MAKE THE DOCUMENT WORK FOR YOUR SITUATION
About this birth preferences plan
Prepare flexible birth preferences for discussion with the maternity team, including support people, communication, comfort options, contingencies, and newborn care questions. This editable template brings the key details into one document: family, care team & communication, labor preferences to discuss, changing circumstances & postpartum discussion. Complete it online, compare the live preview with your records, and download a blank or completed PDF or editable Word document.
What the template includes
The online builder and downloaded documents use the same fields. A selected state can add relevant research prompts. Complete only applicable items; add explanations for exceptions rather than assuming a blank entry resolves them.
Document details4 inputs +
Set the date, jurisdiction, and your internal reference.
- Document date *
- US state *
- County
- Document reference
Family, care team & communication10 inputs +
Use this as a conversation aid, not clinical directions.
- Birthing parent full name *
- Estimated due date
- Planned birth facility *
- Maternity clinician or midwife *
- Support people and roles *
- Doula contact
- Emergency contact *
- Language and interpreter needs
- Accessibility or trauma-informed communication preferences
- Most important goals and priorities *
Labor preferences to discuss8 inputs +
Ask the care team which options fit your circumstances and facility.
- Environment and comfort preferences
- Movement and position preferences to discuss
- Monitoring questions and preferences
- Comfort and pain-relief options to discuss
- Food and hydration questions
- Explanations and consent before examinations
- How to explain changes and alternatives *
- Photo or recording permissions and facility rules
Changing circumstances & postpartum discussion10 inputs +
Clinical decisions depend on the situation and informed consent.
- How to discuss unexpected developments *
- Cesarean questions and support preferences
- If parent and newborn need separate care
- Feeding preferences and support requested
- Skin-to-skin preferences where clinically appropriate
- Newborn tests, medications, and care questions
- Visitor and privacy preferences
- Postpartum support and discharge questions
- Care-team discussion date
- Care-team feedback and agreed modifications
Additional details & signing7 inputs +
Add attachments, exceptions, and the names of authorized signers.
- Attachments / supporting records
- Exceptions / additional terms
- First signer printed name
- First signer title
- Second signer printed name
- Second signer title
- Signing date
How to complete it
1. Document details
Set the date, jurisdiction, and your internal reference. Review document date, us state, county, document reference against your source records.
2. Family, care team & communication
Use this as a conversation aid, not clinical directions. Review birthing parent full name, estimated due date, planned birth facility, maternity clinician or midwife and the remaining details against your source records.
3. Labor preferences to discuss
Ask the care team which options fit your circumstances and facility. Review environment and comfort preferences, movement and position preferences to discuss, monitoring questions and preferences, comfort and pain-relief options to discuss and the remaining details against your source records.
4. Changing circumstances & postpartum discussion
Clinical decisions depend on the situation and informed consent. Review how to discuss unexpected developments, cesarean questions and support preferences, if parent and newborn need separate care, feeding preferences and support requested and the remaining details against your source records.
5. Additional details & signing
Add attachments, exceptions, and the names of authorized signers. Review attachments / supporting records, exceptions / additional terms, first signer printed name, first signer title and the remaining details against your source records.
Practical tips
- Write why a preference matters so the team can suggest suitable alternatives.
- Record newborn-care questions as discussion topics, not instructions to bypass assessment.
Before signing or submitting
This is a preference and communication worksheet, not medical advice or clinical directions. Discuss every care choice with your maternity team.