What items should be included in a birthing plan checklist for a healthy adult with an uncomplicated pregnancy who prefers a natural vaginal birth, wants labor at home or a birthing center with mobility, intermittent fetal monitoring, non‑pharmacologic pain relief, epidural available on request, delayed cord clamping, immediate skin‑to‑skin contact, early breastfeeding, partner present, quiet environment, avoidance of routine episiotomy, and a cesarean contingency with support person present and skin‑to‑skin?

Birthing Plan Checklist

A comprehensive birthing plan should be developed early in prenatal care as a flexible communication tool between you and your birth team, organized into six core categories: birth environment, support persons, labor course, delivery preferences, newborn care, and special considerations 1.

Key Principles Before Creating Your Checklist

The birth plan should be viewed as a guide rather than a rigid contract 1. Discuss preferences early enough in pregnancy to clarify what is safely achievable at your chosen facility and ensure realistic expectations 1. Birth plans improve satisfaction when expectations are met and when you remain actively involved in decision-making, even if circumstances require deviation from the original plan 1.

Important caveat: Having an excessively detailed plan with numerous requests may paradoxically reduce satisfaction by 80% 1. Keep your plan focused on priorities rather than exhaustive.

Comprehensive Checklist by Category

1. Birth Environment

• Location preference: Home, birthing center, or hospital
• Lighting preferences (dimmed, natural light)
• Temperature control
• Music or ambient sounds
• Aromatherapy use
• Privacy level desired
• Room setup (birthing ball, tub access, bed configuration)
• Quiet/calm atmosphere
• Photography/video recording permissions

2. Support Persons

• Primary support person (partner, doula, family member)
• Additional support people present
• Support person presence during procedures
• Support person involvement in decision-making
• Cesarean contingency: Support person present in operating room if needed 1

3. Labor Course Preferences

Mobility and positioning:

• Freedom to move and change positions
• Walking during labor
• Use of birthing ball, stool, or other equipment
• Access to shower/tub for hydrotherapy

Monitoring:

• Intermittent fetal monitoring (preferred for low-risk labor) 2
• Continuous monitoring only if medically indicated
• Wireless monitoring options if available

Nutrition and hydration:

• Oral fluid intake during labor 3
• Light food intake if desired
• IV fluids only if medically necessary

Pain management:

• Non-pharmacologic methods first: breathing techniques, position changes, hydrotherapy, massage, counter-pressure 3
• Epidural available on request but not routine 1
• Other pharmacologic options (nitrous oxide, opioids) if needed
• Clear communication before any pain medication administration

Labor interventions:

• Preference to avoid routine interventions unless medically indicated
• Artificial rupture of membranes only if necessary
• Augmentation with oxytocin only if medically indicated
• Informed discussion before any intervention 4

4. Delivery Preferences

Pushing and birth:

• Spontaneous pushing (push when you feel urge, not directed)
• Position for delivery (upright, side-lying, squatting, hands-and-knees)
• Avoid routine episiotomy 2
• Perineal support techniques
• Mirror to watch birth if desired
• Touch baby's head as crowning

Immediate post-delivery:

• Delayed cord clamping (at least 1-3 minutes) 3
• Partner cuts cord if desired
• Immediate skin-to-skin contact (place baby directly on chest) 3
• Delay non-urgent procedures until after initial bonding
• Natural delivery of placenta (avoid routine traction unless bleeding)

5. Newborn Care

Immediate care:

• Keep baby with mother continuously
• Early breastfeeding initiation (within first hour) 3
• Delay weighing/measuring until after initial bonding
• Vitamin K administration (discuss timing)
• Eye prophylaxis (discuss timing)
• Newborn screening procedures

Feeding:

• Exclusive breastfeeding intention
• No formula unless medically necessary and discussed
• No pacifiers or artificial nipples
• Lactation support availability

Procedures:

• Bathing preferences (delay first bath 24+ hours)
• Circumcision decision (if applicable)
• Hepatitis B vaccine timing

6. Special Considerations/Cesarean Contingency

If cesarean becomes necessary:

• Support person present in operating room 1
• Clear drape option to watch birth
• Skin-to-skin contact in OR if possible 1
• Breastfeeding in recovery room
• Rooming-in as soon as medically safe
• Explanation of why cesarean is needed before proceeding

Emergency situations:

• Keep me informed of baby's condition
• Partner stays with baby if separation needed
• Respect for cultural/religious practices

Implementation Best Practices

Discuss your plan with your provider early (ideally second trimester) to ensure your preferences align with facility capabilities and safety standards 1. Include your partner in creating the plan so expectations are shared 1.

Keep the document concise (1-2 pages maximum) focusing on your highest priorities. Provide copies to your provider, hospital/birth center, and support persons well before your due date.

Frame preferences positively rather than as demands. Use language like "I would prefer..." or "I hope to..." rather than "I will not..." This maintains collaborative relationships with your care team 5.

Acknowledge flexibility: Include a statement that you understand circumstances may require changes and you want to remain involved in decision-making throughout 1.

The evidence shows birth plans increase satisfaction when combined with shared decision-making and when preferences are actually achievable 1, 3. They facilitate better communication, promote your active participation, strengthen autonomy, and are associated with reduced cesarean rates, increased vaginal deliveries, higher Apgar scores, and greater breastfeeding initiation 3.