Birth Plan Template (1-Page)
Single-page, hospital-friendly birth plan covering environment, labor preferences, delivery, and newborn care.
What's inside
- Environment + comfort wishes
- Pain management ladder
- Pushing & delivery preferences
- Immediate newborn care
- Cesarean preferences
BIRTH PLAN — {{client_name}}
Provider: __________________ Place of birth: __________________
Doula: __________________ Support person: __________________
ENVIRONMENT
[ ] Low lighting [ ] My playlist [ ] Aromatherapy
[ ] Limit interruptions / staff entries
LABOR PREFERENCES
Pain management ladder: movement → water → nitrous → epidural
[ ] Intermittent monitoring if low-risk
[ ] Freedom of movement
[ ] Eat / drink as desired
DELIVERY
[ ] Coached pushing only if needed
[ ] Mirror to see baby crown
[ ] Slow delivery of head if possible
[ ] Skin-to-skin immediately after birth
NEWBORN
[ ] Delayed cord clamping (1-3 min minimum)
[ ] Partner cuts cord
[ ] Vitamin K, eye ointment delayed 1 hour
[ ] Baby stays with parent for golden hour
IF CESAREAN BECOMES NECESSARY
[ ] Clear drape if available
[ ] Partner + doula in OR if allowed
[ ] Skin-to-skin in OR or recovery
DISCLAIMER: This template is provided for informational purposes only and does not constitute legal, medical, or financial advice. Have a licensed professional in your jurisdiction review and adapt it before use.Built for every beauty pro — solo, booth renter, mobile, or salon
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