How to Write a Birth Plan: A Simple Checklist & Guide

A good birth plan is a short, clear list of your preferences plus a backup mindset.
Think “roadmap,” not “script.” You’re not failing if labor goes off-plan; you’re preparing to make calmer decisions in the moment.

A written plan helps your team understand your priorities, and reviewing it during pregnancy (not at check-in) makes it more useful (reviewing it ahead of delivery helps align care).

What a Birth Plan Should Do

Your birth plan should answer one practical question: “If things are normal, what do I prefer?”

It should also include: “If things change, what matters most to me?”

That balance matters because labor can shift quickly, and common changes include wanting different pain options than expected or needing a C-section (labor often follows a pattern, but can change course).

What to Include

Keep this to one page if possible. Use short bullets your team can scan fast.

Who should be with you in labor and delivery
Pain preferences: unmedicated, open to epidural, or “offer options as labor progresses”
Labor comfort preferences: movement, position changes, shower/tub use if available
Monitoring/intervention preferences: what you want discussed before non-urgent interventions
Birth preferences: delayed procedures you care about, cord-cutting preference, skin-to-skin if baby is stable
Newborn feeding plan: breastfeeding, formula, combo, and your first-hour goals
If a C-section is needed: who have present, and your top priorities if medically possible

If you have thrombocytopenia, your provider will tell you. In that case, your body can have a low platelet count. Because thrombocytopenia is a relative contraindication to neuraxial blockade, which means that an epidural may not be indicated, you may want to discuss with your provider what your platelet count is and how that might affect your time of clotting, early in your labor. In that case, your birth plan would want to include some options to use if you are not able to have an epidural for pain control. (obstetric analgesia recommendations).

These are the same kinds of decisions many hospital birth-plan templates prompt you to discuss (example items for labor , delivery, and postpartum care).

What to Keep Flexible

Some items are values-based and can stay firm (for example: “I want clear explanations before non-emergency decisions”).
Other items are best kept flexible:

Exact pain-management path
Exact pushing position
Timing details if labor stalls
Vaginal vs C-section outcome

A flexible plan does not mean “anything goes.” It means your core priorities stay steady while clinical details adapt to safety in real time (safest outcome for parent and baby remains the priority when plans change).

One Medical Item Worth Putting in Every Plan

Include a line for Group B Strep (GBS) testing and what happens if positive.

GBS screening should be done in each pregnancy at 36 or 37 weeks (timing and rationale)
If positive, IV antibiotics are given during labor to reduce early newborn infection risk (how prevention works)

Your plan outlines how to respond to GBS : universal GBS screening at 36 0/7 to 37 6/7 weeks is responded to with antibiotics during the labor period, if the culture is positive. This may be adjusted if you are to have a c section and your water has not broken. If you have been told you have a penicillin allergy, you will want to let your caregivers know what type of reaction you had. Knowing this will help your team know what type of antibiotic you might need.

These steps meet the ACOG Committee Opinion No. 797, which recommends late-pregnancy screening and antibiotic use during labor when indicated.

This is a good example of “plan + flexibility”: you can state your preferences clearly while agreeing to time-sensitive safety steps.

Common but Uncomfortable vs Call Now

When you’re tired, nauseated, or uncomfortable at bedtime, it’s easy to second-guess every symptom. Keep this simple:

Common but uncomfortable (usually monitor and mention at next check-in)

Irregular Braxton Hicks contractions, sometimes called false labor, that do not get progressively stronger
Increased discharge near term
Mood changes about pain plans (“I thought I wanted no epidural, now I’m unsure”)

These shifts can be normal near term (early labor signs and Braxton Hicks differences).

Call your clinician now (or seek urgent care)

Bleeding as heavy as a period
Water breaking (trickle or gush)
Any labor signs before 37 weeks
Fever of 100.4°F or higher, severe headache, trouble breathing, chest pain, severe belly pain, major swelling, or baby’s movement slowing/stopping

These are not “wait and see” symptoms (labor-specific urgent signs, urgent maternal warning signs).

Concise Action Checklist

Write a one-page draft with your top 3 priorities first.
Add choices for pain, support people, newborn feeding, and C-section backup preferences.
Bring it to a prenatal visit and review it line by line with your OB or midwife.
Add your “call now” symptom list and emergency contacts at the bottom.
Save one copy in your hospital bag and one on your cell phone.

During prenatal review, ask your OB or midwife to write any hospital-specific differences directly into your plan, because variations in practice may be warranted.
Add contingency lines for induction, planned C-section, vaginal birth after a previous C-section (VBAC), and transfer, if there would be a need to go to a hospital that has a higher level of care, and list each as "Priority / Flexible / Prefer to Avoid."
Create a one-page emergency contact card with three action tiers: call emergency services now, call on-call OB/midwife now, or monitor and report at the next check-in.
Use a one-page fill-in layout with three labels for each preference: Priority / Flexible / Prefer to Avoid. The preferences are; support person, pain options, newborn feeding goals, key medical concerns (GBS status, allergies, previous c-section), and emergency contacts.
Scenario phrase (planned vaginal, open to cesarean): "I prefer a vaginal birth, and if labor is not progressing or concerns about the baby arise, please explain options to me and proceed withthe safest option." (first and second stage labor management guidance).
Scenario phrase (unmedicated preference, open to epidural): "I want to start with movement, breathing, and continuous support, and I am open to an epidural if labor becomes prolonged or exhausting."
Scenario phrase (known GBS-positive): "If I am GBS-positive in this pregnancy, I want antibiotics during labor and alternative antibiotics I may need, since I am allergic to penicillin" (ACOG Committee Opinion No. 797).

FAQ

Q: How long should a birth plan be?
A: One page is usually best. Your labor team needs quick, clear priorities they can scan in seconds.

Q: What if I’m afraid my plan will be ignored?
A: A plan discussed during prenatal visits is much more likely to guide care than a plan first seen on admission day (
early review improves communication). Include your top priorities in bold, plain language.

Q: Should I include a doula or support person preference?
A: Yes. Continuous labor support is linked with better birth experience outcomes and fewer interventions in many settings, so naming your support plan is worthwhile (
evidence summary from Cochrane).

In the Cochrane review, continuous support was associated with fewer c-sections and moreregular vaginal births, making the extra support wise as well as personal.