A Sample Hospital Birth Plan

A Sample Hospital Birth Plan - TheHumbledHomemaker.com

Today, I am delighted to welcome my good blogging buddy, Stacy from Stacy Makes Cents, as a guest poster for our “A Natural Phenomenon Natural Pregnancy & Birthing” series! Today, she’s giving us a sample birth plan for a hospital birth. Please pay her site a visit. You will be blessed!

Guest Post by Stacy of Stacy Makes Cents

The birth of my first child did not go as expected. I wasn’t really prepared. I didn’t know what was going on…I didn’t know what to expect.

I had spent all my time reading silly baby books about what my child should do after birth. Boy, was that a HUGE mistake!

I should have prepared myself for the journey of labor instead of dilly-dallying around with stupid baby schedules that never worked and drove me looney tunes.  Just rely on that natural mama instinct, y’all.

Image by Eddie Awad

BUT, this time I have decided I’m going to be ready. I am fully aware our plans don’t always go as expected…but it’s better to have a plan and be informed than to lie around like a silly invalid. I didn’t have a plan with Annie, but I will for Baby 2.

I’m reading and talking with my doula…I’m trying to learn the classic signs of real labor and pain relief options BEFORE I GO INTO LABOR. So, my husband and I have written out our desired birth plan for this child. I thought it would be helpful for others to be able to see it. Feel free to use it for yourself if you so desire.

Image by Kylan Robinson

“By failing to prepare, you are preparing to fail.” ~Ben Franklin

To: Caregivers at [Insert OB office here (primary doctor – Your Doctor)]
Obstetrical nursing staff of Your Chosen Hospital
From:  Mother and Father

We have chosen to give birth at the maternity ward of Chosen Hospital because of their outstanding facility and great staff.  We are requesting your help to attain our goals and have a happy, healthy birth. In the event of complications, we will give our full cooperation after an informed discussion with the doctor and private consideration between mother, father, and doula.

First Stage of Labor:

  • Those to be present at all times at the labor and birth: (father) and  (doula)
  • I would like to labor at home as long as possible and request the option to return home if I arrive at less than 5 cm dilated.
  • I would like to have my birthing ball and back massager and request to have showers for pain relief when desired.
  • If IV is deemed necessary, please use a heparin lock so that I can move around and walk as needed.
  • Please no internal fetal monitoring unless emergency arises.
  • Vaginal exams only upon consent and as few as possible to avoid rupture of membranes
  • Please no pitocin or breaking of water unless deemed medically necessary
  • No analgesia or anesthesia unless requested
  • Freedom to move and walk during labor
  • I would prefer no hospital gown – I will bring one from home.
  • Quiet room, no excess staff please

Second Stage Labor :

  • Choice of position for pushing; please no stirrups
  • Mother chooses when to push
  • No episiotomy, please
  • If delivery assistance is needed, please use suction instead of foreceps.
  • Please place baby on mother’s abdomen after birth, unless medical intervention is necessary.
  • Cord to be cut by father, after pulsing stops
  • Breastfeed immediately to help birth placenta – no pitocin, uterine massage, or pulling of cord please
  • Keep lights low
  • If stitching is necessary, please use local anesthetic.

Third Stage Labor:

  • Newborn to stay with parents at all times; no nursery visits please
  • Please delay all routine exams for ________ to allow for bonding time.
  • Please perform all physical exams and procedures in room with parents.
  • If warming is needed, baby is to be placed on mother’s chest with blankets.
  • Breastfeeding only: no bottles, pacifiers, artificial nipples, formula, or water
  • Father to stay with baby and mother at all times

We thank you in advance for your support and kind attention to our choices. We look forward to a wonderful birth.

NOTE: In the event of a c-section, I would like (father) and (doula) to be present. Please let the baby remain with mother until stitched up and ready to be moved to recovery.


Have you ever used a birth plan? What would you include on a birth plan for a hospital birth?

About Stacy Myers

Stacy is a stay-at-home mom to her first child, Annie (3). After an “awakening” in March 2011, her family switched to a more natural, whole foods diet. She like

s to blog about how to live on less than you make and how to eat good food while doing it. Her passion is teaching others how to save money and she tag teams with her husband in this endeavor. At Stacy Makes Cents you’ll find information on how to save money in the kitchen, how to have fun with your kids, and how to be thrifty in all areas of life. Her passion is teaching others how to live debt free. Make sure to follow her on Facebook and Twitter to keep up with her daily antics.

Check out the other posts in this series:



Simple Meal Planning - Plan to Eat


  1. says

    I didn’t have a birth plan with either one of mine, but thankfully, the midwives’ procedure was very much like what you have outlined here. Some of it, we actually opted out of – my husband was not in the least interested in cutting the cord, lol, and we did opt to use the nursery, at least overnight.
    Anne @ Quick and Easy Cheap and Healthy recently posted..What Spelt Is, Why You Should Use It, How to Use It, and Where to Buy ItMy Profile

  2. says

    Hi Stacy,

    I just gave birth to my little girl in June and I’m glad I had a birth plan. It was intended to be a water birth, but my water broke before contractions started so at 24 hours after that I had to be moved to a hospital. I wound up with a 32 hour labor and an epidural but I still happy with how the birth went because I knew my options and I really trusted my midwife.

    We’re having our inaugural Eat Make Grow Blog Hop. We are looking for folks to link up who want to share what they have been eating with their families, growing in their gardens or making with all their creative impulses. If you’re interested, I hope you’ll hop on over and link up a couple of your posts. It’s a way for you to grow your readership and find other like minded mamas.

    Hope to see you there,


  3. Nancy says

    Stacy, your birth plan is nearly identical to mine. I had a great nurse-midwife with hospital privileges and she understood my desires and concerns about the delivery. I think it’s important to mentioned because of Erin’s post above, that both the midwife and I signed the birth plan. How can you expect them to feel compelled to honor the plan if they don’t sign it?

  4. Natalia says

    Great plan! You own that room woman. Do what you want in it :) I transition at 3-5cm, meaning I went from 5cm to holding a baby in half an hour. I think the thing that made my second birthing experience go “as planned” was praying, praying, praying. Wow, did God come through aligning people and time just perfectly (and just in the knick – phew! I was demanding an epidural after they told me 5cm!)

  5. Brandi says

    I had a birth plan and was determined to labor naturally. That all went out the window when my son had to come by emergency c-section at 30 wks. Looking back, I wish I had a planned for what I would do in case something like that happened. It was a whirlwind of a day and I felt like everything was a bit out of my control. It all worked out in the end, but there are some regrets.

    • says

      I’ve tried to keep in mind the entire time that a c-section is always a possibility….but as a Mama, that’s a hard thing to consider. I just want to shove it to the back of my mind and forget it’s not there. :-)
      I”m SO GLAD to hear everything worked out in the end….the goal is always to bring the baby out safely.
      Thanks for sharing your story, Brandi. :-)
      Stacy @Stacy Makes Cents recently posted..Our Hospital Birth PlanMy Profile

    • lyss says

      I can relate. I had an emergency c-section at 32 weeks. Not exactly what I planned!Emergencies are never planned though, right?! I do wish I had been more mentally prepared for something going wrong. I’d already had one natural birth, and after all, my mom had 5 natural births, so why couldn’t I? But after my 2nd, I’ve come to the realization that you just never know! I’m still all about doing things naturally if you can, but I’d encourage moms to prepare for the worst, too. Just my 2 cents. : )

      I never thought of doing a birth plan since we were using a birth center where the midwives had the same view of birth as I did. But when you go into labor that early, to the hospital you go! Honestly, a birth plan in my case would have done no good, since things happened so fast, and the ceserean truly was necessary. But I can see how it can be helpful in the case of wanting a natural birth in a hospital. I’ve heard way too many friends talk of what were probably unecessary cesareans! So sad! I may have to plan on the hospital if we have another child, since I assume I’d be considered at risk for another preemie.

  6. Veronica says

    Love it, Stacy! The most important thing is to research & learn for yourself! Knowledge is power, and it’s critical for birth & labor!

  7. Elissa says

    We had a beautiful home birth with our second son. We planned the same for our third child but we ended up going to the hospital. Part of me was mad at myself for not “trying harder” at home but I have forgiven myself and am very grateful to God for another healthy baby boy.

  8. Kim says

    I spent hours and hours on a birth plan before my daughter was born. I wish I would have spent half as much time preparing for what would happen AFTER she was born.

  9. says

    I had no birth plan the first time around except to trust my doctor. While it wasn’t the birth I had envisioned I got my healthy baby. The problems started there. She was taken away from us because of “jaundice” and force fed formula, 4-8 ounces every 3 hours. I was told by my nurse (the head nurse later reprimanded her) that I was not allowed to breastfeed. The hospital caused so many problems for us that I got educated before I even got pregnant again.

    I applaud you for hiring a doula and having a birth plan. I pray that it goes the way you prefer. We were fortunate to have access to Bradley classes and a midwife. I was so prepared for labor that I handled the pain and didn’t end up calling the midwife in time because I didn’t want to bother her until morning. My son was born on the toilet, as my husband was running down the stairs. She arrived just after my placenta, checked us out, and tucked us into bed.

    By the way, I got much more sleep the second time around with my baby right there next to me, than I did the first time around with my daughter screaming by herself in the nursery. We nursed when he wanted, I wasn’t worried and missing him, he wasn’t so exhausted from screaming that he fell asleep in my arms right after he was given to me… I heartily support keeping your baby in the room with you.
    Heather Lei recently posted..Apparently You Still Have to DO ItMy Profile

  10. Rosy says

    I really enjoyed reading this post. I’ve always said the next time we have a baby I will definitely hire a doula because we had such a bad experience with our daughter. I especially like where you state “mother chooses when to push”. I told my husband that if he has to get in front of me and catch our baby that’s just what he’s going to have to do. LOL. I also spent all my time researching what happens once the baby arrives and very little on the actual birth. BIG MISTAKE! My daughter almost didn’t make it through the first night then was in NICU for 12 days. We are very grateful that God allowed her to live and she is now a happy 5 year old but I will probably be OVER prepared next time. You have a really good birth plan (I might have to steal it) I pray everything goes as planned. =)

  11. says

    Birth plans are a very good idea. Mine was followed except for the “baby on mother’s abdomen” and “cord cut after pulsing stops” parts–the hospital claimed they could not do these things due to the need for emergency procedures. Find out what your hospital does if the baby releases meconium before birth. Our hospital insisted on cutting the cord immediately and taking the baby away for 2 hours without letting me see or touch him for even a second!!! It was so horrible I’ll never get over it ever; I think the shock and anger were what triggered my excessive blood loss. The worst part is that it wasn’t at all necessary because the first half-hour of their “emergency treatment” consisted of suctioning baby’s nose and mouth with a simple rubber bulb, so that could have been done on my abdomen with the cord attached!!! The later treatment outside the room was just precautionary. He was FINE. Grrrr! So definitely talk with your hospital and doula about what will happen if meconium is released.

    Something we put in our birth plan that isn’t in yours was that if our baby was a boy (we hadn’t found out in advance) we did NOT want him circumcised. I had read that some hospitals sneak the consent for this into a big pile of forms so that you might approve it without really being aware.

    I hope you have a wonderful birth!
    ‘Becca recently posted..Welcome to Earth Suburb.My Profile

    • says

      Do you know what? I’ve had a similar dream. I woke up crying….I dreamed that when the Bean was born that people kept taking him/her away from me and I never got to breastfeed. It was a devastating dream.
      We’re going this month to tour the new hospital, so I’ll make sure to run my plan by them and see what they say….
      Stacy @Stacy Makes Cents recently posted..What Stacy Makes Cents is All AboutMy Profile

    • Barbara Tomson says

      I’ve never heard of anyone “sneaking” in a consent. Consents are explained prior to signing. You also might want to check out the hospitals’ standard of care & policy and procedure for anything you’re wondering about. The problem is too many people think they have medical degrees & want to ignore advise from the medical staff. Be happy everything turned out well for your baby but it could have not been so great if it was a bad meconium aspiration. Birth plans are fine & yes, the labor nurse does read them & discuss them with the midwife or doctor. Nurses try to work with the birth plan but sometimes there might be a problem with a certain request…. Discuss it with your nurse & she can usually explain why. Oh by the way, sometimes you may just have to come to the nursery with your baby because the lighting in patient’s room isn’t too great when you’re really trying to assess a baby’s color .

  12. Mary says

    Such a great list, thank you for sharing! I used this as the basis of my birthing plan. I so appreciate you making this available!

  13. Michelle Wickline says

    Do you have permission to use the top photo? This photo is of a friend of mine and this photo belongs to her, so I hope you have permission to use it. I have notified her that the picture is on your blog.

      • Michelle Wickline says

        I’m sorry, but I think asking me to calm down is a bit much. Also, putting smiley faces in when you aren’t really being kind is simply trying to insult. I was not upset and my post was not any type of warning or threat. I just wanted to be sure. I know nothing about FlickR Creative Commons and don’t really have the time to learn. I also have no way to tell the difference between and honest professional blogger and a dishonest amateur one. I actually assumed you had permission b/c you seemed like an honest, professional, respectable person. I’m sorry if my above post made it seem like I was angry. I was just letting you know that I was going to inform my friend that her photo was being used in case she did not know, but again, I was assuming/hoping for the best. Thank you for responding so I don’t have to be concerned about the matter anymore. I know of too many people who have pics of themselves and their children used without their permission and it is very frustrating, so I was just making sure. Sometimes it can be difficult to communicate and show expression when we talk without seeing one another so again, please be re-assured that I meant well :)

  14. Marie says

    Thank you for posting this birth plan! I am using it as a template for mine and is the best one I have come across online. Here’s to healthy mother, healthy baby!

  15. says

    This is pretty great. As a nurse may I suggest a change, although the hospital should know what you mean by a “heparin lock” it is now known as a “saline lock,” because it is no longer flushed with heparin but saline only. :) Trust me so laboring Mommy wants Heparin!

  16. Becky says

    Thank you so much for this! Even if I don’t want the same things, I at least now know what to research for each process. This was incredibly helpful. I’d always heard about a birth plan but never even knew where to start! Thanks a million times over!


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