Birth Plan and Preferences Sheet

Who this is for

A page for writing down what you would prefer, stage by stage, before you talk it through with your midwife. Every word on it is yours: the sheet supplies the headings and nothing else, and there is a column beside each one for what was actually agreed when you discussed it.

Anyone preparing for a birth who would rather think it through on paper first, birth partners who need to know what matters to the person giving birth, and people who have been asked to bring their preferences to an appointment.

What this helps you track

• What you would prefer at each stage, written in your own words
• Why it matters to you, which is the part that survives a change of plan
• Who you discussed each one with, and when
• What was actually agreed, recorded beside what you asked for
• Who is with you, who to contact, and what you would want if things change

How to use it

1. Fill in your name, where you are booked in and who is with you at the top of the sheet.
2. Work down the stages and write what you would prefer in ordinary words — as much or as little as you want against each.
3. Say briefly why it matters to you; that line is what lets somebody make a decision on your behalf when the first plan stops being possible.
4. Take the sheet to an appointment and go through it with your midwife or doctor, rather than handing it over.
5. Write what was agreed in the last column, with their name and the date, so the sheet reflects the conversation and not only the wish.
6. Print a copy for your bag and give one to whoever is going with you; they are the person most likely to be asked.

Formats

• Printable PDF (A4 and US Letter)
• Fillable PDF with form fields
• Fill in online, saved in your browser

The printable is laid out inside a box that fits both A4 and US Letter, so the two files are identical and neither one is scaled. The fillable PDF has real form fields. The online version keeps what you enter in your own browser and builds the completed PDF on your device.

How to print

Download the A4 or US Letter file to match the paper in your printer, open it in a PDF reader and print at 100% — not "fit to page", which shrinks the writing space. Both files leave a 14 mm margin, which clears the unprintable edge on home printers. To print the online version with your entries in it, use the Print this sheet button, which prints only the sheet and none of the page around it. More on printing.

Questions

Is a birth plan binding?

No, and this sheet says so plainly at the top. It is a written set of preferences to discuss with the people caring for you. What is possible on the day depends on circumstances and on clinical judgement, which is exactly why there is a column for what was agreed.

Does the sheet tell me what to ask for?

No. It supplies five headings and blank space. We have no view on pain relief, positions, feeding or anything else on this page — those are yours to decide and your midwife's to discuss with you.

What if everything changes on the day?

That is common enough that there is a stage on the sheet for it. Writing down what matters most to you — rather than only what you want to happen — is what makes the sheet useful when the first plan is set aside.

Who should read it?

Your midwife or doctor, and whoever is going with you. The birth partner is the one who will be asked questions while you are busy, so they should have read it before the day rather than in the car.

Should I write a separate one for a caesarean?

Some people do, and you can print a second sheet and label it. The last stage is there for what you would want if plans change, which covers it for most people.