Birth plan: here's how to do it

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Philippe Gloaguen
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Birth plan example

The birth plan (or birth plan) is a written and signed agreement between the pregnant woman and the facility where she has decided to give birth, or with the gynecologist or midwife who follows her.
It is therefore a sheet self-signed to be presented at the hospital and to be discussed with a midwife or gynecologist, especially about what we do not want to be done in labor and delivery.
Of course this is not a document binding and during labor and delivery, the gynecologist will decide what to do and what not to do, but the birth plan is still an important document for the mother.
Here an example of a birth plan, that the Midwife, Dr., presents to her clients during the pre-birth courses. We would like to underline that this is a VERY subjective and personal birth plan and that every woman is free to make her requests according to her needs.





Facsimile birth plan

Data ..........................................



To your kind attention of the Hospital Management ... .. To the Midwives and Doctors of the delivery room of the hospital ... ..

Subject: Birth plan of ....... (name and surname of parents)

We have chosen to give birth at your hospital because we believe it is the best choice to welcome our baby girl. During the pregnancy we have matured some requests, which we hope will be fulfilled. These are very important to us, in order to be able to live the birth of .... (child's name) peacefully ...


We are aware of the fact that if there is a real need to intervene, we will not hesitate to follow your instructions and we will rely on you as health professionals. These are our wishes, we thank you in advance for your attention:

  • We would like the umbilical cord to be cut after the placenta comes out or at least after it has stopped beating
  • I wish I could move freely during labor and be able to choose the most comfortable position to push.
  • We would like our daughter / daughter to stay with us, specifically on her mother's chest and attached to the breast especially for the first 2 hours after delivery.
  • I would like my son, who will be born with a caesarean section, to remain on my chest, after the various checks, until the end of the surgery.
  • I would like to latch the baby to my breast within the first 2 hours after delivery. …. (You can add whatever you want)….
  • Confident of the acceptance of these requests, we thank all the staff who will follow us in this very important event for us. Signature of both parents
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