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Creating Your Own Birth Plan (Free Printable)

August 31, 2019
A free printable and guide to Creating Your Own Birth Plan

Is it just me or are there a lot of babies making their entrance soon? The fall is the busiest time of year for the OBGYN which means a lot of you will be popping soon! Earlier this year I posted a sample baby registry that was – hopefully – helpful! To add to the list of new mother “needs” I wanted to include a sample birth plan.

I remember attending the delivery prep course and having absolutely no idea what a birth plan was. After some of my own research, speaking with doctors, and talking to seasoned mothers, I was able to pull together a birth plan that made sense for me and my husband. Every parent will have a different “plan” so please make sure you are thinking about the wants and needs of your growing family. It is also important to remember that in the heat of labor and delivery, nothing will go as “planned”… this is why your birth plan is helpful – it covers a lot of basics should labor take a different route!

A guide to Creating Your Own Birth Plan
Birth Plan

Please feel free to read below or you can download this FREE PRINTABLE for your guidance (attached are two copies to make it easier to cut & paste for multiple nurses).




To: Caregivers at Hospital Name Here

Doctor: Dr. Name Here

Due Date: Due Date Here


  • I would like to walk around and move as I choose. If an IV is deemed necessary, please use a heparin lock so that I can move around and walk as needed.
  • Please suggest pain management options for me if you see that I am too uncomfortable to handle the pain. I would like to wait as long as possible for medication but:
    • To “take the edge off” Fentanyl is OK (smallest dose possible).
    • I would like an epidural but would like to wait until I am 6-7 centimeters, if possible.
    • If I have not progressed post-epidural, Pitocin is ok (smallest dose possible) but want to avoid if possible.
  • Breaking the water is OK if medically necessary.
  • I would like to choose the position I deliver (laying, squatting, hands/knees, etc.).
  • If delivery assistance is needed, please use suction instead of forceps.
  • I do not want any outside visitors in the room with me – including family members – during labor aside from my husband, enter name here, and hospital staff/doctors.
  • If necessary, I would like an episiotomy rather than risk tearing.
  • If a C-Section is necessary, I would like my husband, enter name here, to stay with me at all times and for him to be the first one to hold the baby/skin-to-skin post-operation.


  • I would like to hold my baby skin-to-skin immediately following delivery.
  • I would like my husband, enter name here, to cut the umbilical cord.
  • I plan on storing my baby’s cord blood in a private bank.
  • I plan on saving my placenta for encapsulation. Someone will be picking up my placenta, please snip off only the part the hospital needs to be left behind.
  • I would like all the procedures that are done and medications that are given to my baby to be explained to me beforehand.
  • I would like to delay vaccinating my baby until 2 months – please no Hepatitis B vaccine (vitamin K & eye treatment are OK).
  • If my baby must be taken from me to receive medical treatment, I would like my husband, husband name here, to go with him.
  • I plan on exclusively breastfeeding my baby while in the hospital. Please do not bottle-feed the baby.
  • I would like to meet with a lactation consultant prior to leaving the hospital (and any other consultants that can offer tips).
  • I would like my baby to be circumcised at the hospital and I would like my husband, enter name here, to be present for the process – sugar water is OK during this process.
  • After birth, I would like to stay in the delivery room as long as we are allowed.

What did you find most/least helpful during labor and delivery?

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