Melissa was born in a birthing pool nine months ago, which was my fourth birth and the only one that went more or less the way I'd written it down. I mention that ratio because it's the most helpful thing I have to offer you about birth plans.
We make baby textiles here and not medical decisions, so please read this as a guide to writing a document. Everything on your plan belongs in a conversation with your midwife, obstetrician or doctor, who knows both your pregnancy and the policies of the place you're giving birth in.
What a birth plan is for
It's a communication tool. Its job is to tell a room full of people you've never met what counts to you, at a moment when you may not be in a position to explain it yourself. Judged that way, a good birth plan is short, readable at a glance, and written in full knowledge that circumstances may overrule any line on it.
The word plan does most of the damage. A plan implies control over a sequence of events, and birth doesn't offer that to anybody. Some hospitals have moved to calling them birth preferences for exactly this reason, and I think the framing counts a great deal: a parent who wrote a plan can feel she failed when things change, and a parent who wrote preferences generally doesn't.
How long it should be
One page. Your midwife may be meeting you for the first time during a shift change while managing several rooms, and a three-page document will be skimmed at best. Bullet points, ordered by what counts most to you, is the format that gets read, and anything you feel strongly about belongs in the first third of the page.
Put your name, your partner or support person's name and your due date at the top. Note anything clinically important, allergies, existing conditions, previous births, anything your team has flagged, before you get to preferences at all. Then lead with your two or three non-negotiables, because if everything is emphasized then nothing is.
Write the preferences as flexible statements: I'd prefer this, and if that isn't possible I'd like that. The second half of each sentence is the part that helps you on the day. Bring several copies: one for your notes, one for your support person, one for whoever happens to be in the room.
The rest of getting ready
What to cover
Broadly four areas: the environment, pain relief, the birth itself, and the first hour afterward. You don't need a position on every single item, and leaving something off is a completely legitimate answer that usually means you trust the team to decide.
For the environment, say who you want present, what you'd like done about lighting and music, whether you want to move freely, and what you'd like said or not said out loud. For pain relief, say what you'd like to try first, what you'd like offered, and what you'd prefer not to be offered unless you ask for it. Being specific there saves a conversation later, when talking is harder.
On labor and birth, give your preferences on monitoring and positions and on what you want explained before it happens. A great many people care far less about a given intervention than about being told what's happening and why, and that's something to write down.
Write something about assisted birth and cesarean even if both seem unlikely, because preferences about who stays with you, what you'd like to see and whether you want a running commentary all still apply. Then the first hour: skin-to-skin, delayed cord clamping, who cuts the cord, your feeding intention, and whether the newborn checks happen on you or away from you. Say what support you'd like with feeding if it doesn't start easily, because that's the request I most wish I'd written down the first time.
What to leave off
Anything that isn't a preference. Timelines are the commonest mistake, because a labor can't be scheduled and a plan that assumes a duration only sets you up to feel behind.
Avoid instructions that are really clinical decisions. A plan can't rule out an intervention that becomes medically necessary, and writing it as though it can makes the conversation harder if that moment arrives.
Leave off anything you haven't checked against the place you're giving birth in. Policies on water birth, on who may be present, on monitoring and on visitors vary enormously between hospitals, between countries, and between a hospital and a birth center. We had Melissa in Bangkok and I checked the water birth policy twice, which is the only reason that page of my plan survived.
Writing one that survives things changing
Write the second half of every sentence. "I'd like to avoid an epidural, and if I ask for one please don't talk me out of it." "I'd prefer to move freely, and if I need continuous monitoring please help me stay upright if that's safe."
A plan written with its own alternatives already inside it doesn't break when the situation changes. It bends, which is exactly what you want from it.
It also helps enormously to name the person who speaks for you. If you're occupied, exhausted or simply unable to advocate, your support person should know your preferences well enough to say them out loud without reading the document. Talk it through with them beforehand, because that conversation counts for a lot more than the piece of paper.
When to write it
Draft it around 32 to 34 weeks, discuss it at an appointment, and finalize it after that conversation. Earlier and you're guessing at things your care team hasn't raised yet. Much later and there may be no appointment left in which to talk it through. Put a copy in the hospital bag when you pack it, alongside the going-home outfit and the muslins and whatever you want the baby wrapped in. One last thing, which I'd like to say as warmly as I can, because a lot of birth-plan writing implies the opposite. A birth that departs entirely from the plan isn't a failed birth, and a plan that gets set aside wasn't wasted effort. It did its job by making your preferences known and by making you think all of it through before you were asked to decide under pressure. Three of my four went nowhere near the document, and all four of them are asleep upstairs.
The evidence
This guide is general information, written to help you understand a topic and ask better questions. It is not medical advice and does not replace your own doctor, midwife or paediatrician. Anything that worries you about your baby belongs with them.