Simple Birth Plan Template (Free and editable PDF or Google Doc printable with examples)

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As you’re preparing to give birth, having a birth plan template or example can be a great way to organize your wishes, communicate your preferences, and learn about the options available to you. This article includes a simple free birth plan template that you can download as a Google doc and fully customize for your own needs. 

What is a birth plan?

A birth plan is a summary of your preferences when it comes to giving birth to your baby. While this is labeled “a plan,” there’s a mutual understanding that your preferences may change as you go along, and that your doctor or midwife may have to make calls to ensure a safe delivery. 

How do I write a Birth Plan? 

If you’re wondering how to make a birth plan, the best place to start is to use a birth plan template or an example and adapt it for your own needs. Use the editable Google Doc provided at the end of this article. 

When it comes to creating a birth plan, the rule of thumb is to keep it simple. 

Do you really need a birth plan?

A birth plan is a way for mom to organize her own wishes and preferences and to communicate them with her partner and healthcare providers. Looking at birth plan examples can also open the conversation between you and your doctor or midwife about the options that are available. 

When do I bring up my birth plan with my doctor, nurses, or midwives?

There’s no rule about when and how to bring up your birth plan. Your birth preferences should be an ongoing conversation with your healthcare providers, but give them grace if they forget some details. (That’s what the birth plan is for!)

Once you are admitted to hospital, it can help to share some key information, and then bring up that everything is summarized in a birth plan if they’d like to see it. 

Remember that the more simple the birth plan, the easier it will be to follow. 

What’s a visual birth plan?

Some moms include pictures or birth plan icons to communicate instead of written text. There are programs that allow you to create a visual birth plan, but they’re not always free or customizable. 

Birth plan checklist

If you’re wondering what to include in a birth plan, use the birth plan example template below (Customizable Google Doc provided at the bottom)

  • Remember to keep it simple
  • Include all urgent medical information
  • If there are any procedures you wish to avoid – include them
  • Express your wishes for labor, delivery, and after delivery

How to use the Birth Plan Template

This simple birth plan template is designed to make life easy. You can copy and paste the text below, or use the Google Doc template to get started. (Just be sure to make a copy, and then save as a Word doc, Google doc or PDF.) 

Then just delete any row that does not apply to you, and add any additional information. Easy peasy.

Free Birth Plan Template

Delete any rows that do not apply to your own birth plan example.

Basics:

Full name:
Partner’s name and phone number:
Due date or Induction date: 
(include weeks pregnant for induction)
Doctor’s or Midwife’s name and contact
Hospital or Delivery location address:
My delivery is planned as:Vaginal
C-section
Water birth
VBAC
Special consideration:I have group B strep
I am Rh incompatible with my baby
I have gestational diabetes
I have gestational hypertension
I have allergies to __
I have special medical needs: 
Date modified: 

People involved

In early labor Partner
Parents
Other Children
Doula
Other
Names and other notes
During labor and deliveryPartner
Parents
Other Children
Doula
Other
Names and other notes
Immediately after deliveryPartner
Parents
Other Children
Doula
Other
Names and other notes

Special interventions preferences

If possible, I would prefer to avoid:

  • Labor induction
  • Labor augmentation
  • Rupturing of the membrane
  • Episiotomy
  • Vacuum extraction
  • Forceps 
  • C-section

Labor

Pain management: 

  • I would like an epidural as early as possible
  • I would like to avoid an epidural
  • I plan on using my own pain management techniques

During early labor I would like to:

  • Have a shower if available
  • Be in a bathtub if available
  • Walk around
  • Eat and drink 
  • Avoid an IV

Delivery

I would like to try:

  • A birthing chair
  • A birthing stool
  • A squatting bar
  • Various positions like:
    • Squat
    • Semi-recline
    • Lying on the side
    • Be on hands and knees

While pushing, I would like to: 

  • Push as directed
  • Push without coaching
  • Use my own breathing techniques
  • Use a mirror to see the baby crown

Immediately after delivery

Immediately after delivery I would like

  • For my partner to cut the umbilical cord
  • To bank cord blood
  • To donate cord blood
  • To save my placenta

I would also like to

  • Hold my baby skin-to-skin immediately after birth
  • Try to breastfeed immediately after birth
  • Have my partner hold the baby immediately after birth

After delivery and during recovery

After birth, I’d like to stay in the hospital:

  • As long as possible
  • As briefly as possible

I’d like my partner:

  • To have unlimited visiting
  • To sleep in my room

For feeding the baby I:

  • Plan on breastfeeding exclusively
  • Plan on bottle-feeding
  • Am happy to supplement with formula
  • Would prefer to avoid formula
  • Would like to see a lactation specialist
birth plan template breastfeeding

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