What Should Actually Go on a Birth Preferences Sheet?
If you've started preparing for birth, you've probably come across a birth plan template, or even a few.
Maybe it had checkboxes, maybe even full paragraphs. Before long, your "birth plan" can become three pages of decisions about a birth that hasn't even happened yet.
But here's the thing:
A birth preferences sheet isn't supposed to predict exactly how your birth will unfold.
Its purpose is to help your care team quickly understand what matters most to you, especially when you're focused on labor and don't necessarily want to stop and explain your values and preferences every time someone new enters the room.
So what should actually go on it?
First, Think "Preferences," Not "Plan"
Birth is unpredictable, we know this.
You can prepare incredibly well and still encounter conversations you didn't expect. That doesn't make preparing your birth preferences pointless, it makes understanding your options even more valuable.
I prefer the term birth preferences because it leaves room for birth to unfold naturally while still acknowledging that you have values to be respected, and a voice in every aspect of your journey.
Your preferences might change, new information might come up, something you originally hoped to avoid may become something you decide in the moment that is right for you.
The goal isn't to follow a document like it’s black and white. The goal is to walk into birth knowing what's important to you and feeling prepared to participate in the decisions that arise.
Second, Keep It Short & Legible
Let’s be honest for a minute.. Your labor and delivery team can get busy, and you may be the second or third (or even more!) patient they are caring for that day. They don’t need your entire birth philosophy. They need the highlights.
Ideally, your birth preferences should fit on one page, should be easy to read (printed is great!), and organized in a way that it can be scanned quickly for information. Think short, clear statements, sections that align with the flow of labor, and the things that would genuinely affect how your team cares for you as labor unfolds.
Third, Include What’s Important to You
I’ve spent a lot of time thoughtfully creating a Birth Preferences template that reflects the values and goals many of my clients bring into birth, while also taking into consideration the common practices and standards of care within SWFL hospitals.
Here is how I break it down:
Labor Environment & Comfort Tools
You don't need to describe your dream birth environment in detail, but if certain factors are important to you, include them.
For example, you may choose to include:
Dim lighting
Quiet environment (ie. muted monitors)
Minimal interruptions
Access to a shower or tub for hydrotherapy
Limited visitors (including staff)
Clothes you will be wearing during labor
Wireless monitoring (if available) to allow free mobility in the event you need continuous monitoring
These may seem like small details, but your environment can influence how safe, private, and comfortable you feel during labor.
There are also certain comfort tools you can include if you have ideas of what you would like to have in the room.
Birth ball & peanut ball
Squat bar
Birth stool
Ice packs or warm packs
Aromatherapy
Music
You don't need to “lock in” your exact comfort tools beforehand. In fact, you probably shouldn't. You won’t know exactly what will work in the moment until you get there, but it’s helpful to have options available in your birth space to find what works best for you.
As your doula, I always have various tools in my bag that are always available to you. And of course, I always bring my strength for as much counterpressure as you’d like!
Pain Management
Your preferences sheet can communicate your initial approach to pain management without locking you into a decision.
For example: "I would like an epidural and will let you know when I am ready."
One particularly helpful preference can be whether you want pain medication offeredto you.
Some people want their nurse to regularly remind them of available options. Others would rather not be asked repeatedly and prefer to initiate that conversation themselves. If you do not want to be offered pain medication, clearly state it! “Please do not offer me pain medication.”
Neither approach is better. What matters is what feels right to you.
Cervical Exams and Interventions
Labor can sometimes involve frequent exams, monitoring, IVs, medications, and interventions.
If you'd like your team to communicate before these happen, your preferences might include:
Limited cervical exams vs. routine cervical exams
IV/Saline lock at admission vs. only if medically necessary
Routine IV fluids vs. no continuous hookups to IV
Fetal monitoring: continuous vs. intermittent
Augmentation methods: “I am open to discussing ___” vs. “I do not want ___”
These preferences aren't about refusing medical care. They're about communication and participation. If you are safe, baby is safe, and labor is progressing beautifully, ask questions to discover the reasoning behind the recommendation.
Pushing and Birth
Instead of trying to predict exactly how you'll push, consider communicating the things that matter most to you.
You may opt to include:
Freedom to choose pushing positions
If you would like to be coached on when and how to push
Warm compresses to the perineum
Perineal massage
Avoiding routine episiotomy
Using a mirror or touching baby's head as they emerge
As a birth doula, I talk about this phase of labor thoroughly with families, so they know what to expect during the pushing phase, specifically relating to their chosen birth location. From there we discuss their vision and hopes for this phase, so they can include what’s important to them in their birth preferences.
Immediately After Birth
The minutes after birth are so important to discuss ahead of time with your care team because there's often a lot happening very quickly.
Your preferences might address:
Immediate skin-to-skin
Keeping baby on your chest during routine newborn assessments (ie. APGAR)
Whether or not you would like baby to receive routine bulb suctioning
Whether you'd like baby’s vernix wiped off or not
Delayed/optimal cord clamping (you can be specific by stating “please ask for consent before clamping”)
Delaying routine measurements until after initial bonding time
You can also include preferences for what happens if you and baby need to be separated. For example, you may want your partner or another support person to remain with the baby at all times.
Delivery of the placenta is also something to consider adding to your birth preferences and discussed with your provider before hand. You may choose to include things like:
If you would like to receive routine Pitocin after baby’s birth
If you would like a gentle delivery, you can include “gentle delivery, no excessive cord traction”
If you would like to see your placenta or take it home, it’s good to add that as well
Newborn Procedures
Depending on your birth location, routine newborn care recommendations may include medications, vitamins, bathing, and other procedures.
You may want to address things such as:
Vitamin K
Erythromycin eye ointment
Hepatitis B vaccine
Circumcision
Timing of baby's first bath
Feeding preferences
These decisions are best researched and discussed with your pediatric or maternity care team before birth so you're not trying to process new information while exhausted and holding a brand-new baby.
What About Cesarean Preferences?
Even if you're planning a vaginal birth, having a short section for Cesarean preferences can be worthwhile.
Not because you're expecting one, but because if your birth takes an unexpected path, you've already considered what might help that experience feel more aligned with your values.
Depending on your hospital and circumstances, you might ask about:
Your support person being present
Your doula being present
Music, dim lighting, or limited conversation in the operating room
A clear drape or lowering the drape at birth
Immediate skin-to-skin
If you’d like delayed/optimal cord clamping (I usually recommend including “as long as medically possible” in this section)
Your partner staying with baby if separation is necessary
Knowing your options for an unexpected path doesn't make that outcome more likely. It simply means you are informed if your vision for birth changes and you don't have to start learning about those options for the first time while it's happening.
What Doesn't Need to Go on Your Birth Preferences Sheet?
You don't need to include every decision you could possibly encounter, that’s where you end up having pages and pages of preferences. You also don't need to write an essay explaining why each preference matters to you.
Your birth preferences also shouldn't have to serve as your only form of communication. Some of the most preparation happens before you ever arrive at your birth location.
Talk with your provider, ask what is routinely offered, find out which options are available, discuss your priorities in-depth with your partner and doula, and advocate for yourself and your values for birth during those prenatal appointments with your provider.
After those conversations, your preferences play the role as the quick-reference version of those conversations.
Your Birth Preferences Should Sound Like You
There isn't one perfect birth preferences template, which is why I often modify my own template to reflect the wishes of each specific family.
Someone planning an unmedicated birth may prioritize hydrotherapy, movement, intermittent monitoring, and physiological pushing.
Someone planning an epidural may prioritize more support with position changes, comfort tools, rest, and coaching.
Someone planning an induction may prioritize their preferences for each stage of the induction process (but that’s a whole other blog post entirely!)
Your priorities are allowed to be different from someone else's. There is no “right” way to birth your baby.
The Most Important Part Isn't the Piece of Paper
A beautifully designed birth preferences sheet isn't what makes you prepared for birth.
The conversations you have while creating it are. As a doula, I walk families through the “buffet” of options and scenarios, that way they have a clear understanding of the process, even if birth doesn’t unfold as planned. From there, they can better understand the process as a whole and are not caught off guard if the provider suddenly recommends a new intervention.
Birth preparation isn't about scripting exactly how your birth will happen. It's about knowing what matters to you, understanding your options, and having the tools to navigate the unpredictability of birth.
