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Creating a Home Birth Plan (With Template)

Mom and newborn after a home water birth

Writing up a birth plan helps to ensure that your wishes are addressed during labor and delivery. While you might not think it's as necessary when you're giving birth at home, having a written plan helps the people who will be assisting you to give you the birth experience you desire without worrying about getting last-minute items or processes into place.

Using a Printable Home Birth Plan Checklist

Using the printable home birth plan template to create your plan can help you by providing your instructions for each item listed. Use Adobe to download the plan template and fill in your information, then review it with your birthing team or work on it together with them. You should also review the plan with your midwife and obstetrician so he or she is aware of your intentions and can provide any helpful feedback on additional things to consider. It's also a good idea to give them a copy to keep in your medical record. To use the template:

  1. The template is divided into sections by category with a blank area at the end of each section to add in additional instructions not covered on the list.
  2. The supply checklist towards the end can be used to check off the items you want included at your birthing event. There are additional blank lines at the end to add in items not included on the list.
  3. Don't forget to include your emergency information in case you must be transferred to a hospital.
Home Birth Plan With Template

Creating Your Home Birth Plan

It's a good idea to start on your home birth plan at least a month out from the birth so you're not rushing to complete it. Set up a time to sit down with your midwife or doula and your significant other to go through the details and create a document that everyone clearly understands. A basic home birth plan should cover all the necessary information for you and your baby-to-come, as well as contingency information in case of an emergency:

Your Midwife and/or Obstetrician

Include your physician's name, address, phone number and emergency contact information, as well as the hospital where they have admitting privileges.

Current Medications

Add a list of any medications that you regularly take, including over-the-counter medications, just in case you have to go to the hospital.

Birthing Supplies

A list of supplies that you want on hand during the birth. This includes the supplies your midwife will need and birthing supplies such as birthing pools, birthing balls, rebozos, or a birthing chair.

Birthing Environment

A description of the environment during labor and delivery, such as how you want the room's lighting and temperature. Some women prefer having items to keep them relaxed such as soft music, essential oils and scented candles. This can also include things like whether you want extra pillows, the size and softness of the pillows, blankets, and heating pads or ice packs (or both!). You can also list out what food and beverages you want available.

People Present

A list of who you would like to have in the room, as well as any people you do not want there if that is an issue. You can also include secondary steps, such as whether you want some people to leave if you start to experience a difficult birth and prefer a less crowded room when you're uncomfortable.

Smiling Parents With Newborn

Photos and Video

Include detailed instructions on photographing and/or videotaping the birth. You may want one or both to happen, or want it made clear you do not want any type of photos or videos taken. If that's the case you might even want to add that you do not want smartphones brought into the room. If you do allow photos or videos, you should make it clear who is allowed to do this and also if you will be having a professional birth photographer present and their contact information.

Pain Medication

Provide instructions on whether you want to be given any medications during the labor and delivery to ease your discomfort. This can include both over-the-counter drugs and prescription medications.

Birthing Method

Instructions on the actual method of delivery such as whether you want to use a method like spinning babies or using a rebozo scarf. You should also indicate how much coaching you want to have on breathing and pushing the baby out. Some women find this very helpful and motivating during labor while others prefer it to be quiet.

Emergency Plan

Instructions on what to do in case of an emergency and under what circumstances are you willing to be taken to the hospital and who should take you. You can also note instructions for specific potential issues, such as whether you are willing to allow induction, an episiotomy, pain medication such as epidural, or the use of forceps. If a c-section must occur, include information on what you want to happen during that procedure, such as whether you want to be conscious or given anesthesia.

The Baby After Delivery

You should give detailed instructions on what to do after delivery with the baby.

  • Some mothers would like the baby cleaned off before being given to them to hold, while others do not want the vernix caseosa coating removed immediately.
  • You can request that your baby be placed on your chest for skin-to-skin for a certain amount of time right after the birth. In some cases the mother will request this for the other spouse if they are incapacitated, such as if you need to be taken to the hospital for a c-section and cannot hold the baby right away.
  • Another consideration to answer in your plan is whether you want the baby to breastfeed from you right away or if formula should be given.
  • If you plan to breastfeed, you may want to make it known you do not want a pacifier given to the baby.
  • You should also include instructions on what medical procedures will be performed on the infant, such as a vitamin K injection, use of a pulse oximeter and a metabolic screen and any other immediate procedures that your doctor recommends. While these will be done at the hospital, you should include instructions in case you have to be taken to the hospital in an emergency and the birth ends up happening there.
  • Finally you should include instructions about circumcision if your baby is a boy, and whether you want it done or not.

Umbilical Cord and Placenta

Instructions on cutting the umbilical cord and who will do the procedure are important.

  • In some cases this is done by the other parent, but if that person is not present, or if you want a different person or persons involved, you should note that in the plan.
  • When the cord is cut is also important, as some health practitioners believe that delaying cutting the umbilical cord can have health benefits for the baby.
  • You should also indicate what you want done with the placenta and whether you want medication to make the placenta discharge quicker.

Plan for Other Children and Pets

If you have other children, you should include instructions on where they should be during the birth and if they will not be present, who will be supervising them. You should also add at what point they can be allowed into the room after the birthing process is over. If you have pets, such as a dog or cat, you should also indicate where they will be during the birth and who will be caring for them, and at what point they can be allowed in the room, if at all.

Plan Your Baby's Home Birth

Having your baby at home can make the experience less stressful for some women and provide for a more natural birth. However, make sure you develop a plan and checklist ahead of time with your birthing team so everyone is on the same page on your special day and there's no additional stress due to confusion or lack of preparedness.

Creating a Home Birth Plan (With Template)