A birth plan is a short list of what you'd like to happen during labour, birth and the first hours with your baby. The NHS guide to what to include in your birth plan calls it a way of letting your midwife, nurses and doctors know what you want. Most plans cover where you'd like to give birth, who'll be with you, pain relief, positions, monitoring, how you feel about interventions, the third stage and cord clamping, and your baby's first care: skin-to-skin, vitamin K, the hepatitis B vaccine and feeding.
The best plans are written with your midwife, kept short, and held lightly. Labour doesn't always follow a script, and you can change your mind at any point.
What is a birth plan for?
A birth plan helps you think through your options before labour and tells the people caring for you what matters to you. Australia's Pregnancy, Birth and Baby guide to birth choices says working out your preferences is a chance to learn about birth and talk through options with your partner and care team. It says research shows people who prepare their birth preferences are more likely to be satisfied with how their birth goes.
A written plan is especially useful if you won't see the same midwife or doctor throughout. Pregnancy, Birth and Baby's page on interventions says it helps a team who doesn't know you understand your preferences quickly.
You don't have to write one. Pregnancy, Birth and Baby notes that not everyone does, and you can share preferences by talking instead.
How do I keep a birth plan flexible?
- Talk it through with your midwife or doctor. The NHS suggests this so they understand your choices and can advise you. Some options depend on where you give birth and on your health.
- Write preferences, not rules. Phrases like "I'd prefer…" and "If possible…" leave room for what happens on the day.
- Plan for the unplanned. Add a few lines on what you'd want if labour is induced, if you need an assisted birth or a caesarean, or if your baby needs special care.
- Keep it short and clear. Pregnancy, Birth and Baby suggests a simple list of what's most important, a digital copy, a spare copy, and asking your provider to add it to your notes. Pack a copy in your hospital bag.
- You can change your mind. Pregnancy, Birth and Baby says you still have the right to change your plan in labour, even when your baby is close to being born.
The NHS says giving birth doesn't always go to plan and things may have to change at the last minute. If your team recommends something different, Pregnancy, Birth and Baby says in most cases you decide whether to go ahead. Ask what's happening, why, and whether there's time to talk it over.
A birth plan doesn't change when to call for help. See signs of labour for when to ring your maternity unit.
What should a birth plan include?
Use this as a template. You don't need to fill in every row, and "I'm not sure yet, please talk me through it" is a fine answer.
| Section | What to decide | Example wording |
|---|---|---|
| Place of birth | Hospital, birth centre or home | "Hospital birth suite, with a birth pool if free" |
| Birth partners | Who's with you, including for a caesarean | "My partner and my sister; my partner stays for any caesarean" |
| Students | Whether trainees can be present | "Students welcome; please ask first" |
| Pain relief | What you'd like to try, and when to be offered more | "Water and gas first; tell me about an epidural if I ask" |
| Positions and water | Moving around, birth positions, labouring or birthing in water | "I'd like to stay upright and mobile" |
| Monitoring | Intermittent listening or continuous monitoring | "Intermittent listening if all is well" |
| Interventions | Induction, assisted birth, episiotomy, caesarean | "Please explain the options and give me time to decide" |
| Third stage | Active or physiological; keeping the placenta | "Active third stage" |
| Cord | When to clamp, and who cuts it | "Wait to clamp the cord; my partner would like to cut it" |
| After the birth | Skin-to-skin, first feed, checks | "Baby straight onto my chest, weighing after the first feed" |
| Baby's care | Vitamin K, hepatitis B vaccine | "Yes to the vitamin K injection" |
| Feeding | Breastfeeding, formula or combination | "Breastfeeding; help with the first feed please" |
| Personal needs | Language, culture, faith, disability, past trauma | "I'd like a female doctor where possible" |
The NHS checklist and Pregnancy, Birth and Baby's list cover most of these. The sections below explain the options behind each row.
What are my options for place of birth, birth partners and pain relief?
Place of birth. The NHS lists home, a midwifery unit or hospital, and Pregnancy, Birth and Baby lists hospital, birthing centre or home. What's available depends on where you live and your health, so ask your midwife.
Birth partners. Think about who you want with you, and what you'd like them to do. Pregnancy, Birth and Baby suggests agreeing how your support person will help, including when to speak to staff for you. The NHS checklist asks whether you'd want someone with you for a forceps or vacuum birth or a caesarean.
Pain relief. The NHS guide to pain relief in labour describes these options:
| Option | What the NHS says |
|---|---|
| Breathing, moving, massage | Your position can make a difference |
| Water (bath or birth pool) | Can help you relax and make contractions seem less painful |
| TENS machine | Hasn't been shown to work in the active phase of labour |
| Gas and air | Won't remove all the pain but can reduce it |
| Pethidine or diamorphine injection | Not recommended close to the pushing stage |
| Remifentanil drip you control | Can make you feel breathless or need oxygen |
| Epidural | Gives complete relief in most cases, but can lengthen the pushing stage and needs continuous monitoring |
The UK's NICE guideline on intrapartum care adds sterile water injections as an option for back pain in labour. The NHS advice is to write down your wishes but keep an open mind, because your preferences may change.
What can I ask for about positions, water and monitoring?
Positions. NICE says women should be encouraged and helped to move and use whatever positions feel most comfortable throughout labour, except lying flat on the back. For the pushing stage without an epidural, it says upright positions and keeping mobile may help. With an epidural, it says lying on your side may increase the chance of a vaginal birth without assistance.
Water. NICE says to offer the chance to labour in water for pain relief, and to consider birth in water. It says water birth may be linked with a lower risk of heavy bleeding and of admission to the neonatal unit, and a higher risk of the cord snapping before it's clamped, and that the evidence on whether the risk of a baby dying differs is inconclusive.
Monitoring. NICE's guideline on fetal monitoring in labour says that if you're at low risk of complications, your baby's heartbeat should be checked by intermittent listening, with a handheld doppler or Pinard stethoscope, at least every 15 minutes in established labour and every 5 minutes in the pushing stage. Continuous monitoring (CTG) is offered if there are risk factors or concerns. NICE notes it may limit how much you can move and whether you can use water. Some units have wireless monitors, so it's worth asking.
What should I say about induction, assisted birth and caesarean?
Pregnancy, Birth and Baby says interventions can help keep you and your baby safe, and lists reasons they may be recommended, such as a health condition, waters breaking without labour starting, very slow progress or signs your baby is distressed. Useful lines for your plan:
- Induction. Pregnancy, Birth and Baby describes medicines placed in the vagina to prepare your body, a drip to start contractions, and breaking the waters, and says a combination is common. You might write that you'd like each step explained and time to ask questions.
- Assisted birth. This means using forceps or a vacuum cup (ventouse). Pregnancy, Birth and Baby says you have the final say on which method is used, and that an episiotomy (a cut to widen the vaginal opening) is sometimes recommended.
- Caesarean. It may be planned or happen during labour. Note who you'd like in theatre with you, and that you'd like skin-to-skin as soon as possible. NICE says that if you aren't well enough, your birth companion can hold your baby skin-to-skin instead.
What happens in the third stage, and when should the cord be clamped?
The third stage is the time from your baby's birth until the placenta comes out. NICE and Pregnancy, Birth and Baby's third-stage page describe two approaches:
| Active | Physiological | |
|---|---|---|
| Medicine | Injection (oxytocin) to help the womb contract | None routinely |
| Cord | Clamped, then gentle pulling on the cord once the placenta separates | Left until it stops pulsing or the placenta is out |
| Usual time | Up to about 30 minutes | Up to about an hour |
NICE says active management lowers the risk of heavy bleeding after birth and of needing a blood transfusion, with more side effects such as nausea and vomiting. If you choose a physiological third stage, it says your team should discuss your level of risk and support your choice. Pregnancy, Birth and Baby says active management is more likely to be recommended if you're at higher risk of heavy bleeding, for example after a long or induced labour.
Cord clamping. Waiting a little before clamping lets more blood pass from the placenta to your baby.
- WHO: the WHO recommends clamping no earlier than 1 minute after birth, and says it may improve iron levels for up to 6 months.
- UK: NICE says not to clamp earlier than 1 minute unless there's concern about the cord or the baby's heart rate. With an active third stage, it says to clamp before 5 minutes, and to support you if you ask for later.
- Australia: Pregnancy, Birth and Baby says clamping usually happens after the cord stops pulsing, usually about a minute after birth, and that it may need to be cut straight away if you or your baby are unwell.
- US: ACOG recommends waiting at least 30 to 60 seconds for vigorous term and premature babies. It notes a small increase in jaundice needing light treatment.
Tell your midwife in advance if your partner would like to cut the cord, or if you plan to bank or donate cord blood. Pregnancy, Birth and Baby also notes that families have different cultural practices around the placenta, such as burying it, and that your choices should be respected.
What about skin-to-skin, vitamin K and the hepatitis B vaccine?
Skin-to-skin. NICE encourages skin-to-skin as soon as possible after birth, with your baby dried and covered with a warm blanket, and says routine checks such as weighing shouldn't separate you in the first hour unless you ask or your baby needs care. See preparing to breastfeed for what to include about the first hour and the first feed.
Vitamin K. Babies are born with very little vitamin K, which helps blood clot. Australia's Pregnancy, Birth and Baby says Australian guidelines recommend one injection soon after birth. Drops by mouth are an option for some babies, but need 3 doses: at birth, at 3 to 5 days, and at 4 weeks if fully breastfed. NICE also says the injection works best, and that oral doses may need to continue after you go home. The CDC says babies who don't get the shot are 81 times more likely to develop late vitamin K deficiency bleeding, which can cause bleeding into the brain, and that the shot can wait up to 6 hours so you can bond first.
Hepatitis B vaccine. The advice differs by country:
| Country | Hepatitis B vaccine at birth |
|---|---|
| Australia | All babies, within 7 days, ideally within 24 hours |
| UK | Only babies whose mothers have hepatitis B, within 24 hours (then at 4 weeks) |
| US (AAP) | All babies, within 24 hours |
| US (CDC) | Shared decision if the mother tests negative; within 12 hours if she's positive or her status is unknown |
The Australian timing is from NSW Health's schedule, and the UK's from the NHS hepatitis B vaccine page, which says all UK babies get hepatitis B protection in the 6-in-1 vaccine from 8 weeks. The AAP still strongly recommends a birth dose for all babies. The CDC's December 2025 fact sheet moved to individual decision-making when the mother tests negative, suggesting that a delayed series start no earlier than 2 months. It says babies of mothers who test positive or whose status is unknown should still have the vaccine within 12 hours, plus immune globulin. See vaccinations for the full schedules.
How do I include feeding plans and personal needs?
Feeding. The NHS checklist asks how you want to feed your baby. If you plan to breastfeed, ask for help with the first feed and with hand expressing. If you plan to formula-feed, check whether to bring bottles and formula. Preparing to breastfeed covers what to ask for.
Language and culture. Pregnancy, Birth and Baby suggests listing any cultural factors that matter to you. A Goulburn Valley Health leaflet from Australia reminds women they can ask for an interpreter, and it helps to arrange one before labour. You might also note your faith or dietary needs, preferences about the gender of your carers, and practices after birth.
Past trauma or fear of birth. A difficult previous birth, a traumatic medical experience, sexual assault or childhood abuse can all make birth feel frightening. A United Lincolnshire Hospitals NHS Trust leaflet on fear of childbirth suggests talking to your midwife or obstetrician, who can refer you for specialist support, and writing a detailed birth plan with them. You don't have to give details in the written plan. A line such as "Please explain before any examination and ask my permission" tells staff what helps.
Disability or health needs. Note anything that affects how you move, communicate or take in information. NICE says people with mobility issues should have their needs assessed and adjustments made so they can use water in labour if they want to.
If you're feeling very anxious or low in pregnancy, tell your midwife or GP. If you have thoughts of harming yourself, call a crisis line (Lifeline on 13 11 14 in Australia, Samaritans on 116 123 in the UK, 988 in the US) or your local emergency number (000 in Australia, 999 in the UK, 911 in the US) now.
