My Birth Plan

Name: {Your Name}

Due Date: {Your Due Date}

Preferred Birth Location: {Hospital/Birthing Center/Home}

Support Team:

• {Partner's Name}
• {Doula's Name}
• {Other Support Person's Name}

Pain Management Preferences:

• {Epidural/Medication-Free/Other}

Labor Positions:

• {Preferred Positions}

After Birth Preferences:

• {Skin-to-Skin Contact/Breastfeeding Support/Other}

Special Requests:

• {Any Specific Requests}

Flexibility Note: I understand that circumstances may change and am open to discussing alternatives with my healthcare team.

Birth Plan Overview

Expectant Parent: {Your Name}

Birth Partner(s): {Partner's Name/Support Person}

Planned Birth Date: {Due Date}

Location: {Hospital/Birthing Center/Home}

Labor Preferences:

• Pain Relief: {Epidural/None/Other}
• Positions: {Walking/Squatting/Other}

Delivery Preferences:

• {Vaginal/C-Section/Other}

Post-Delivery Wishes:

• {Immediate Skin-to-Skin/Delayed Cord Clamping/Other}

Additional Notes:

• {Any Other Preferences or Concerns}

Reminder: This plan is a guide and can be adjusted as needed.

Birth Plan

Name: {Your Name}

Due Date: {Your Due Date}

Location: {Preferred Location}

Support Team: {Names of Support People}

Pain Management: {Your Preferences}

Labor and Delivery:

• Positions: {Your Choices}
• Interventions: {Your Preferences}

Post-Birth:

• {Skin-to-Skin/Breastfeeding/Other}

Note: Open to changes as necessary.

My Birth Preferences

Name: {Your Name}

Expected Delivery Date: {Due Date}

Preferred Location: {Hospital/Home/Birthing Center}

Support Team Members:

• {Partner's Name}
• {Doula's Name}

Pain Relief Options:

• {Epidural/Medication-Free/Other}

Labor Positions:

• {Walking/Sitting/Other}

After Birth Care:

• {Immediate Bonding/Breastfeeding/Other}

Special Instructions:

• {Any Additional Requests}

Flexibility Clause: Willing to adapt as needed.

Birth Plan

Parent's Name: {Your Name}

Due Date: {Due Date}

Birth Location: {Location}

Support Team: {Names}

Pain Management: {Preferences}

Labor Preferences:

• Positions: {Choices}

Post-Delivery:

• {Preferences}

Note: Open to adjustments.