What birth preferences are, and what they are not
Most people search for a birth plan. We use the phrase birth preferences because it describes the document more honestly: it is a summary of what matters to you, written down so the people caring for you can read it in under a minute. The two terms mean the same thing, and your nurse will understand either one.
The value is mostly in the making of it. Working through the sections below asks you to think about lighting, movement, pain relief, monitoring, and newborn care before you are in labor — when you can read, ask questions, and change your mind calmly. By the time you hand a page to your nurse, you have already done the useful part.
Preferences are not demands, and they are not a contract. Labor is not fully predictable, and neither your body nor your care team can promise a particular outcome. A birth preferences sheet does not make a birth go a certain way; it makes it more likely that the people around you know who you are and what you care about while it goes however it goes.
This worksheet is general childbirth education. It is not medical advice, it is not personalised to your pregnancy, and it does not replace guidance from the professionals looking after you. Every clinical decision belongs in a conversation with your own provider.
How to use this worksheet
- Read through the sections on your own first and mark anything you have a real opinion about. Skipping a section is a legitimate answer.
- Go through it again with your partner or support person. They are the one who will be speaking up for you when you are busy, so they need to know your reasoning, not just your ticks.
- Bring it to a prenatal appointment and discuss it with your OB or midwife. Ask what is routine at your hospital, what is genuinely available, and what would need to change if a complication came up.
- Ask what the hospital already provides — birth balls, wireless monitoring, tubs, nitrous oxide, clear drapes for cesareans. Availability varies widely between US hospitals, and it is easier to find out now.
- Print at least three copies: one for your chart, one for your nurse, and one for your support person. Nursing shifts change, so a copy that lives in the room is worth having.
- Keep the final version to one page, grouped and scannable. A nurse reading a page in thirty seconds will remember three clear preferences; they will not remember two pages of prose.
- Update it if circumstances change — a breech baby, a planned induction, a scheduled cesarean, or simply a change of mind. Rewriting it is normal.
About me and my care team
The top of the page should tell a nurse meeting you for the first time who everyone in the room is. It sounds administrative, but it saves repeated questions during contractions.
- Your name and what you would like to be called.
- Your due date and, if relevant, whether this is a planned induction or scheduled cesarean.
- Your OB or midwife, and the practice they belong to.
- The hospital or birth center where you plan to give birth.
- Your support person's name and relationship to you.
- Your doula's name, if you are working with one.
- Anything about communication that would help: hearing needs, anxiety around needles or exams, a history of trauma you want handled gently, or a preference for being told what will happen before it happens.
- Your preferred language, and whether you need a medical interpreter. Hospitals are required to provide one — a family member should not have to interpret for you.
Labor environment
Environment is where you have the most influence and the least clinical risk, so it is worth being specific. Small things — the overhead light off, your own playlist, a door that stays closed — change how a room feels over many hours.
- Lighting: dimmed, lamps only, or bright — say which you prefer.
- Noise and music: your own playlist, quiet, television on or off.
- Movement: walking the hall, rocking, standing through contractions.
- Position changes: whether you would like to be prompted to change position regularly.
- Birth ball or peanut ball: ask whether the unit provides them or whether you should bring your own.
- Hydration: water, ice chips, or electrolyte drinks, as your team permits.
- Visitors: who may come in, who should wait, and who decides in the moment.
- Photography or video: what you are comfortable with, and what hospital policy allows during birth.
- Privacy: knocking before entering, limiting observers and students, keeping you covered where possible.
- Communication style: direct and detailed, or brief and reassuring. Whether you want to be asked or told.
- Cultural or spiritual preferences: prayers, blessings, items in the room, modesty needs, or practices around the placenta.
Comfort and pain-management preferences
There is no better or braver way to manage labor pain. An epidural is not a shortcut, and going without one is not a badge. What matters is that you understand the options in advance, know what is available where you are giving birth, and can change your mind at any point without feeling that you have failed at something.
It also helps to say how you want options offered. Some people want to be reminded that an epidural is available; others find repeated offers hard to resist when they had hoped to labor without one. Both are reasonable, and your nurse cannot guess which you are.
- Breathing, relaxation, hypnobirthing techniques, or guided visualisation.
- Movement, swaying, and position changes.
- Water: a shower or tub, where available and clinically appropriate.
- Massage, counter-pressure on the lower back, or a TENS unit if you are bringing one.
- Heat or cold packs.
- Nitrous oxide, where the hospital offers it — availability in the US varies a great deal.
- IV pain medication, which can take the edge off early labor.
- Epidural, including whether you want one early, later, or only if you ask.
- Openness to discussing options as labor progresses, rather than deciding now.
- How you want options offered: on request only, at set points, or whenever your nurse thinks it would help.
Monitoring and routine care
This section is best written as discussion prompts rather than instructions. Monitoring and routine care are where clinical judgement matters most, and the useful outcome is a shared understanding — not a list of refusals.
- Fetal monitoring: continuous, intermittent, or wireless, where medically appropriate and available.
- Cervical checks: how often, by whom, and being asked before each one.
- IV access: a saline lock instead of continuous fluids, where appropriate and according to hospital policy.
- Eating and drinking during labor, where your care team permits it.
- Mobility: staying out of bed as much as your labor and monitoring allow.
- Labor augmentation: being told why Pitocin is being suggested, what the alternatives are, and how long you might wait first.
- Membrane rupture: a conversation before your water is broken, unless it is urgent.
- Consent: an explanation and your agreement before examinations and procedures, except in an emergency.
Pushing and birth positions
Which positions are open to you depends on how your labor is going, whether you have an epidural, and what monitoring you need. Write your preferences as first choices, and expect your team to tell you when something is not possible.
- Upright, hands-and-knees, squatting, or side-lying positions where they are safe and workable.
- Guided pushing with counting, or instinctive pushing led by your own urges.
- Use of a mirror, or explicitly no mirror.
- Whether you would like to touch the baby's head as it crowns.
- Who announces the baby's sex, if it is not already known.
- Your partner's role: at your head, helping support a leg, or cutting the cord.
- Episiotomy: a discussion before one is performed, other than in an emergency.
- Assisted delivery: an explanation of why vacuum or forceps is being recommended, and what the alternatives are.
If a cesarean birth is needed
Around a third of births in the United States are cesareans, and some of them are unplanned. Writing this section is not pessimism — it is the part of your preferences most likely to be read in a hurry, and the part where feeling informed makes the largest difference to how the birth is remembered.
If a cesarean becomes necessary, the reason is a clinical one and the pace may be fast. What you can still influence is how much you are told, who is with you, and what happens in the minutes after your baby is born.
- A clear explanation of what is happening and why, in plain language.
- Your support person present in the operating room, where the hospital permits it.
- Your own music playing.
- A clear drape or a lowered drape at the moment of birth, where available.
- Skin-to-skin in the operating room or in recovery, when it is medically appropriate.
- Partner skin-to-skin if you are not able to hold the baby yet.
- Delayed cord clamping, where appropriate.
- Lactation support as soon as you are settled.
- Photos, if permitted by hospital policy.
- A description of what you will feel — pressure and pulling rather than pain — and being told before anything changes.
Immediately after birth
Several routine newborn decisions happen in the first hours. They are usually presented quickly, so it helps to have thought about them and to know which questions you want to ask the pediatric team.
- Immediate skin-to-skin, if you and the baby are well.
- Delayed cord clamping, where clinically appropriate.
- Where the newborn assessment happens — on your chest where possible, or at the warmer.
- Feeding preference: breastfeeding or chestfeeding, formula, or a combination.
- Lactation support during your stay and a plan for after discharge.
- Vitamin K: routinely offered in the US to prevent bleeding; discuss it with your pediatric team.
- Erythromycin eye ointment: routinely offered; discuss timing and any questions with the pediatric team.
- Hepatitis B vaccine: routinely offered in the newborn period; discuss with the pediatric team.
- Bath timing: many families delay the first bath, which is usually easy to accommodate.
- Rooming-in versus nursery time, where a nursery is offered.
- Pacifier use, or a request that one is not given without asking you.
- Circumcision, if relevant to your family: whether it is done during the hospital stay, and what pain relief is used.
If your baby needs additional care
Some babies need observation, extra help breathing, or a stay in the NICU. It is one of the harder possibilities to write about in advance, and one of the most useful — because when it happens, most families say the same thing: they wanted to know what was going on.
- Clear, regular updates in plain language, even when there is nothing new to report.
- Your support person accompanying the baby, where permitted, so someone you trust is present.
- Photos or video of your baby when you cannot be there.
- Help starting pumping or hand expression early, if you plan to provide milk.
- Lactation support familiar with feeding a baby who is receiving extra care.
- Knowing who to contact on the NICU or newborn team, and when rounds happen so you can be there for them.
- Being told what the plan is for the next few hours, not only what has already happened.
Postpartum preferences
The hospital stay after birth is short, and it is easy to arrive at discharge without having asked the things you meant to ask. A few lines here are worth writing.
- Pain management: how you would like recovery pain discussed and reviewed, particularly after a cesarean or a repair.
- Feeding support: an in-person lactation consult if you want one, and help with positioning before you go home.
- Rest and visitor boundaries: who is welcome, when, and for how long. Staff will usually enforce this for you if you ask.
- Emotional support: being checked in on, and knowing who to speak to if you are struggling.
- Mobility assistance: help with your first walk, your first shower, and getting in and out of bed.
- Discharge education: newborn care, feeding, your own recovery, and what your follow-up appointments are.
- Warning signs to review before you leave — for you and for your baby — and the number to call at any hour.
Your top three priorities
If you write only one part of this worksheet, write this one. Care teams read quickly, and a short list of what matters most is far more likely to be remembered and honoured than a long document.
Choose three. Make them specific enough to act on — "tell me before anything is done" or "my partner stays with the baby at all times" or "I want an epidural as early as possible" — and put them at the top of the page you hand over.
Questions for your care team
Keep a running list as you work through this worksheet, and bring it to your next appointment. These prompts cover what most families end up asking.
- What is routine at this hospital during labor, and how much of it is flexible?
- What monitoring will I need, and is wireless or intermittent monitoring an option for me?
- What comfort measures does the unit provide — tub, shower, birth ball, nitrous oxide?
- How does your practice handle going past your due date, and when would induction be discussed?
- Under what circumstances would you recommend a cesarean, and what would that conversation look like?
- Who will actually be at my birth if you are not on call?
- What is your approach to episiotomy and assisted delivery?
- What lactation support is available during my stay and after I go home?
- How long is a typical stay after a vaginal birth and after a cesarean here?
- Is there anything in my pregnancy that would change your answers to any of the above?
When you are ready to go further than the worksheet:
- Hospital bag checklistWhat to pack for labor, recovery, and your newborn — including the printed copies of this worksheet.
- Self-paced birth preparationLabor stages, comfort measures, and decision-making, worked through at your own pace.
- Live classesAsk questions live and practise these conversations with other parents.
- Private sessionsOne-to-one time with Morolake Ilesanmi, RN, ICCE to talk through your own situation.
- BirthPrep FAQHow our childbirth education works, and who it is for.
- All resourcesThe full library of free guides and checklists.