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Birth Plans

Sample Birth Plan: Family Three

Following is a statement of our childbirth desires. We have educated ourselves prior to making these choices and feel that we are prepared to follow through on them. We understand that complications do arise and in such instances trust our physician to make the necessary decisions. We greatly appreciate your cooperation in realizing our plan.


I would like to give birth at name removed

I would like the following people to be present for the birth: names removed.

I would like to bring music and have the lights dimmed.

I would like to wear my own clothes during labor and delivery.


I prefer not to have a routine enema, shaving or IV

First-Stage Labor

I would prefer not to have an IV until medically necessary.

I would prefer not to be separated from my partner at any point during labor or birth.

If inducing or augmenting labor become necessary, I would like to try walking and nipple stimulation.

I would prefer not to undergo internal exams unless they are medically necessary.

I am interested in pain medication only if I'm too uncomfortable to handle the pain.

I would like to handle pain in the following ways: massage, relaxation, shower and whirlpool tub.

Second-Stage Labor

I would rather risk a tear than have an episiotomy. I have done exercises to minimize the risk.

I do not want residents or students present during my birth.

Cesarean Section

I would like to avoid a cesarean if at all possible.

I would like my husband to be present at all times during the operation.

I would like to be conscious.

I would like to have immediate contact with the babies.


I would like to hold my babies immediately after birth.

I would like to wait until the umbilical cord stops pulsating before it's clamped and cut.

I would like my husband to cut the umbilical cord.

I would like to postpone newborn procedures until I have a chance to bond with the babies.

I would like all newborn procedures to take place in my presence.

If I can't be with my babies, I would like my husband to stay with them at all times.

I plan to breastfeed my babies.

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