01 The Basics

This heads the printed page so your provider knows whose plan they're reading.

Your name

Due date

Care provider / OB / midwife

Birth location

Primary support person

Doula (if any)

02 Setting & Atmosphere

The environment you'd like around you during labor.

Dim lighting in the room Play my own music/playlist Keep the room quiet, minimal talking Limit number of staff/students in roomAsk before entering Photos/video are welcome No photos or video, please Wear my own clothing, not a gown Explain any procedure before doing it

03 During Labor

Movement, monitoring, and comfort preferences while labor progresses.

Freedom to walk and move around Choose my own labor positions Eat and drink as I like during labor Intermittent fetal monitoringRather than continuous, if medically appropriate No routine IV unless medically neededHeparin/saline lock is fine Access to shower or tub for comfort Birth ball / peanut ball available Minimize cervical checksOnly when there's a clear reason

04 Pain Management

Select the approach(es) you're open to. It's fine to check more than one and decide in the moment.

Prefer to labor unmedicated if possible Plan to get an epidural Open to an epidural, will ask when ready Nitrous oxide (laughing gas) if available IV/systemic pain medication if needed Water immersion for comfort Counterpressure / massage from support person Please don't offer pain medicationI'll ask if I want it

05 Pushing & Delivery

Preferences for the pushing stage and the moments right before birth.

Choose my own pushing position Mirror so I can see the birth Guide my own pushing, minimal coaching Perineal massage/warm compress to reduce tearing Avoid episiotomy unless medically necessary Avoid vacuum/forceps unless medically necessary I'd like to touch/reach down as the head crowns I'd like to catch my own baby, if possible

06 Immediately After Birth

The first minutes matter — here's what you'd like to happen.

Immediate skin-to-skin contact Delayed cord clampingAt least 60 seconds, if possible Support person cuts the cord Delay weighing/measuring until after first bonding Allow placenta to deliver naturallyRather than routine active management I'd like to see/keep the placenta Quiet, undisturbed first hour together

07 Newborn Care

Routine care and feeding preferences for your baby.

08 If a Cesarean Becomes Necessary

You can include backup preferences in case plans change — most people find this reassuring rather than pessimistic.

Yes, include my cesarean preferences on the printed plan

Support person present in the OR Clear drape so I can watch the birth Arms free / not strapped down, if possible Lower the drape at the moment of birth Skin-to-skin in the OR if I'm able If I can't, support person does skin-to-skin Delayed cord clamping in the OR, if possible Play music in the OR Narrate what's happening as you go

09 Anything Else

Cultural, religious, or personal notes your team should know — allergies, past birth experiences, specific fears, anything that didn't fit above.

Additional notes