Hospital Birth Plan

Hospital/Birth Center Birthing Plans, Preferences and Options

The most important aspect of planning a hospital birth is choosing a care provider (doctor or midwife) who shares your beliefs about birth. If you believe birth is a normal, natural, safe process you need to choose a provider who believes the same (and acts that way). Actions really do speak louder than words. Find out your provider’s induction, episiotomy, epidural, c-section, and circumcision rates. That will tell you what your provider really believes (since some providers may say one thing to you but really believe another). Also find out the statistics for your hospital. If your provider is not supportive of your birth preferences, switch to a provider who is! It’s never too late to switch unless the baby has been born. I know that the idea of switching providers may seem scary or might even feel disloyal to the provider that you’ve been seeing. Don’t let this prevent you from making the choices you need to make in order to have the safest, best birth for yourself and your baby. Your baby gets one birth. Make it a good one.

Due to hospital policies it is sometimes difficult to have a truly natural, no intervention birth in a hospital setting. It is imperative that you have a supportive provider who will excuse you from potentially getting into confrontations with the nurses by signing off on a birth preference plan that includes things such as eating and drinking while in labor, not having an IV, intermittent monitoring, and laboring in the tub even if your membranes have released. That said, remember that you always have the right to refuse an intervention. It’s your body and your baby. It’s just easier to have a calm and peaceful hospital birth if your provider is supportive of your desires.

Hospital or Birth Center Birth Preferences Worksheet

(links will pop open in a new window)

Mother’s Name:

Birth Attendant’s Name:


  • I want to wear my own clothes.
  • I want to wear a hospital gown.
  • I want the environment to be kept as quiet as possible.
  • I want the lights in the room to be kept dim during labor.
  • I want to bring my own music to listen to during labor.
  • Environment is not important to me.


  • I want to be free to move as I please and to adopt any position that is comfortable to me.
  • Mobility is not important to me.  I want to labor in bed.


I would like:

  • intermittent monitoring
  • continuous monitoring

Using a(n):

  • fetoscope
  • hand-held Doppler
  • external fetal monitor
  • internal fetal monitor
  • telemetry unit


  • I would prefer no monitoring

Vaginal Exams 

  • I don’t want any vaginal exams.
  • I want to keep vaginal exams to a minimum (all exams must be approved by me).
  • I only want exams at my request.
  • The number and frequency of vaginal exams are not important to me.

IV’s and Hydration 

  • I want to avoid IV or Heparin/Saline lock all together (unless medically necessary).
  • I want a Heparin/Saline lock not an IV.
  • I want an IV put in immediately.
  • I want to freely eat and drink as I am comfortable.
  • I want only clear liquid and light snacks.
  • I want ice chips.

Labor Augmentation and Induction

  • I want to avoid induction unless it is medically necessary.
  • I want to use natural methods, regular position changes, and/or herbs to induce/augment labor. 
  • I want to have my membranes stripped 
  • I want to keep my bag of waters intact.
  • I want to have labor induced by breaking the amniotic sac . 
  • I want to use pharmaceutical methods 

Comfort Measures during Early and Active labor 

  • I want to use the following non-pharmaceutical ways to cope with labor:
  • I want to use an epidural.
  • I want to use a walking epidural 
  • I want to use narcotics during labor. 

Comfort Measures for the Second Stage Labor (Pushing)

  • I want to have the freedom to change positions and use natural comfort measure techniques.
  • I want to use a birthing/squat bar.
  • I want to use a birthing chair/stool.
  • I want to use a birth ball. 
  • I want to use stirrups.
  • I want a local anesthetic.
  • I want a epidural at this point (some doctors will not give epidurals past 8 – 9 cm).


  • I want to choose the position I deliver in (whatever feels right at the time).
  • I want to deliver in the lithotomy position (traditional on your back or slightly elevated).

Perineal Care 

  • I would prefer not to have an episiotomy unless absolutely required for the baby’s safety. Please use warm compress and perineal massage to avoid an episiotomy. 
  • I don’t want to be told when and how to push. I trust my body to tell me when and how not to push. 
  • I do want to be told when not to push to allow my perineum to stretch.
  • I want to be told when and how to push. 
  • I prefer to tear over having a episiotomy.
  • I want an episiotomy.

Third Stage (delivery of the placenta) 

  • I prefer to have no time constraints on the delivery of the placenta.
  • I prefer to push the placenta out.
  • I prefer to breastfeed my infant immediately to stimulate uterine contractions and would like to avoid a shot of pitocin unless it is absolutely necessary.
  • I prefer to leave the umbilical cord unclamped and uncut until the placenta is delivered.
  • I prefer a lotus birth (the placenta and cord remain attached to the baby until they dry up and fall off on their own). 
  • I prefer to have a managed 3rd stage with pitocin and cord traction.
  • I would like to cut the cord.
  • I would like my partner to cut the cord.

After Birth Procedures 

  • I prefer that my baby not receive the following procedures (circled):
  • I prefer that my baby have a dose of oral Vitamin K instead of a Vitamin K shot.
  • I would like to bathe my baby.
  • I would like my baby to be bathed in my presence.
  • I prefer that my baby be sponge-bathed.
  • I prefer that my baby not be bathed.
  • I would rather have the vernix (if any) rubbed into my baby’s skin than have it be wiped off.
  • If I have a son, I prefer that he not be circumcised. 
  • I prefer that my baby room-in with me. 
  • I prefer that my baby be with me when I am awake, but that he or she goes to the nursery when I’m asleep.
  • I prefer my baby to be brought to me when he or she is hungry.  I will feed my baby (even if it’s at night and I need to be woken up).
  • I prefer that my baby stay in the nursery unless I ask for him or her to be brought to me.
  • I would like to breastfeed my baby and would prefer that no artificial nipples (pacifiers, bottles, etc.) or supplements (sugar water, formula, etc.) be used on my baby without my express consent. 
  • I would like to formula-feed my baby.
  • I would like all bottles to be given by me or my partner.

Informed Consent Questions

Here is a list of questions to ask when interventions or unplanned procedures are proposed at any point during your pregnancy or the birth of your child:

  • Is this an emergency or do we have time to talk?
  • What are the benefits of doing this?
  • What are the risks of doing this?
  • If we do this, what other procedures or treatments might we need as a result?
  • What else can we try first or instead?
  • What would happen if we waited before doing this?
  • What would happen if we didn’t do this at all?

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Birth Preference Plan for Xxxxx Xxxxxx

Spouse: Xxxxx Xxxxxx

Doula: Xxx Xxxxxx

Doctor: Xxxxx Xxxxxxx

Thanks for being part of our baby’s birth. I’ve written down my birth preferences because it will be difficult for me to relay all of this information to you while I am preoccupied with my labor. This is my third baby. I am planning an unmedicated birth using the HypnoBirthing┬« childbirth method. If there is a nurse that is familiar with and/or especially excited to attend HypnoBirthing women, I would love to have her. I used HypnoBirthing with my second baby with excellent results and in the absence of special circumstances I imagine this baby’s birth will go just as well or better. These are my preferences assuming my baby and I are experiencing a normal labor and birth.

General Requests

Because I’m using hypnosis, it’s important for everyone to avoid use of the word “pain”. You may ask me my comfort level or what sensations I’m experiencing if you are curious. I understand you’re supposed to ask me what my pain level is. Whisper! And then mark me down at a one. I’ll let you know if I’m experiencing pain and if I want medication.

Because I am using hypnosis please postpone asking me questions or talking to me while I am having a surge (contraction). I will have my eyes closed during a surge, but between surges I will open my eyes and be available for conversation. It is likely that I will not hear you while having a surge anyway. Thank you for using a calm, quiet voice and entering the room as quietly as possible in order to maintain the air of relaxation.

Labor Requests

No IV for me, thanks. I’ll be drinking water and juice, etc. to prevent dehydration. I do love ice, so feel free to bring lots of that.

I prefer intermittent monitoring (10 minutes per hour) rather than continuous. It’s unlikely that I’ll labor in the bed, so you might need to bring in a Doppler. I’ll probably spend a good portion of my labor in the tub or on a birth ball.

Because vaginal exams are uncomfortable to me, I would prefer that they be limited to one at admittance and then only one every few hours, depending on the length of my labor. Please ask for my permission before examining me as I will want to wait for a time between surges. Helpful things to say would be release and relax and open for your baby.

Second Stage Requests

I will probably choose to birth in a hands and knees position. Please ask before adjusting the bed or attempting to change my position. If I’m comfortable, I won’t want to move and an attempt to move me or the bed would be quite distracting.

Please refrain from any coaching to hold my breath while I am birthing my baby. I have my own techniques that I will be using and any instruction to hold my breath and push will be distracting (and likely annoying as well). Please remind me to keep it slow by saying “listen to your body” and ‘breathe your baby down” and “open for your baby“.

Please remind me to slow things down as the baby is crowning by saying “listen to your perineum“. My perineum may be saying something different from my body. I’d prefer not to tear even if it means taking a bit longer to get the baby out, so if there’s a conflict between what my body (“get it out!”) and perineum are saying, I want my perineum to win.

Please wait to clamp the cord until it has stopped pulsating, or possibly until the placenta has been birthed.

After the Birth/Baby Requests

We’d like to delay cleaning, measuring, and weighing until after bonding for a while and after we’ve initiated breastfeeding. If I require a repair I may have my husband hold the baby.

We will be skipping the vitamin K injection and Hepatitis B vaccination. Please have any required waiver forms available . We’ll delay the eye drops until after bonding and breastfeeding (we can do it with the weighing, etc.).

I will be keeping the baby in my room with me. If the baby needs to go to the nursery (such as for the PKU and hearing test), I will go with him or her. If for some reason I am separated from my baby, please do not give him or her any artificial nipples (pacifier, bottle).

If we have a son, we will not be circumcising. Thank you for not attempting to retract or manipulate his foreskin.

Thank you for making this a positive experience!