Writing a birth or postnatal plan

What is a birth plan?

A birth plan is a way of considering what is important to the woman or birthing person when approaching birth. It is written by the woman or birthing person, and discussed with the midwife (NHS, 2024).

A good plan is not rigid, as circumstances may change during pregnancy, labour and birth. It is particularly useful to have considered what is important to the mother or birthing person if unexpected situations arise.  

So, for example, ‘what if’ labour is induced, birth is assisted with forceps or ventouse, or there is an unplanned caesarean birth. And ‘what if’ the baby needs to go to special care.

It should also consider whether all plans need to change if circumstances change, or if some parts of the plan can be kept.

An effective plan can cover everything from the end of pregnancy through to care of the baby in the hours after birth. It doesn’t need to be very long, and might be just a few important bullet points.

It can be written at any point during pregnancy, although it can be a good idea to have it written before 37 weeks (earlier in the case of twins and multiples). 

Why write a birth plan?

Birth plans are optional (NHS, 2024). When given time to discuss options with a health care professional, birth plans can improve (Bell et al, 2023):

• Expectations
• Communication
• Satisfaction
• A sense of control 

Dissatisfaction or birth trauma can come from not feeling involved in decision making. Women and birthing people sometimes describe feeling unheard or not in control of what is happening.  

Making decisions about your own care is a fundamental human right, and crucial for the quality of the overall childbearing experience (Bell et al, 2023).  

A birth plan can be a way of accessing respectful care by addressing unequal power between parents and healthcare providers. It can help overcome historical trauma and marginalisation (Glover et al, 2024). 

How do you write a birth plan?

The NHS provides a birth plan template, which some parents might find useful to use as a starting point. However, templates have been criticised as limiting thinking around personal choices, and leading people to a ‘correct’ decision (Bell et al, 2023).  

Taking time to think about a birth plan with a partner or friend, and discussing it with the midwife, can overcome these limitations. The National Institute of Health and Care Excellence (NICE) encourages asking questions and thinking about options (NICE, 2023).

Some people also work with a senior member of staff to create a care plan for their specific clinical or personal situation.  

The midwife or midwives reading the birth plan during labour is unlikely to be familiar to the mother or birthing person. Therefore, everything important should be included, even if it has already been discussed with a healthcare provider.

Ideally, the finished birth plan will be clear and simple. Bullet points make it easier for health care providers to quickly understand the woman or birthing person's priorities. 

What does a birth plan include?

The plan can include what feels right for the individual. These are common suggestions:

• Personal circumstances  

1. The mother or birthing person’s decisions about care – reasons don’t need to be given, but these may help the healthcare provider
2. Any relevant medical history not covered in the maternity notes but important for birth choices
3. Cultural or religious considerations

• Place of birth  
• The role of the birth partner  
• Planned coping strategies, such as:

1. Being active and mobile, using different positions and movement, or other complementary tools such as massage, water, or hypnosis
2. Use of pharmacological pain management (drugs for pain management)

• Preferences in the event of unplanned situations such as:

1. Labour starting before planned caesarean birth
2. Induction
3. Forceps or ventouse
4. Unplanned caesarean birth

• Intention for feeding the baby
• Care of the baby or babies (e.g. Vitamin K, neonatal care)
• Plans for travelling home if not already there 

What does a postnatal plan include?

Women or birthing people can make a postnatal plan for after the baby arrives. This helps prepare for a period which could feel quite overwhelming. They might want to think about what is important to them, and how they plan to:

• Make time for daily hygiene routines – body, teeth, hair
• Have nutritious food prepared to eat
• Be active – starting with very short daily walks
• Feel supported and connected – to family, friends and community
• Feel like themselves – doing something they enjoy 

They could also make a note of who will be their support network:

• Healthcare, social care, therapist
• Family and friends – tell them in advance what would be helpful
• Local parent and baby groups – start researching before the birth 

It’s common for new parents to find the early days challenging. A postnatal plan might include reminders to allow time and space to adjust to this life change.

Our mental health articles include information about signs of mental ill health, and where to get support. 

Are there any downsides to writing a birth plan?

When first used in the 1980s some health professionals were resistant to the use of birth plans, feeling it undermined their role (Ghahremani et al, 2023). They also felt that plans could be too rigid or idealistic, and set women and birthing people up for disappointment (Bell et al, 2023).

Some suggested that plans should be renamed as ‘preferences’, 'wishes' or 'desires'. This has been challenged as not recognising the research done and decisions made (Bell et al, 2023).

More recently healthcare systems have recognised that plans can be a useful tool to develop conversations around choices (Ghahremani et al, 2023).  

However, research shows that believed differences in power and time constraints can lead women and birthing people to accept suggestions without fully understanding what is being decided (Bell et al, 2023).

When given adequate time , birth plans can enable realistic discussions around (Ghahremani et al, 2023):

• Which services are available locally
• The evidence for different options
• Tailoring safety for the individual