Free Birth Plan Template 08Free Birth Plan Template 08Free Birth Plan Template 08
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My Birth Plan
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Name:

Partner's name:

Doctor's or midwife's name:

Today's date:

This birth plan is a guide for my labor and delivery. Since childbirth does not always go as planned, some of
this birth plan may change.
Place and People
I would like to deliver my baby:
In a hospital:

(Name, phone number)

In a birthing center:
At home
I would like my baby to be delivered by:
My family doctor:

(Name)

My obstetrician:
My midwife:
My perinatologist:
I'd like these people to be with me during labor and birth:
Partner:

(Names)

Friend(s):
Family:
Doula:

1

During Labor
I'd like to be able to go back home if I'm not in active labor.
After I've been admitted, I'd prefer:
To eat if I wish to.
To drink clear flu