🌿 How to Use This Birth Plan

• Make this plan your own by making a copy in Google Docs, then copying and pasting the statements you want into the corresponding section on your official birth plan.
  

• Keep it to one page and limit your preferences to 15 points for clarity.
  

• Print only the page with your selected preferences—skip the instructions and phrases you won’t use.
  

• Print a couple of copies and place them in your birth bag, and share with your support people.
  

• Message me anytime with questions as you build your plan.

Hi I’m: _________________________
My Support Person(s) will be: _________________________
Planned Place of Birth: _________________________
Estimated Due Date: _________________________

Labor

 ☐ Other: _______________________________________________________

(Paste your labor preferences☝️here… delete this line before printing your personalized copy)

Labor Preference Examples to Choose From:
☐ I prefer to move freely and change positions throughout labor.
☐ Please offer intermittent monitoring if safe for baby and me.
☐ I would like a quiet, calm environment with minimal unnecessary staff.
☐ My support person(s) should be present at all times.
☐ I would like to use the shower, tub, or birth ball for comfort.
☐ I prefer to avoid unnecessary vaginal exams.
☐ Please do not offer pain medication unless I request it.
☐ I’d like dim lighting during labor.
☐ I prefer minimal interruptions and privacy from staff when possible.
☐ I want encouragement and reassurance from my support person(s).
☐ I would like essential oils, music, or aromatherapy for comfort.
☐ I want my own food/drinks during labor if allowed.
☐ I prefer slow, steady communication from staff.
☐ I would like to avoid induction unless medically necessary.
☐ I want opportunities to practice breathing or relaxation techniques.
☐ Other: ___________________________________________________

Pushing

 ☐ Other: _______________________________________________________

(Paste your pushing preferences ☝️ here… delete this line before printing your personalized copy)

Pushing Preference Examples to Choose From:
☐ I prefer to follow my body’s natural urge to push rather than coached pushing.
☐ If possible, I’d like to avoid an episiotomy and allow natural tearing.
☐ My partner (or support person) will cut the umbilical cord.
☐ I’d like to push in upright or side-lying positions, not just flat on my back.
☐ Please allow delayed cord clamping until the cord stops pulsing.
☐ I would like a mirror or guidance if available so I can see baby crowning.
☐ I’d like verbal encouragement and coaching only if needed.
☐ I prefer to touch or hold my baby immediately after birth.
☐ I would like a calm environment with minimal staff around.
☐ I’d like freedom to choose when and how often to push.
☐ Please minimize interventions unless medically necessary.
☐ I’d like my support person(s) to assist physically if needed.
☐ I want guidance on perineal support to prevent tearing.
☐ I’d like gentle lighting during pushing.
☐ I prefer music or soothing sounds during pushing.

Postpartum

 ☐ Other: _______________________________________________________

(Paste your postpartum preferences ☝️ here… delete this line before printing your personalized copy)

Postpartum Preference Examples to Choose From:
☐ I request immediate skin-to-skin and at least one uninterrupted golden hour.
☐ Please delay routine newborn procedures until after bonding, if baby is stable.
☐ I prefer exclusive breastfeeding (no pacifiers, bottles, or formula unless medically necessary).
☐ Please ask before administering newborn medications or vaccines.
☐ I’d like all exams and procedures to be done at my bedside when possible.
☐ Please minimize interruptions during recovery and bonding time.
☐ If I need a cesarean, I’d like skin-to-skin in the OR or recovery, if possible.
☐ I want my support person(s) to stay with me and the baby as much as possible.
☐ I’d like guidance and support for breastfeeding if needed.
☐ I prefer dim lighting and quiet in my recovery room.
☐ I’d like to delay weighing and measuring the baby until after initial bonding.
☐ I want limited visitors during the first hours.
☐ I’d like the baby to room-in with me at all times.
☐ Please allow me to make feeding choices without pressure.
☐ I’d like assistance with postpartum comfort measures (perineal care, ice packs, etc.) as needed.
☐ I want clear explanations of any medications or procedures before they are done.
☐ Other: ________