Keeping it Simple: An Alternative Birth Plan

When writing a birth plan, it's important to keep your list of preferences simple and succinct. Using bullet points and including the most critical information (ie: please don't offer pain medication; I'm allergic to latex; please keep mom and baby together after birth, skin to skin; we are delaying Hepatitis B shot) will help ensure that your birth plan is read and heeded. The traditional birth plan format includes a one-page list of information grouped into categories like, "Labor," "Birth," "Newborn," and "If Cesarean is Necessary." For an alternative format, consider using the following graphic to lay out your birth plan. This visual four-square birth plan helps the reader find information quickly and simply, and leaves just enough room for the most important information.


Ideas for filling in the four square birth plan:


  • Please don't offer pain medication
  • Shower/tub for comfort
  • Experiment with many positions for pushing

Special Instructions

  • Mom is allergic to perfumes
  • Partner would like to cut cord and announce gender
  • Please delay cord clamping

In an Emergency

  • Please allow partner and doula to be present in case of cesarean
  • Partner will be skin to skin with baby if mom cannot
  • If baby requires NICU, mom will pump colostrum - please, no formula

Newborn Care

  • Please delay bath
  • No eye ointment
  • Please give vitamin K shot


These are just a few ideas to populate the squares -- and perhaps your squares will have different categories! Experiment with the best format and contents to fit your preferences for birth.


You must create an account or login with your existing account to provide article ratings.

Recent Stories

Top 10 Childbirth Fears (A Series): What if My Labor Stalls?

Pregnancy & Infant Loss Awareness Month - A Resource & Link Round Up

When Should I Buy Maternity Clothes?

Download our App
Your Pregnancy Week by Week
Find A Lamaze Class
Lamaze Online Parent Education
Lamaze Video Library
Push for Your Baby