Writing a Birth Plan: What to Include, What Matters, and Managing Expectations

A birth plan — or "birth preferences" as many midwives and antenatal educators now prefer to call it — is a written record of your wishes for labour, birth, and the immediate postnatal period. It is an opportunity to communicate with your care team before you are in the thick of it, when clear thinking is harder.

Done well, a birth plan is genuinely useful. Done poorly, it becomes a source of rigidity and disappointment. The difference lies largely in mindset.

What a Birth Plan Is and Is Not

It is: A communication tool. A way to tell your care team what matters to you, so they can try to honour your preferences within the constraints of what is safe and possible on the day.

It is not: A contract. A guarantee. A way to control an inherently unpredictable event. No birth plan can account for every eventuality, and insisting on one approach when the clinical situation has changed is not in your or your baby's interest.

The best birth plans are written by people who have done enough antenatal education to understand the range of possible scenarios, and who are prepared to adapt.

What to Include

Keep it short — one to two sides of A4 maximum. Midwives read many birth plans under time pressure. A concise, clearly formatted document is far more useful than four pages of small text.

Section 1: Pain relief preferences

Be clear but flexible. Include:

• What you have heard about and are interested in trying first (movement, water, breathing, TENS, gas and air, epidural)
• If there is anything you particularly want to avoid, and why
• What your trigger is for requesting an epidural, if you are open to one
• Any medical reasons that affect your options (e.g., previous back surgery may affect epidural placement)

Avoid writing "I do not want an epidural" without any qualification. This is fine as a preference, but staff need to know whether you mean "I would like to be supported to manage without one" or "I absolutely refuse one under any circumstances" — these require different responses.

Section 2: Environment

Labour environment significantly affects experience and can influence labour progress. Consider:

• Dim lighting
• Your own music
• Who you want in the room (and who you do not)
• Minimal vaginal examinations, or examinations only by a specific midwife
• Freedom to move, including using the pool if available

Most of these are straightforward to accommodate as long as the unit is not under exceptional pressure.

Section 3: Monitoring

There is a difference between routine intermittent auscultation (listening to the baby's heartbeat with a handheld Doppler every 15 minutes in active labour) and continuous electronic fetal monitoring (CTG). If you have a low-risk pregnancy and want to remain mobile, it is entirely reasonable to request intermittent auscultation.

Note that certain circumstances require continuous monitoring — previous caesarean, induction of labour, epidural analgesia, certain complications. Your birth plan can note your preference while acknowledging this.

Section 4: Delivery preferences

• Pushing position: are you interested in being upright, on all fours, in the pool, or do you have no strong preference?
• Coached pushing vs breathing the baby down
• Perineal support and warm compresses (evidence-based for reducing severe tears)
• Episiotomy: you can request that your midwife discusses this with you before performing one except in an emergency

Section 5: Third stage (delivery of the placenta)

The third stage is often overlooked in birth planning but is worth a mention.

• Physiological third stage: waiting for the cord to stop pulsating and for the placenta to be delivered without any syntometrine injection. Takes longer (up to an hour) but some people prefer this approach.
• Active management: a synthetic oxytocin injection (syntometrine) is given after delivery to contract the uterus, speed up placental delivery, and reduce postpartum haemorrhage risk. This is recommended by NICE for most births.

If you want a physiological third stage, note it — but understand the midwife may recommend active management based on how your labour has gone.

Delayed cord clamping is now standard practice in most UK units (NICE recommends waiting at least one to three minutes). Worth noting if it matters to you, and enquire whether the unit does this routinely.

Section 6: Immediate after birth

• Skin-to-skin contact: how much, for how long, and does your partner also want skin-to-skin?
• Cord cutting: does your partner want to cut the cord?
• First feed: breastfeeding, formula, or undecided?
• When you want observations, weighing, and Vitamin K to happen relative to skin-to-skin time

Section 7: If a caesarean becomes necessary

Most people do not plan for a caesarean and then find they need one. Having preferences noted in advance is helpful.

• Music in the operating theatre
• Screen lowered to see the birth
• Immediate skin-to-skin on the table if baby is well
• Partner staying with baby if neonatal review is needed
• What to do with the placenta if you have wishes regarding this
• Breastfeeding in recovery

Section 8: Feeding intentions

A brief note is sufficient: breastfeeding, formula feeding, or planning to decide. This affects the support you receive on the postnatal ward.

How to Communicate Your Plan

• Share it with your midwife at a late antenatal appointment. Use it as a basis for discussion.
• Bring printed copies to the hospital — at least two.
• At the start of labour, your birth partner can show it to the midwife when introductions are made.
• A brief verbal summary ("The main things we have noted are...") is often more effective than expecting a midwife to read the whole document in a busy moment.

Holding Your Preferences Lightly

The most important part of any birth plan conversation is the meta-point: you are preparing for birth, which is one of the most unpredictable significant events in human life. Preferences are not demands. Flexibility is not failure.

Parents who had a very different birth from the one they planned — including emergency caesareans, general anaesthetic, or unexpected complications — often describe the experience as traumatic partly because it departed so far from their expectations. The more you understand the range of possible outcomes before the day, the better equipped you will be to navigate whatever actually happens.

A good midwife or obstetrician will explain what is happening and why, and will ask for your informed consent for each intervention. You are always entitled to ask: "What is the reason for this?", "What are the alternatives?", "What happens if we wait?" Your birth plan signals that you are engaged, informed, and have preferences — it does not remove your right to make decisions in the moment.