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Please this is my Birth Plan and every one should think of doing their own. It can be a template for your birth plan. It can help you and give you an idea of how to write a birth plan but please don’t copy it. Thank you for your cooperation!


Home Birth Plan

Mother:  Valerie                       Partner/ Support:  Andrew
Due Date:  05/20/11
Practitioner:  Commercial Midwives           Place of Birth:  Home


I have given careful thought to my preferences during and after labor and have outlined them below. I understand that these are guidelines only and that under certain circumstances, they may not be followed.

I hope that you will honor these wishes and allow me to experience the birth I hope for.

Thank you.

Labor and Delivery

  • I would like a Home Birth
  • I would like a Waterbirth
  • My preference would be to be monitored using the waterproof Doppler. I don’t want to have to get out of the pool for monitoring.
  • I would like to be free to walk around during labor.
  • I wish to be able to move around and change position at will throughout labor.
  • I would like to be allowed to choose the position in which I give birth, including squatting.
  • I would like to be able to drink and eat during labor.
  • I will like to listen my own music during labor.
  • I would like the environment to be kept as peace and quiet as possible.
  • I would like a dim light in the room during my labor with candles and essentials oils.
  • I would like use some relaxation techniques (breathing, focusing, etc.), Heat or Cold packs and Massage (back, foot, counter pressure, etc.).
  • I do not want an IV unless I become dehydrated.
  • Please do not offer me pain medications, I will ask for them if I want them.


  • I do not wish to have continuous fetal monitoring unless it is required by the condition of my baby.
  • I do not want an internal monitor unless my baby has shown some sign of distress.
  • I would prefer to keep the number of vaginal exams to a minimum.

Immediately After Delivery

  • I would like to have my partner cut the cord.
  • I would like a delay the cord cutting
  • I would like No separation of Mother & Baby
  • I plan to breastfeed my baby and would like to begin nursing as soon as possible after birth.
  • I would like to keep the placenta


  • I would like to take still photographs during labor and the birth.
  • I would like to make a video recording of labor and the birth, if possible.

Labor Augmentation/Induction

  • I would prefer to use natural methods to start labor – No Induction
  • I do not wish to have the amniotic membrane ruptured artificially unless signs of fetal distress require internal monitoring.
  • If labor is not progressing, I would like to have the amniotic membrane ruptured before other methods are used to augment labor.
  • I would prefer to be allowed to try changing position and other natural methods (walking, nipple stimulation) before Pitocin is administered.


  • NO C-Section, unless absolutely necessary – I would like to avoid completely a Cesarean.
  • If I have to have a C-Section, I want to breastfeed my baby while the incision is being stitched up, or in the recovery room right afterwards.


  • NO episiotomy unless absolutely required for my baby’s safety
  • Please use compresses, perinea massage and positioning to help avoid the need for an episiotomy
  • NO use of forceps or a vacuum extractor


If I have to transfer to hospital, I want Andrew to come with me. I do not want to be separated from him. I want to keep my baby with me at all times in the hospital and to have him in bed with me.

Thank you for all your help.

Valerie and Andrew