Birth Plan Template with Preference Worksheets and One Page Summary

Birth plan template with soft, guided worksheets that help you explore your birth preferences, discuss them with your doctor or midwife and hand your care team a clear one page summary. It also includes a hospital bag checklist, notes for your support person and a page for when it is time to leave. The set is undated, 16 pages long and arrives as an instant PDF download in US Letter and A4. Nothing is shipped.

Feel informed, heard and a little more at ease as your due date gets closer.

How this birth plan template helps you prepare

Go through the topics one by one: the room and mood, labor itself, ways to stay comfortable, the hours right after birth and feeding. Beside every option, mark I'd like this, open to it, prefer not or ask me. Bring the worksheets and questions to a prenatal visit, and afterwards copy just the wishes that matter most onto the one page summary, which your care team can scan in seconds.

Your support person gets a page of their own too, so they know how to keep you calm and which topics to speak up about.

Who these birth preference worksheets are for

• Moms to be in their second or third trimester, whether birthing at a hospital, a birth center or at home
• Partners and birth companions wanting to know exactly how to be useful on the day
• First time moms unsure what to ask or which options exist
• Doulas looking for a calm, simple worksheet to share with clients

Design and printing

• Soft, minimalist style with white pages and light blush pink touches that save ink
• Roomy margins so your home printer never cuts anything off
• Portrait format in A4 (210 x 297 mm) or US Letter (8.5 x 11 inches)
• Undated, so you can work through it at your own pace and print the summary page as many times as you like
• Use it in a binder or on a clipboard, or ask a print shop to spiral bind it

Inside the birth plan template: 16 pages

1. 1Cover page listing the contents
2. 2Start here, with four steps (explore, discuss, summarize, share), what matters most to you and how you hope to feel
3. 3About me and my care team: contacts, support people, key things to know about you, health notes to pass on and who is caring for things at home
4. 4Birth environment: the atmosphere, who you want in the room, photos and video, moving around, your notes and items to bring from home
5. 5Labor preferences with ten wishes to tick, such as freedom to move, wearing your own clothes and hearing about any procedure beforehand, plus labor questions and what helps you relax
6. 6Comfort and pain relief options to talk through: comfort ideas you want to try, your approach to pain medication, choices you want to understand better, coping words and what your provider thinks
7. 7The birth moment: choices to talk over, the first words or moment you dream of, and space for your provider's notes
8. 8After birth and newborn care: those first hours, questions on routine newborn care, visitors and announcements, and keepsakes
9. 9Feeding plans: how you hope to feed, the support you would like, questions to ask, what to do if feeding feels hard, feeding contacts and items to buy ahead
10. 10If plans change: your wishes should a cesarean or extra help be needed, should your baby need additional care, and the things that matter most to you in any situation
11. 11My birth plan, a single shareable sheet with short sections on the setting, labor, comfort and pain relief, the moment of birth, the first hours, feeding, changed plans and anything else they should know
12. 12Questions for my provider, with starter ideas, an appointment date and next steps
13. 13Hospital bag checklist for you, your baby and your support person, plus last-minute items and a bag packed by date
14. 14Support person notes: ways to keep you calm, words that work, things to steer clear of, where the comfort kit is packed, what to advocate for on your behalf, reminders and who to phone with the happy news
15. 15When it's time to go: when to phone your care team, travel plans, phone numbers, tasks before leaving and home arrangements while you are away
16. 16Notes and reflections for thoughts before the birth and what you learned at appointments

What you download

• Birth Plan Worksheets, US Letter PDF (16 pages)
• Birth Plan Worksheets, A4 PDF (16 pages)
• Read Me First, a brief PDF printing guide

How to download and print

• Check out with PayPal, a debit or credit card, Apple Pay or Google Pay. Your download page opens as soon as the payment goes through.
• We email the same private download links to you, so you can download your files again later.
• Open the PDF in a free reader such as Adobe Acrobat Reader and print at 100% or Actual size.
• Print only the pages you need, as often as you like, for your own personal use.

Good to know

• This is a print-ready PDF, not a fillable form. You can still import it into most note taking apps and write on the pages.
• You receive a digital file only. Nothing physical is mailed to you.
• Colors may look a little different on your screen than on paper.
• Made for your own personal use. Sharing, reselling or redistributing the files is not allowed.
• Digital files cannot be returned. If a file does not open or print properly, email us and we will help quickly.
• Use it as a planning tool rather than medical advice. It cannot replace your doctor, midwife or any other professional. Treat everything you write as a preference to talk over with them, and remember that your care team's guidance always comes first.

How this was made

Designed and written by PetiteDiary. AI tools helped draft parts of the text, and some background scenes in the preview images were created with AI. Every page was designed, reviewed and checked before release.

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