A birth plan is a one- to two-page document that lists your preferences for labor, delivery, and newborn care. It typically uses a simple checklist or short-statement format organized into sections: labor environment, pain management, delivery preferences, cesarean contingencies, and baby care after birth. The American College of Obstetricians and Gynecologists (ACOG) publishes a sample template that most hospital-based plans follow closely.
The goal isn’t to script every moment. It’s a communication tool that tells your care team what matters to you so they don’t have to ask during active labor. A study of over 1,000 women found significantly higher satisfaction scores among those who had a birth plan compared to those who didn’t, and research consistently shows that the more requests on a plan that get fulfilled, the greater sense of control a person feels during delivery.
Labor Preferences
The first section covers how you want to experience early and active labor. This is where you note things like freedom to move around, whether you want to drink fluids, and what comfort tools you’d like available: a birthing ball, birthing stool, squat bar, or access to a warm shower or bath. These aren’t exotic requests. Most hospitals can accommodate them, but staff won’t always offer if they don’t know you’re interested.
You’ll also state who you want in the room during labor. This means naming your partner, a doula, a family member, or anyone else providing support. It’s also the place to indicate whether you’re comfortable with medical students or residents observing. Another common choice here is IV access: you can request a standard IV line for fluids and medications, or a saline lock, which keeps a vein accessible without being hooked up to a fluid bag. The saline lock gives you more freedom to move.
Pain Management
This section is where you outline your approach to pain relief, and there’s a wide range to choose from. Most plans present three starting positions: you want pain medication and would like to discuss options early, you don’t want it offered unless you specifically ask, or you’re undecided and want the conversation when the time comes.
If you’re open to medication, the main options break into two categories. Systemic pain relievers affect your whole body and are typically used in early labor. They’re given through an injection or an IV, and some hospitals offer an inhaled form you control with a mask. These ease pain without putting you to sleep, but they’re generally not used close to delivery because they can slow the baby’s reflexes.
An epidural is the most common regional option. A small catheter is placed near the spinal cord, and the medication begins working within 10 to 20 minutes. Because the catheter stays in place, additional doses can be given throughout labor without a new injection. A spinal block is a single injection that works almost immediately but lasts only one to two hours, so it’s typically reserved for the delivery itself or a cesarean.
Non-medication approaches are worth listing even if you plan to use an epidural, since they can help during early labor before medication is placed. Options include massage, deep breathing, music, aromatherapy, hypnosis, acupuncture or acupressure, and a technique called TENS, where small electrical pulses on your lower back activate your body’s own pain-relief pathways. Continuous support from a partner or doula is itself one of the most well-studied natural pain relief methods.
Delivery Preferences
This section covers the actual birth. Common choices include whether you want dimmed lighting, a quiet room, a mirror to watch the delivery, or permission for a support person to take photos or video. You can note who you’d like to cut the umbilical cord and whether you want your baby placed directly on your chest immediately after birth. Requesting immediate skin-to-skin contact and early breastfeeding are two of the most frequently listed preferences.
You can also state that you’d prefer to avoid an episiotomy (a small cut to widen the vaginal opening) unless medically necessary. If you’ve arranged for umbilical cord blood banking, this is where you note it so the team is prepared with the collection kit.
Cesarean Birth Preferences
Even if you’re planning a vaginal delivery, including a short section on cesarean preferences is one of the most useful things you can do. If an unplanned C-section becomes necessary, your team can reference your wishes without you having to make decisions in a stressful moment.
Common cesarean preferences include staying awake rather than being sedated, having the surgical drape lowered so you can see your baby born, having the procedure explained as it happens, and playing your own music in the operating room. You can request skin-to-skin contact as soon as it’s safe, or ask that your partner hold the baby right away if you’re unable to. Other options: having a support person accompany the baby to the nursery and being informed about any shots or treatments the newborn receives.
Newborn Care
The final section addresses what happens with your baby in the hours and days after birth. The key decisions here are feeding, rooming, and routine procedures.
For feeding, you’ll indicate whether you plan to breastfeed exclusively, bottle-feed, or combine both. You can also specify whether staff may offer the baby a pacifier, formula, or sugar water, or none of those. This matters because nursery staff follow whatever instructions are on file, so being clear prevents well-meaning choices that conflict with your goals.
Rooming preferences range from keeping the baby with you at all times, to having the baby in your room except while you sleep, to using the nursery with the baby brought to you for feedings. It’s perfectly fine to mark “undecided” and choose after the birth, once you know how you’re feeling. If your baby is a boy, this section is also where you note whether you’d like a circumcision performed at the hospital.
Format and Length
The most effective birth plans are concise. A checklist format with brief statements works better than lengthy paragraphs because nurses and on-call providers need to scan your preferences quickly, sometimes during a shift change. One page is ideal. Two pages is the practical maximum. Research published in the American Journal of Obstetrics and Gynecology found that providers sometimes don’t read the plan or reference it in care decisions, and a shorter, clearer document reduces that risk.
Many hospitals and birth centers now offer their own fill-in templates, which have the added advantage of aligning with what that specific facility can actually provide. ACOG’s sample birth plan uses a checkbox format organized by category, and it’s a reliable starting point if your provider doesn’t offer one. Whichever format you choose, bring several printed copies to the hospital: one for your chart, one for your labor nurse, and one for your support person to reference on your behalf.
Why It’s Worth Writing One
Birth plans work best as conversation starters. Filling one out forces you to research your options ahead of time, and reviewing it with your provider at a prenatal visit lets you find out which preferences are realistic at your birth location. A study found unanimous agreement among patients with birth plans that the document encouraged communication with their provider and improved their satisfaction with the experience. The consistent finding across multiple studies is that people with birth plans report a greater sense of autonomy, and that feeling of control tracks closely with overall birth satisfaction.
That said, flexibility matters. Labor is unpredictable, and the plan that serves you best is one you’ve discussed in advance with your care team, with backup preferences noted for scenarios that don’t go as expected. Think of it less as a contract and more as a set of clearly stated priorities that your team can honor whenever safely possible.