Birth plan: what to include and why flexibility matters

A birth plan is a document you write in advance to communicate your preferences to the midwives and doctors caring for you during labour and birth. It is not a contract, and it is not a prediction of how things will go. It is a tool for starting conversations in advance rather than in the middle of contractions.

The NHS actively encourages writing a birth plan and discussing it with your midwife at an antenatal appointment before your due date.¹ The more your care team knows about your preferences ahead of time, the less you need to explain in the moment.

What a birth plan is — and isn't

It is a statement of your preferences and values. It is not a guarantee. Births regularly deviate from any plan. A long labour may need intervention you didn't want; a hoped-for epidural may not be available immediately; a planned unmedicated birth may become a situation where pain relief is the safest or most humane option.

Writing a plan does not mean demanding a particular outcome. It means entering the experience having thought through what matters to you, so that your care team can honour those preferences when circumstances allow — and know when to explain why they can't.

Keep the plan short: one page, clearly headed, easy to scan when a midwife picks it up between contractions. Long plans with detailed paragraphs are harder to act on quickly.

What to include

Pain relief preferences

Think through the options in advance, even if you are planning an unmedicated birth. Options include:

• Breathing techniques, movement, water (pool or shower)
• Entonox (gas and air)
• TENS machine (you usually hire or buy this in advance)
• Opioid injections (pethidine or diamorphine — these affect the baby too, worth understanding)
• Epidural

There is no right answer. "I would like to try without pain relief but am open to an epidural if I need one" is a completely valid preference. So is "I would like an epidural as soon as possible." State your preference; your team will work with it.

Mobility and environment

• Would you like to be as mobile as possible during labour?
• Do you have preferences about the room environment — lighting, music, who is present?
• Are you hoping to use a birth pool, if available?

Who will be with you

List your birth partner or partners by name. Most NHS units allow one birth partner; some allow two. Confirm the policy at your specific unit.

Immediate after-birth preferences

These are among the most important to include, because they happen in the first minutes after birth when you may not be in a state to advocate clearly:

Skin-to-skin contact. Immediate or early skin-to-skin after birth supports temperature regulation, breastfeeding initiation, and bonding. The NICE guidelines support offering this to all mothers after uncomplicated vaginal births and after caesarean section where the mother is well.² State if this is a priority.

Delayed cord clamping. Waiting at least one minute before clamping the cord allows continued blood transfer from placenta to baby and is associated with better iron stores in infancy. NICE recommends offering it as standard practice.² It is now routine in many UK units, but worth stating explicitly.

Vitamin K. The NHS recommends vitamin K for all newborns to prevent vitamin K deficiency bleeding (VKDB), a rare but serious condition.¹ It is offered as an intramuscular injection (single dose, most effective) or oral drops (requires multiple doses over weeks). Decide in advance and note your preference.

First feed. Note whether you plan to breastfeed, formula feed, or combination feed. If you want immediate breastfeeding support after birth, say so.

If you need a caesarean section

If you are having a planned (elective) caesarean, you can still include preferences for the experience: delayed cord clamping, skin-to-skin on the table if you're well enough, who cuts the cord. If you are writing a birth plan for a vaginal birth and a caesarean becomes necessary, having noted your preferences in advance means your team knows what matters to you.

Why flexibility is the point

Around one in three births in the UK involves some form of obstetric intervention.¹ Epidurals, assisted delivery (forceps or ventouse), and emergency caesarean sections are common. This does not represent failure — it represents obstetrics working as it should.

The parents who find birth hardest to process are often those who held the plan tightly rather than the preferences. The plan is for the circumstances where everything goes smoothly. For the circumstances where it doesn't, you want to have already thought: "if this changes, what matters most to me about how the team communicates?"

Talk through your plan at an antenatal appointment. Your midwife will flag anything unrealistic given your specific situation (health conditions, presentation, hospital policy) and will note your preferences in your records.

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Also in this cluster: Signs of labour: when to go in · Hospital bag checklist

Sources

1. NHS. "Writing a Birth Plan." NHS, 2024. https://www.nhs.uk/pregnancy/labour-and-birth/what-happens-when-you-go-into-labour/your-birth-plan/
2. National Institute for Health and Care Excellence. "Intrapartum Care for Healthy Women and Babies." NICE guideline NG235, 2023. https://www.nice.org.uk/guidance/ng235