What a birth plan is for

The NHS describes a birth plan as "a chance to plan things like where you want to give birth, who's going to be with you during the birth, and what facilities you'd like to use." It is a record of preferences that your midwife can read at a glance, not a contract.

The same page adds the caveat that makes the whole thing work: "It's important to remember that giving birth doesn't always go perfectly to plan, and things may have to change at the last minute. Your midwife will be there to help you make the best and safest decision for you and your baby."

NICE builds the plan into routine care rather than treating it as optional. Its fetal monitoring guideline asks teams to "discuss fetal monitoring options with a woman as part of her antenatal care and document the discussions and decisions in her personalised care plan". Its intrapartum guideline asks that the third-stage options be discussed "antenatally, during her initial assessment and in labour", and that the decision you reach is documented in your records.

The NHS checklist

NHS Best Start in Life publishes a list of prompts. In its own words, think about:

Where do you want to give birth — at home, in a midwifery unit or in hospital?
Do you want someone with you during the birth, such as your partner or a family member?
If you need a forceps or vacuum delivery, would you want someone with you?
If a caesarean is necessary, do you want someone with you?
What birthing equipment do you want to use — mats, beanbags?
Do you want to use any special facilities, such as a birthing pool?
Do you want to keep active during labour?
What position would you prefer to be in while you're in labour?
Do you want immediate skin-to-skin contact with your baby, before the cord is cut?
Are you happy for midwives, nurses and doctors in training to be present?
What are your pain relief preferences?
How do you want to feed your baby?
Can your baby be given vitamin K if they need it?

There is an official NHS birth plan template you can download and fill in, and the advice is to write it alongside your midwife rather than alone: "talk to your midwife about your choices so they understand and can advise you."

Four lines most people leave out

Third stage of labour

This is a real, documented choice and it rarely appears on downloaded templates. NICE defines active management as a package — a uterotonic drug, cord clamping and cutting, and controlled cord traction — and physiological management as no routine drug, no clamping until the cord has stopped pulsating or the placenta is out, and delivery of the placenta by your own effort. NICE advises that active management "is associated with a lower risk of a postpartum haemorrhage or blood transfusion", and that if you request physiological management your team should "discuss her level of risk so she can make an informed decision" and "support her in her choice."

Cord clamping

NICE tells clinicians not to clamp "earlier than 1 minute from the birth of the baby" unless there is concern about the cord or the baby's heart rate is below 60 and not rising, and to clamp before 5 minutes if controlled cord traction is being used. It then adds: "if the woman requests that the cord is clamped and cut later than 5 minutes, support her choice." Writing that down is the easiest way to be asked rather than told.

Monitoring

NG229 asks teams to confirm with you "which method of fetal monitoring has already been advised as part of their personalised care plan", and to explain that where there are no risk factors "there is a risk of increased interventions with continuous CTG monitoring compared with intermittent auscultation". It also says risk assessment is continual and the advised method may change during labour. A line saying you would prefer intermittent listening unless there is a clinical reason to change is entirely reasonable.

What you want if the plan changes

The NHS checklist asks whether you want someone with you for a forceps or vacuum birth and for a caesarean, and those are the questions worth answering carefully. Add: whether you would still want skin-to-skin in theatre, whether your partner should stay with you or go with the baby, and who should cut the cord. RCOG notes that during an assisted birth, if your baby is well, "you may choose to have immediate skin to skin contact and/or delayed cord clamping."

Things that belong in a conversation, not a document

Two areas are best raised face to face because the answer depends on your unit and your pregnancy. The first is whether you can use the pool, and whether the unit is alongside a hospital or freestanding — the NHS notes that separate units cannot offer an epidural. The second is any history of trauma, anxiety or a previous difficult birth. RCOG's guidance is that if you have concerns about birth you should tell your healthcare professional as early as possible, and that units may be able to offer peer support, group sessions or appointments with anaesthetists, specialist midwives or mental health professionals.

Keep it short and legible

A midwife may be meeting you for the first time in established labour. Two sides at most, headed sections, plain preferences. Bring a copy in your bag as well as in your notes.

And write it in the language of preference rather than prohibition. "I would like to stay mobile and use the pool if it is free; I would prefer to be asked before a vaginal examination" is something a team can work with. A list of things you refuse regardless of circumstance is harder to honour and, on the day, harder to talk about.

Birth Plan: What to Include