Birth Plan Template

Birth Plan

Use this easy ﬁll-in-blank birth plan to communicate your wants and

needs to your medical team.

Personal Details

Name:

Partner:

Due Date:

Hospital:

My obstetrician and/or midwife:

I’d like the following people to be present during labour and/or birth:

Partner:

Friends:

Relatives:

Doula:

Children:

I’d also like:

To bring my own music.

To dim the lights.

To wear my own clothes during labour and delivery.

To have pictures and/or video taken during labour and delivery.

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Parent category: Medical