A Sample Birth Plan

I know that things can be unpredictable during labor and delivery and ultimately want the health of myself and baby to take precedence.  In all non-emergency situations, I would like to discuss proposed procedures including the risks and benefits to them in order to direct the decision making process with informed consent.

Your help with these preferences is greatly appreciated!


I would like the following people to be present during labor and the birth:  My husband (John Doe) and my doula (Jane Smith)

I would like to maintain mobility as much as possible during labor.  To facilitate this, I would like to have a hep lock and intermittent monitoring of the baby.

I would like to have an unmedicated birth and therefore do not want pain medications offered to me unless I specifically ask for them.


I would like the lights dimmed and hushed voices as the baby is born.

I want to avoid an episiotomy and prefer tearing to having one.

I would like to push instinctively without being told when or for how long.  I would like to push without time limits as long as baby and I are doing fine.

I would like to push and birth in whatever position feels right at the time.  I would like my baby placed on my chest/abdomen immediately after birth for 2 hours to facilitate bonding and breastfeeding

I would like for the umbilical cord to stop pulsating before it is clamped and cut.


If one becomes necessary I want my husband to be present with me at all times during the operation.  I want my glasses with me so that I can actually see my baby.  If the baby is to leave the OR I want my husband to go with the baby and for my doula to stay with me.  I want to breastfeed my baby in the recovery room.

After Birth:

I would like to use my own baby wash and give the baby it’s first bath.

Thank you again for taking such good care of us during this eventful time of our lives!

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