Birth Plan Builder | Birth Advocate

Step 1 of 7

Let's start with you.

This information will appear at the top of your birth plan so your care team knows who you are and what to call you.

Preferred name / what to call you

Due date

Delivery location

OB / Midwife name

Pronouns (optional)

Languages spoken

We'll flag if an interpreter should be arranged.

Allergies or medical conditions your team should know

Medical decision maker

If you are unable to speak for yourself, who has the authority to make medical decisions on your behalf?

Full name

Their phone number

Step 2 of 7

Who's in the room.

Tell your care team exactly who you want present during labor, delivery, and recovery, and their role.

Support people

Photography & video

Photos / video during labor

Photos / video during delivery

Visitors during labor

Open to additional visitors during labor

Open to medical students or residents observing

Anything else about who should (or should not) be present

Step 3 of 7

Consent & interventions.

These are your preferences for common procedures and interventions. You have the right to consent to or decline any of these. Your care team will discuss before proceeding.

Labor interventions

Induction / Pitocin if labor stalls

Synthetic oxytocin to speed up or start contractions

See more labor interventions

IV / hep-lock Intravenous line for fluids or medication access

Continuous fetal monitoring Straps / belt that tracks baby's heart rate continuously

Amniotomy (AROM) Artificially breaking the water / amniotic sac

Internal fetal scalp electrode A small clip attached to baby's scalp for monitoring

Delivery

Episiotomy

Surgical cut to widen the vaginal opening

Cesarean section

If recommended, do you want to discuss options first?

See more delivery preferences

Forceps or vacuum-assisted delivery Assisted vaginal delivery tools

Coached pushing Staff directing when and how to push

Other consent notes

Step 4 of 7

Pain relief.

There is no wrong answer here. Whatever helps you feel safe and in control is the right choice.

Your pain relief preference

Unmedicated / natural

Epidural

IV pain medication

Nitrous oxide

Open to options / decide in the moment

Customize further, comfort measures & pushing position

Non-medical comfort measures I want available

Birthing ball

Tub / shower

Freedom to walk & move

Massage

Heat / cold packs

Aromatherapy

Music / playlist

Dim lights

Quiet room

Hypnobirthing / meditation

Various labor positions

Pushing position preference

Semi-reclined

Side-lying

Hands and knees

Squatting

Birthing stool

Whatever feels right in the moment

Pain relief notes

Step 5 of 7

Baby's first moments.

These decisions apply right after birth, before any routine newborn procedures begin.

Immediately after birth

Immediate skin-to-skin contact

Baby placed on my chest right after birth, before being weighed or measured

Delayed cord clamping

Wait until cord stops pulsing (1–3 min) before clamping

Partner to cut the cord If applicable

See / catch my baby during delivery Mirror, or hands-on catch guided by midwife/OB

Newborn routine procedures

Vitamin K injection Prevents rare but serious bleeding disorders in newborns

Erythromycin eye ointment Antibiotic eye treatment, standard in most hospitals

Hepatitis B vaccine First dose given in hospital after birth

Newborn bath at hospital Many parents now delay or decline the first bath

Pacifier use in hospital

Feeding

Breastfeeding / chestfeeding

Pumping

Formula

Combination

Undecided / support welcome

No formula supplementation without my consent

Baby care notes

Plan B · Step 6 of 7

Your backup plan.

If a C-section becomes necessary, this is your Plan B. In an emergency, someone else may need to make decisions for you. Let's make sure your wishes are documented and your people are ready.

More about your decision maker

You named who speaks for you on the first page. A little more detail helps your team act on it.

Relationship to you

Do you have a signed healthcare proxy / power of attorney?

Secondary decision maker

Full name (optional)

Relationship

If a C-section becomes necessary

Support person with me in the OR As long as it's medically safe

Gentle / family-centered C-section

Slow delivery, skin-to-skin in OR if possible, clear drape option

Music played in the OR

Communication preferences

Explain all procedures before performing them Even in urgent situations, a brief explanation matters

Direct updates / decisions to me, not my support person Unless I am unable to respond

Anything else about emergency situations or your wishes

Step 7 of 7

Your birth plan.

Review everything below. Then download or print your plan to share with your hospital, OB, and support team.

Plan A and Plan B print as two separate documents, so the right one reaches your hospital, OB, or support team.