds)
- ☑ Minimal interruptions during contractions
- ☐ Aromatherapy diffuser (if permitted)
- ☑ Freedom to move around freely
Support Team
- ☑ Partner James present throughout all stages
- ☑ Doula — Sarah Miles (555-0147) present
- ☐ Mother present during labor
- ☑ No additional observers without our permission
Labor Interventions
- ☐ IV line preferred — hep-lock only (no continuous IV unless medically required)
- ☑ Freedom to eat and drink lightly during early labor
- ☐ Continuous electronic fetal monitoring
- ☑ Intermittent monitoring preferred when possible
- ☐ Amniotomy (artificial rupture of membranes) — prefer to avoid unless medically necessary
Comfort & Mobility Requests
- ☑ Access to a birthing ball
- ☑ Access to shower or tub for hydrotherapy
- ☑ Freedom to walk hallways between checks
- ☑ Ability to choose labor positions freely
Emma & James Callahan — Birth Plan
Page 2 of 4
Pain Management & Delivery
Emma & James Callahan · Due April 12, 2025
Pain Management
- ☑ Prefer to try natural coping first: walking, position changes, birthing ball, shower / tub
- ☑ Open to epidural if I decide I need it
- ☐ Nitrous oxide (laughing gas), if available
- ☑ Please ask before suggesting pain medication
- ☑ No medication administered without my consent
Pushing & Delivery
- ☑ Coached pushing (directed by care team)
- ☐ Uncoached / breathe-down pushing
- ☑ Mirror available to view delivery
- ☐ Episiotomy — prefer natural tearing over incision
- ☑ Partner James to announce baby's sex if possible
- ☑ Partner James to cut the umbilical cord
Immediately After Birth
- ☑ Immediate skin-to-skin contact with Emma
- ☑ Delayed cord clamping — minimum 60 seconds
- ☑ Photos and video are welcome throughout
- ☐ Cord blood banking (collection kit provided)
- ☑ Routine newborn assessments done at Emma's side if possible
- ☑ Baby placed on chest before any cleaning / weighing
Placenta
- ☑ Physiologic (natural) delivery of placenta preferred
- ☐ Pitocin to manage third stage (only if necessary)
- ☐ We would like to keep the placenta
Emma & James Callahan — Birth Plan
Page 3 of 4
Postpartum & C-Section Preferences
Emma & James Callahan · Due April 12, 2025
Newborn Care
- ☑ Begin breastfeeding as soon as possible after birth
- ☑ Rooming-in — baby stays with us at all times
- ☐ Pacifier — prefer to delay introduction
- ☑ Vitamin K injection (standard)
- ☑ Erythromycin eye ointment (standard)
- ☑ Newborn hearing screen
Visitors
- ☐ No visitors for first 2 hours — bonding time only
- ☑ Immediate family only on the first day
- ☑ Please contact James to arrange all visits
If C-Section Is Necessary
- ☑ Partner James present in the OR
- ☑ Drape lowered (or clear drape) to see birth moment
- ☑ Immediate skin-to-skin in OR if mother and baby are stable
- ☑ James carries and stays with baby if Emma is unable
- ☑ All postpartum preferences above still apply
- ☑ Please narrate what is happening throughout procedure
Notes to Our Care Team
"Thank you for supporting us through this experience. We are open to discussing any deviations from this plan and fully trust your medical expertise. Please explain all procedures before performing them — we want to be active, informed participants in our care. Your kindness means the world to us."
Emergency Contact
James Callahan (Partner)
555-0198
Doula
Sarah Miles
555-0147
Physician
Dr. Sarah Okonkwo
Riverside Medical Center
Emma & James Callahan — Birth Plan
Page 4 of 4
Frequently asked questions
What is a birth plan?
A birth plan is a document you share with your care team that outlines your preferences for labor, delivery, and postpartum care. It ensures your wishes are clearly communicated even during the intensity of childbirth.
What should a birth plan include?
A complete birth plan covers: your support team, environment preferences (lighting, music), labor intervention preferences, pain management options, delivery preferences (cord clamping, skin-to-skin), newborn care wishes, and C-section preferences.
When should I write my birth plan?
Write your birth plan during the third trimester — around 32–36 weeks — so you have time to review it with your OB or midwife before labor begins.
How long should a birth plan be?
Keep it to 1–2 pages. Longer birth plans are less likely to be read in full during labor. Use checkboxes and bullets rather than paragraphs — exactly how this template is structured.
Is this birth plan template free?
Yes — free to use and customize. Describe your preferences to the AI and it will update the checkboxes and notes to match your wishes.
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