No matter who you are or what your health history is, you deserve the opportunity to take some control over your birthing experience. That’s where birth plans — sometimes called birth preferences — come in.

Birth plans are something that all birthing people should have the ability to create, and all compassionate, patient-centered healthcare providers should support. Whether you’re using an existing template, creating one from scratch, or just jotting down priorities, we’re here to help you make empowered decisions, every step of the way.

What Is a Birth Plan?

Birth plans are documents that outline a pregnant woman’s preferences for birth. (1) Although birth experiences are largely outside of any individual’s control, creating a plan is an exercise in proactively preparing for scenarios and identifying the best options if they arise.

Birth plans can include preferences for:
• Birth location: This could be at home, a birth center, or the hospital.

• Support persons: Such as your partner, family, children, or doula.

• Birth attendants: This can include a physician, midwife, or nursing staff.

• Birth environment: How’s the lighting? Are you blasting Rihanna, or crying it out to Phoebe Bridgers? How about aromatherapy?

• Labor: This could include things like birthing positions, support items, religious or cultural preferences.

• Labor management: Such as preference between spontaneous and induced labor.

• Fetal well-being assessment: E.g., intermittent or continuous monitoring.

• Pain relief: Is your preference au natural and unmedicated? Medicated? Non-pharmacological pain relief? Your pain, your call.

• Delivery: This could include position, involvement and location of support people, natural tearing versus episiotomy, delayed cord clamping, use of vacuum or forceps, who is going to cut the umbilical cord, and more.

• Cesarean delivery: Which support people do you want present? What are the anesthesia options? How about draping, skin-to-skin contact and nursing in the operating room?

• Newborn care: Skin-to-skin contact or dry infant first? Do you want to start nursing at once? How about timing of routine procedures, and cord blood banking? How long do you want to plan to stay in the hospital?

With all of your preferences in mind, it’s important to remember that childbirth is a complex physiological experience — your provider will ultimately need to do what’s necessary to keep you and the baby safe.

But equally important is the reality that pregnant women have different needs — for example, sometimes a cesarean delivery is preferred or medically recommended. Regardless of what your medical needs or history are, there are areas in which you can take more control. Work with your healthcare provider to determine those areas and make a plan that supports your preferences and your health.

To put it simply, don’t let anyone tell you that having a birth plan isn’t an option for you.

Why Is a Birth Plan Important?

“I always discuss the importance of birth plans with my patients,” says Dr. Navya Mysore MDCM, CCFP. “It's important for the birth parent and the partner to have a plan in place to feel grounded as the experience of labor and delivery can often feel overwhelming, especially one's first birth experience.”

The numbers back her up. A 2010 randomized controlled trial found that those who made birth plans reported feeling: (2)
• Greater satisfaction with their birth experiences.
• More realistic expectations about their experiences.
• More agency over their experiences.

Additionally, a 2019 literature review found that birth plans can positively impact labor, delivery, maternal, and fetal outcomes — especially for people who are giving birth for the first time. (3) The review’s authors also noted that birth plans can improve the mother’s satisfaction with the experience. However, when expectations aren’t met, pregnant women may feel dissatisfied with their experiences. Finally, they highlighted that providers are an important part of making sure birth plans are supported to the full extent possible.

Another study from 2015 and two from 2017 add that birth plans can also help decrease the likelihood of medical interventions. (4,5,6)

Combing through the evidence

When considering birth planning, it’s easy to feel overwhelmed at the number of decisions. Parenthood will do that. First, it’s important to understand that there is no right or wrong choice here — what matters is making decisions that align with your values and preferences.

If you’re looking for an expert/advocate/spirit-guide through the birth planning process, consider a doula, the non-clinical care providers who are experts in birth-planning. You can also always lean on your healthcare provider to help you make your decisions (and you should absolutely review your plan with your provider once it’s locked in.)

If you want to look into a few things yourself — Evidence-Based Birth is one of the best places to start. Evidence-Based Birth is a resource hub that breaks down the evidence behind different preferences, so birthing people can come to their own, informed decisions.

5 Tips On How to Create Your Birth Plan

We asked Dr. Mysore for her perspective on birth planning as a clinician who’s supported hundreds of birthing people. Here are her recommendations on making a birth plan:

Tip #1: Think about your priorities

“I typically suggest taking some time in your second or third trimester to understand what your priorities are during the birth process, and how they can be implemented,” says Dr. Mysore. “For example, one priority could be that you want to stay mobile for as long as possible during the birthing process. Try having more detail with the priority — for example, wanting to stay mobile during the birthing process until I get my epidural.”

Dr. Mysore recommends having five top priorities and backup plans if those priorities can’t be met. This way, you’ll have the ability to make at least some decisions, no matter what happens.

Tip #2: Avoid all-or-nothing statements

“While making these priorities, make sure you are not creating all-or-nothing statements such as 'I will not have an epidural during labor,’” recommends Dr. Mysore. “You do not know what your labor experience will be like — and your plans may change dramatically during the process itself. All-or-nothing statements can definitely leave you feeling disappointed even though at the end of the day, you cannot predict how your labor will unfold.”

Tip #3: Review the plan with your provider

“I always recommend reviewing your birth plan with your healthcare provider, your OB-GYN, or midwife,” says Dr. Mysore. “If your healthcare provider doesn't want to look at your birth plan or the clinic doesn't allow birth plans, I recommend finding a provider who will listen to your concerns and take the time to review your birth plan so you can feel heard going into labor and delivery.”

When you review your plan with your provider, they can flag any preferences that aren’t safely achievable based on your and the baby’s health. You can work together to identify areas where you do have the most control.

Tip #4: Use clear communications and advocate for what you need

“Make sure that there is clear communication. This can be hard when emergencies happen, but advocating for yourself is important, especially when you are in a vulnerable situation,” explains Dr. Mysore. “It's normal that you cannot always advocate for yourself — you are doing lots of hard work but that is where your partner or your doula, if you choose to have one, can help advocate for you.”

Tip #5: Make sure your provider is someone you trust

Trust is a critical part of positive patient-provider relationships of any kind, but especially during childbirth. You need to be able to trust that your provider has your and the baby’s best interests in mind. “If there is a true emergency,” Dr. Mysore says, “they need to be able to quickly react to ensure everyone is safe.”

Ritual’s Birth Plan Template

Childbirth is unpredictable but we believe that a well-thought-out plan can be a valuable tool. We recognize the complexities this miracle of an experience can bring, so we've crafted a sample birth plan template.

While a birth plan serves as a guiding tool to align your expectations, it's equally crucial to remain open to adjustments, changes, and the multitude of options that may arise. So, embrace the unexpected, trust your instincts, and remember, your birth plan is just the beginning of one incredible adventure. Welcome to parenthood! It's going to be wild.

References:

1. Ghahremani T, Bailey K, Whittington J, Phillips AM, Spracher BN, Thomas S, Magann EF. (2023.) Birth plans: definitions, content, effects, and best practices. American journal of obstetrics and gynecology, 228(5S), S977–S982.

2. Kuo SC, Lin KC, Hsu CH, Yang CC, Chang MY, Tsao CM, Lin LC. (2010.) Evaluation of the effects of a birth plan on Taiwanese women's childbirth experiences, control and expectations fulfilment: a randomised controlled trial. International journal of nursing studies, 47(7), 806–814.

3. Medeiros RMK, Figueiredo G, Correa ÁCP, Barbieri M. (2019.) Repercussions of using the birth plan in the parturition process. Repercussões da utilização do plano de parto no processo de parturição. Revista gaucha de enfermagem, 40, e20180233.

4. Afshar Y, Mei JY, Gregory KD, Kilpatrick SJ, Esakoff TF. (2018.) Birth plans—Impact on mode of delivery, obstetrical interventions, and birth experience satisfaction: A prospective cohort study. Birth, 45: 43-49. https://doi.org/10.1111/birt.12320

5. Suárez-Cortés M, Armero-Barranco D, Canteras-Jordana M, Martínez-Roche ME. (2015.) Use and influence of Delivery and Birth Plans in the humanizing delivery process. Revista latino-americana de enfermagem, 23(3), 520–526.

6. Afshar Y, Wang ET, Mei J, Esakoff TF, Pisarska MD, Gregory KD. (2017.) Childbirth Education Class and Birth Plans Are Associated with a Vaginal Delivery. Birth (Berkeley, Calif.), 44(1), 29–34.