Sample Birth Plan Letter

Here's a sample birth plan letter. You can write your birth plan any way you want. Writing it in letter form is just one option.

If you're having your baby in a hospital, you'll want to include your preferences for which hospital procedures you do and don't want for you and your baby.

Birth Plan Letter

I, _____, am preparing to give birth at home. My midwife is _____, who is honestly supportive of my choices.

My support team includes my husband, _____, and my doula, _____. We plan on calling (our midwife) when labor has been very active for an hour. I do not want to have my cervix checked unless it becomes necessary.

Because I am having a drug-free birth, I would like to use a shower, walking, birth ball, or a tub to control pain.

I will be prepared with my own food and drinks. I do not want anybody allowed in the house besides my support team and midwives.

I will control my pushing efforts. I will assume any position that is comfortable for me to give birth in, including squatting, on my hands and knees, in the shower, or I may decide to have a waterbirth.

I would like to wait to cut the umbilical cord until it stops pulsing. I want my baby immediately placed upon my chest and left there at all times. I would like to immediately start breast-feeding and not have my baby taken for measurements until after the first hour. I would like to have my husband and I to give our baby her first bath.

Thank you for honoring our feelings regarding the birth of our child and for your assistance at our birth.

(Mother's Signature)

(Father's Signature)


Click here to see a categorized birth plan sample
Click here for another sample birth plan


Image Credit:
Mabycakes/Flickr


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