Writing a birth plan: what to include, what to leave flexible and how to use it

Pregnancy · Updated July 2026 · All articles

A birth plan is one of those things that sounds like it should come with a right and wrong answer, when in reality it is a highly personal document that works best when it reflects what genuinely matters to you. Done well, a birth plan does three useful things: it helps you clarify your own priorities before labour begins; it gives your midwife a snapshot of what matters to you without needing a long conversation at the start of a shift; and it gives your birth partner a reference point for advocating on your behalf when you are too focused on labour to advocate for yourself. Here is how to write one that actually works.

What a birth plan actually is

A birth plan, more accurately called birth preferences, is a short document that summarises your wishes for how labour, birth and the immediate postnatal period should be managed, wherever possible. The phrase "wherever possible" is important. A birth plan is not a contract, a guarantee or a rigid script. Labour is inherently unpredictable and the most effective birth plans are written by people who understand this.

What a birth plan is: a communication tool; a conversation starter with your midwife; a reference for your birth partner; and an expression of your informed preferences. What it is not: a means of controlling every aspect of your labour; a document that will protect you from complications; or a test of whether you had the birth you deserved. These distinctions matter because people who approach birth plans as binding plans are more likely to feel that birth went wrong, even when both mother and baby are safe, because the "plan" was not followed.

Why it is worth writing one

Even knowing that birth is unpredictable, there are good reasons to write a birth plan. The process of writing it requires you to think through your preferences, understand your options, and have conversations with your midwife that might not otherwise happen at a routine appointment. Many people who write a birth plan report that the process itself is more valuable than the document, because it prompts them to research pain relief options, ask about the third stage, or raise a concern they had not found the right moment for.

During labour itself, particularly in the active phase, most people find it difficult to think clearly and communicate complex preferences. Having a written document in your notes and with your birth partner means your preferences are accessible without needing you to articulate them at a moment when you are in significant discomfort. Your birth partner can refer to it, highlight priorities to the midwife, and check that your key preferences are being considered.

What to include

Your environment: lighting (dim, natural, bright), music (your playlist, no music, ambient sound), who you want present, whether you want students or additional observers (you always have the right to say no), and any important items you are bringing (a scented item, a birth ball, a tens machine).

Movement and positions: whether you would like to be free to move, use a birth pool, use a birth ball, or remain mobile as much as possible. Some people feel strongly about avoiding the classic semi-reclined position; others prefer the support it offers. Note your preference either way.

Pain relief: this is one of the most important sections. Your options include: no pain relief; breathing and relaxation techniques; a tens machine (bring your own); gas and air (Entonox); an epidural; pethidine or other opioids; a water birth. You can express a preference and you can also note that you are open to reassessing as labour progresses. Writing "I would prefer to start without an epidural but would like it to remain available if I change my mind" is entirely reasonable and useful for the team to know.

Monitoring: whether you would prefer continuous electronic fetal monitoring or intermittent monitoring (which allows more movement). Your midwife will advise if continuous monitoring is medically indicated; this section records your preference for low-risk scenarios.

Third stage (delivery of the placenta): the third stage of labour is the delivery of the placenta after the baby is born. The main choice is between a managed third stage (an injection of oxytocin to speed placental delivery and reduce bleeding) and a physiological third stage (waiting for the placenta to deliver naturally without the injection). A managed third stage is recommended for most people because it significantly reduces the risk of postpartum haemorrhage. If you would prefer a physiological third stage, note this and discuss it with your midwife.

Cord clamping: delayed cord clamping (waiting at least one to three minutes before cutting the cord) allows blood from the placenta to transfer to the baby and is now recommended as standard by NICE and the WHO. Unless there is a medical reason for immediate clamping, this is now the default in most UK hospitals, but noting it in your birth plan ensures it is not overlooked if things are busy. You can also note your preference about who cuts the cord.

Skin-to-skin contact: immediate skin-to-skin contact after birth supports bonding, breastfeeding and newborn temperature regulation. Note that you would like the baby placed on your chest immediately after birth, or as soon as safely possible. If you have a caesarean section, skin-to-skin in theatre is possible in many units, and it is worth noting this preference even if you are planning a vaginal birth.

Feeding intention: note whether you intend to breastfeed, formula feed or are undecided. This is not a commitment you are held to, but it helps the midwifery team support you appropriately from the start.

What to leave flexible

There are some areas where trying to specify too much in advance can work against you. The most important of these is interventions in emergencies. If a complication arises that requires a forceps delivery, an emergency caesarean, or a different approach from your preference, the clinical team will explain what is happening and why. Putting rigid language in a birth plan about refusing interventions can create unnecessary distress when circumstances require them. Instead, note your general preference (for example "I would prefer to avoid interventions if possible" or "please explain any intervention before proceeding if there is time") rather than categorical refusals.

Pain relief preferences are also best expressed as a starting point rather than a firm commitment. Many people who are certain they do not want an epidural find labour more intense than anticipated and are glad to have the option available. Many people who are sure they will want an epidural manage without one. Leaving the door open in either direction is more useful than a firm statement you may regret not being able to change.

How to present your birth plan to your team

Keep your birth plan to one page. A document that a midwife can read in two minutes is a document that will actually be read. Use clear headings and bullet points rather than paragraphs. Prioritise: if there is one thing above all else that matters to you, put it first or mark it clearly. This might be delayed cord clamping, skin-to-skin, a specific pain relief preference, or something personal to your situation such as a religious or cultural practice.

Print two copies: one for your maternity notes (which stay at the hospital) and one to hand to the midwife when you arrive in labour. In some units you can also upload it to a digital patient record in advance. Tell the midwife you have a birth plan when you introduce yourself, and offer it as an opening for conversation rather than handing it over as a checklist to be signed off.

Discuss your birth plan with your midwife at your 36-week appointment. This gives you an opportunity to ask about what is routinely offered at your unit, to understand what the local policy is on specific preferences (such as physiological third stage), and to adjust your plan based on information you might not have had when you wrote the first draft.

When things do not go to plan

A significant proportion of births involve some departure from the birth plan, whether that is accepting pain relief you planned to decline, requiring an assisted delivery, or having an emergency caesarean. This does not mean the birth plan was a failure or that you failed. It means birth is unpredictable and that the clinical team responded to circumstances as they developed.

The most useful reframe is to think of the birth plan as a set of preferences that guided your care when circumstances allowed, and a document that helped your team understand you as a person rather than as a set of medical observations. Even in an emergency caesarean, preferences from the birth plan (skin-to-skin in theatre, delayed cord clamping, who cuts the cord) may still be honoured. The birth plan remains relevant; it just becomes partial rather than complete.

If your birth experience does not go as you hoped and you find yourself struggling emotionally in the weeks after, this is not uncommon. Many hospitals offer birth afterthoughts or birth debrief services where a midwife will go through your notes and talk through what happened. This can be genuinely helpful in making sense of an experience that felt confusing or distressing.

Your partner's role in advocating

Your birth partner is one of the most important uses of a birth plan. They will be present during labour in a way that no individual midwife is, because midwives change shifts. A birth partner who has read the plan, understands your priorities, and knows which items matter most to you is infinitely more effective than one who is not sure what you wanted.

Go through the birth plan with your partner before labour begins. Agree on a few key priorities so they know what to raise if something is not happening as you hoped. Also agree on how you want them to advocate: some people want their partner to be proactive and ask about preferences; others find this increases anxiety and prefer the partner to wait until asked. Having this conversation in advance means your partner can support you in the way that actually helps rather than guessing.

Frequently asked questions

What is the difference between a birth plan and birth preferences?

The terms are used interchangeably, though many midwives and birth educators now prefer "birth preferences" because it more accurately describes what the document is: a record of what you would like, not a guarantee of what will happen. Either term is fine; what matters is that the document is clear, concise and understood by your birth team.

How long should a birth plan be?

One page is ideal. Midwives care for multiple people during a shift and need to absorb your preferences quickly. A clear, well-organised one-page document is far more likely to be read and acted on than a detailed multi-page account. Prioritise your most important preferences and leave the rest for conversation.

Should I include preferences for a caesarean section in my birth plan?

Yes. Even if you are planning a vaginal birth, writing a short section covering your preferences in the event of a caesarean section is useful. This can include preferences for skin-to-skin in theatre, delayed cord clamping, who you want present, and feeding intention. These preferences are equally valid in a caesarean birth and good teams will try to accommodate them.

When should I write my birth plan?

Most people write their birth plan in the third trimester, between weeks 28 and 36. Writing it too early means you are still learning and your preferences may change. Writing it at 36 weeks gives time to discuss it at your 36-week midwife appointment and make any revisions before it goes in your notes.

What if labour does not go to plan?

Birth plans are a starting point for communication, not a binding contract. When interventions become necessary, the clinical team will explain what is happening and why. The most useful thing a birth plan does in these circumstances is ensure your birth partner already knows your priorities and can advocate for the preferences that can still be honoured even when the overall plan has changed.

Do midwives actually read birth plans?

Most midwives do read them, particularly when they are short, well-organised and handed over proactively at the start of care. A birth plan that is one clear page, with the most important preferences highlighted or listed first, is much more likely to be read and referenced than a long document. Introducing it in conversation rather than just handing over a document also helps.

This article is for general information only. Always consult your midwife, obstetrician, or GP for advice specific to your pregnancy.