Birth Plan Template

Use the template below for an easy printable birth plan. (Click on the image for a downloadable file.) Keep it simple–the nurses/midwives will likely ask you all of these questions anyway. The broader, more detailed parts of your plan should already be known between you and your doula/support partner and don’t need to be included in this plan. A good basic plan consists of just a few things: pain management options during labor and delivery, and your immediate postpartum wishes. If you have questions about any of this, don’t hesitate to ask your doctor, midwife, or doula for help!
For pain management during labor and delivery, you may want to list some or all of the following:

*labor in the tub/shower
*fentanyl shot
*nitrous
*epidural
*NO epidural

For postpartum, your care providers will want to know the following:
*delayed cord clamping
*dad/partner cut cord
*antibiotic eye drops-YES/NO
*vitamin K-YES/NO
*Hep B-YES/NO