Writing a birth plan: what to include and how to approach it
A birth plan, sometimes called birth preferences, is a written record of the choices and preferences you would like your care team to be aware of during labour, birth and the time immediately afterwards. Writing one gives you the chance to think through your options before the moment arrives, and to communicate clearly with the midwives and doctors who will be with you. Around 34 to 36 weeks of pregnancy is a good time to put it together, ideally going through it with your midwife so that any questions can be answered while there is still time to consider them.
What a birth plan is and what it is not
It helps to be clear from the start about what a birth plan can and cannot do. It is not a binding agreement, and it does not guarantee that labour will unfold exactly as you have imagined. Birth can be unpredictable, and there will be times when your care team needs to recommend a course of action that differs from your written preferences. A good birth plan accounts for this by including what you would prefer if things change, for example, your wishes if an assisted delivery or a caesarean section becomes necessary. Approaching it as a guide to your values and priorities rather than a fixed script makes it far more useful to everyone involved.
Who to include and where you plan to give birth
One of the first things to record in your birth plan is who you would like to have with you. Your birth partner or partners play an important role in supporting you through labour, and naming them clearly in your plan ensures the team knows who should be present. Alongside this, note where you would like to give birth. The main options are a hospital labour ward, a midwife-led birth centre, or a home birth. Each setting has different facilities and staffing arrangements, and your midwife can help you understand which options are appropriate for your circumstances. Discussing your preference in advance means your team can prepare accordingly.
Positions, movement and water
Labour does not have to happen in bed. Many people find that being able to move freely, change positions and stay upright makes a real difference to how they cope. Your birth plan can note that you would like to be able to move around and try different positions during labour. If you are interested in a water birth, this is also worth recording: labouring or giving birth in a pool is available at many midwife-led units and at home, though it may not be suitable if you have certain risk factors. Mention it in your plan and ask your midwife about availability and eligibility.
Pain relief preferences
Pain relief in labour covers a wide range of options, from breathing techniques and massage through to gas and air, pethidine and epidurals. Your birth plan is a good place to note which options you are most interested in, which you would prefer to avoid if possible, and how you feel about being offered pain relief during labour. At the same time, it is worth staying open-minded: how you feel about pain relief before labour may be quite different from how you feel in the moment. Noting your starting preferences while also making clear that you are open to reassessing is a practical approach. A dedicated article on pain relief in labour covers the individual options in more detail.
Monitoring during labour
During labour, your baby's heartbeat will be monitored to check how they are coping. There are two main approaches: intermittent auscultation, where a midwife listens to the heartbeat at regular intervals using a handheld device, and continuous electronic fetal monitoring (CTG), where a machine provides an ongoing trace. Intermittent monitoring is standard for straightforward pregnancies, while continuous monitoring is recommended if there are particular risk factors present. Your birth plan can note your preference, but your care team will advise on which approach is clinically appropriate for your situation.
Vaginal examinations and assisted delivery
Your birth plan can include your feelings about vaginal examinations during labour, including how frequently you would like them offered and whether you would prefer to be asked each time rather than having them happen as a matter of routine. It is also sensible to think ahead about what you would want if labour progresses to the point where assisted delivery, either with forceps or ventouse, is suggested. Noting your preferences in this situation means your care team will know what matters most to you, even if you are not in a position to discuss it at length in the moment.
Immediately after birth: cord, placenta and skin-to-skin
The period right after your baby is born involves several decisions that are worth noting in advance. Delayed cord clamping, which means waiting at least one minute before the umbilical cord is cut, is now standard NHS practice for most births and has been shown to benefit the baby's iron stores. Including your preference in your birth plan reinforces this even when things are busy. You can also note whether you would like your birth partner to cut the cord if circumstances allow, and whether you are interested in cord blood banking, which requires arrangements to be made before the birth.
Skin-to-skin contact immediately after birth, where your baby is placed on your chest, is widely encouraged and can be noted in your plan. For the third stage of labour, which is the delivery of the placenta, you can express a preference for a physiological (natural) third stage or a managed third stage involving an injection to speed up the process. Your midwife can explain the differences and help you decide what suits your situation.
Vitamin K for your baby
After birth, all babies are offered vitamin K to prevent a rare but serious condition called vitamin K deficiency bleeding. The NHS recommends it for all newborns. It can be given as a single injection or as several oral doses. Your birth plan can note which you would prefer. If you have questions about vitamin K, your midwife is the right person to ask during your antenatal appointments.
Feeding intentions and the birth partner's role
Your birth plan is a useful place to record how you intend to feed your baby: breastfeeding, formula feeding, or a combination of both. This helps midwives and postnatal staff support you appropriately from the start. There are no right or wrong answers here, and your intentions can of course change once your baby is born. Alongside feeding intentions, consider whether there is anything else you want to note about your birth partner's role, whether that is being actively involved in supporting you, being present for every stage, or knowing in advance what they should do if you are unable to speak for yourself.
Frequently asked questions
What is a birth plan?
A birth plan is a document where you record your preferences for your labour, birth and the immediate period afterwards. It helps the care team understand your wishes and gives you a chance to think through the choices available to you in advance. Discussing it with your midwife before labour means any questions can be answered beforehand.
What if my birth plan cannot be followed?
Birth plans are guides, not guarantees. Labour can change quickly and your care team may need to recommend something different from your plan. The most useful birth plans also include what you would prefer if circumstances change, for example, your preferences if a caesarean section becomes necessary.
Should I write a birth plan if I am having a planned caesarean section?
Yes. A birth plan still applies to a planned caesarean. You can note preferences around skin-to-skin contact, your birth partner being present, music in theatre, delayed cord clamping, feeding intentions and anything else important to you.
What is delayed cord clamping and should I ask for it?
Delayed cord clamping means waiting at least one minute (often longer) after birth before cutting the umbilical cord. This allows more blood to transfer from the placenta to the baby, which benefits iron stores. It is now standard NHS practice for most births, but noting your preference in your birth plan reinforces it.
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