Birth Plan Sample

Here's a birth plan sample to give you an idea of how you can write your own birth plan. There are several ways to write a birth plan. This is just one example.

This one just has a few simple paragraphs that highlight the most important things to this mom.

(Mother's and Father's Names)
Physician:
Estimated Due Date: May 13

We have outlined our preferences for birth below. We are looking forward to a completely natural birth and greatly appreciate the support of the nurses and staff to help us achieve the type of birth we desire. We do realize that complications may arise, and if so, we trust that our doctor will make the appropriate decisions.

We would like a calm environment and only wish for the father to be present during labor and birth, in addition to necessary medical personnel. We would like to avoid induction unless absolutely necessary, and do not wish to have time limits imposed upon labor as long as labor is progressing naturally. We prefer to avoid a routine IV and opt for a heparin lock in case an IV becomes necessary. Please do not offer pain medication; if necessary, we will request.

After dilation is complete, we prefer to wait for the urge to push and wish to push in whatever position feels most comfortable. We would like to avoid episiotomy.

After the baby is born, we strongly desire to breastfeed immediately. We would like to wait for any newborn procedures until after the baby’s first feed. We wish for the father to cut the cord, and would like to wait to do so until the cord stops pulsating. We would like the baby’s father to be with the baby for any procedures possible, and we would like the baby to room in with us at all times. If the baby is taken to the nursery for any reason, we do not want the baby to be given a bottle or a pacifier.

Thank you for your support and participation in the birth of our baby!


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