Sample Birth Plan for a Hospital Birth

Need a birth plan but not sure where to start? Here is a sample birth plan for a hospital birth that you can customize for your needs.

Guest post by Shannon of Growing Slower

Now that you’ve read 4 Simple Tips for Making a Birth Plan (that Gets Read), you may be wondering what a birth plan looks like. A birth plan is great to have to communicate to hospital staff what you prefer during labor, delivery and postpartum. It’s helpful to have a birth plan even if you’re planning a home birth, just in case you need to transfer.

I hope you are taking lots time during your pregnancy to research your options (You do have options!) for birth, newborn, and postpartum care. As part of my 30 Day Healthy Pregnancy Challenge, I wanted to do a few simple things to prepare for the arrival of Baby #2 including update our birth plan.

Everyone’s birth plan will be different, but just as an example here is our family’s birth plan for our upcoming birth. Because we’re planning another home birth, this is more of a worst case scenario birth plan that covers what might happen if we are transferred to the hospital for any reason. Of course we can’t predict what that reason might be, so these preferences may change depending on what is possible at the time.

Here’s a sample in case you need some help getting started:

My Sample Birth Plan

Mother: Shannon Brown
Father’s Name
EDD: 8/7/2013

We would like the opportunity to accept or refuse all medications and procedures

During Labor: We would like …

No vaginal exams unless requested

No epidural, please don’t offer

Intermittent external monitoring by Doppler

No internal fetal monitoring

Freedom to move as desired

To eat and drink as desired

No routine IV, enema, or shaving

Father to stay with Shannon the entire time

Labor Augmentation: We would like …

No stripping of the membrane

No rupturing of the membrane

No drug intervention

To labor without time limits

Episiotomy/Vacuum/Forceps: We would like …

No episiotomy under any circumstances

No vacuum-assisted delivery

No forceps-assisted delivery

Local anesthesia if repair after a tear

During/After Birth: We would like …

To push without time limits

To push in any position of our choosing

To wait until the placenta is delivered for the cord to be cut

To let the placenta come naturally without drugs or pulling

Shannon to hold baby and establish breastfeeding immediately after birth

To have routine checks for vital signs performed while Shannon holds baby

No suctioning of baby unless necessary

To have the PKU heel poke screening of baby delayed until the 2-week checkup

No Vitamin K, eye ointment, vaccinations, bath or other routine treatments of baby

No bottle, water, formula, or pacifier given to baby

No circumcision

Skin to skin contact especially if baby is admitted to NICU

We would like …

No cesarean unless all other options have been exhausted

Father to stay with Shannon the entire time, then to stay with baby once he or she is delivered

Shannon’s hands to be free

Baby to be placed on Shannon’s chest after delivery to breastfeed

Whether you’re giving birth in the hospital, at home, or at a birth center, creating a birth plan is an important part of having the birth experience you want. Although usually called a birth plan, it is also a postpartum and newborn care plan. This is a great opportunity to research all of your options and discuss them with your partner and your care provider.

Have you created a birth plan? What did you include?

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