During pregnancy expectant mothers may choose to create a birth plan. A birth plan is a written document that communicates a woman’s preferences concerning the types of care, procedures and management of the labor and delivery process as well as the management of the baby’s care following the birth. 

Although it is referred to as a plan, a birth plan is more like a list of requests. Though healthcare professionals may have an indication as to what an expectant mother wants, a birth plan helps communicate her ideas. It also eliminates the need for a woman to explain her preferences clearly at the actual time of labor and delivery when it may be difficult.

It is recommended that a birth plan be a simple, clearly written list of preferences. It should cover three major areas, including:

• Wishes during a normal labor and delivery
• Preferences in the case of unexpected events
• Requests as to how the baby should be treated after delivery

A birth plan can be used as a guideline for healthcare providers and the labor and delivery staff, and is not considered a binding agreement. Since it is not always possible for medical staff to accommodate each request, the preferences listed on a woman’s birth plan cannot be guaranteed. In addition, the events within any labor and delivery can never be fully anticipated or planned in advance. It is especially difficult when unexpected developments or complications arise during labor and delivery. As a result, a woman’s birth plan should be flexible because variations may be necessary. Emergency situations may require changes to the birth plan for the safety of the woman and/or her baby. Healthcare professionals will determine the best course of action based on the well-being of the mother and child.

When compiling a birth plan, a woman is encouraged to research her labor and delivery options. Many options are dependent on the facility she intends to use for giving birth (e.g., hospital, birthing center, own home). What may be possible at some facilities may not be possible at others. Before a woman makes decisions regarding her birth plan, parents should tour the hospital or birthing center where the mother plans to deliver. It is recommended that they also discuss the routine policies and procedures with the staff. For example, if a facility’s labor protocol has a policy requiring fetal monitoring, a woman will not benefit from stating “no fetal monitoring” in her birth plan. She may also choose to find another facility that may be more flexible in order to meet some of her requests.

In addition, a woman who finds that the routine care procedures of her facility are identical to her requests can then leave that information out of her birth plan. Some obstetricians (OB), nurse-midwives and birthing facilities have birth plan forms available.

Deciding which factors are most important to the individual is an essential part of the birth plan. Factors that are not important to the patient, and those that do not apply to her, should be left out of the plan. This makes it easier for the healthcare provider and labor and delivery staff to understand and follow the plan. Women are encouraged to keep the tone of their birth plan cooperative by using phrases such as “I would like,” “I prefer” and “I would hope to avoid.” The plan should also be limited to one or two pages. Some women choose to have one page of requests for a normal delivery and a second page addressing how to handle potential complications.

After compiling the first draft, it is recommended that a woman discuss her plan with her OB or nurse-midwife. This meeting should occur about four to six months before her due date. In some cases, certain factors in a woman’s pregnancy (e.g., age, health, problems during previous pregnancies) may prevent the provider from being able to fulfill certain requests. She can then modify the plan as necessary. She may choose to meet with her OB or nurse-midwife again after she attends birth preparation classes during the seventh or eighth month of pregnancy.

Once a woman has created a final version of the birth plan, she should review it with her partner to be sure it is clear. It helps to have a family member or friend who may be present during labor and delivery familiar with the plan. She should also create several copies of it. A copy should be given to the physician or nurse-midwife, the birth attendant and the partner or birthing coach. In addition, copies should be put in her file at the designated place of birth and in the bag being packed for the hospital. It should be labeled with the patient’s identifying information, including:

• Her name
• Partner/birthing coach’s name
• Birth attendant’s name
• Name of birth facility
• Birth facility address and phone number
• Due date
• Name and contact information of physician or nurse-midwife