Free Birth Plan Template 47Free Birth Plan Template 47Free Birth Plan Template 47
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Creating Your Birth Plan
A Printable Checklist



By Liza Barnes, Health Educator

There are many good reasons to create a birth plan. Besides
communicating your desires about your baby's birth to your health care provider, writing a birth
plan helps you (and your partner) to mentally prepare for the birth. It also may help facilitate
discussions with your health care providers about details that you may have overlooked. Think
through each and every choice you list on your birth plan.
First Stage (Labor)
Whom will you invite to attend/witness the birth?
What are your environmental preferences (lighting, noise level, music, etc.)?
What are your film/video preferences (check one)?

Yes, I want to record the event with video

No just cameras

No recording devices of any kind

What are your clothing preferences (check one)?

A hospital gown

My own clothing

What are your fetal monitoring preferences (check one)?

Internal fetal monitor

External fetal monitor