Natural Birth Plan Template

Below is the birth plan Hannah and I gave your OBGYN to express our desire for a natural, unmedicated childbirth. Feel free to use it as your natural birth plan template.


We have chosen to give birth to our child at [hospital name] because of the progressive facilities and outstanding recommendations given to us by friends. We are also glad to have Dr. [name] assisting us through this joyous occasion. We realize that every birth experience is different. In our desire to have the most memorable and happiest birth possible, we have listed our preferences below.

We have made these decisions after much research, consultation, and thought, and we appreciate your help in attaining these goals. In the unlikely event of complications, we will render our full cooperation after an informed discussion with the doctor, and after adequate time for private consideration.

First-Stage Labor

  • No internal fetal heart rate monitoring;
  • Vaginal exams only upon consent; as few and as gently as possible to avoid premature rupture of membranes;
  • No augmentation of labor, such as pitocin, amniotomy, or stripping of membranes;
  • No analgesia/anesthesia unless we ask for it;
  • Freedom to move and walk around during labor;
  • Use of tub and shower as desired prior to membrane rupture;
  • Quiet room, dim lights, soft music (brought by us); no excess hospital staff, please;
  • If I.V. Prep deemed necessary, please use heparin lock.

Second-Stage Labor

  • Choice of positions for pushing. No stirrups;
  • Patient would rather tear naturally than have an episiotomy;
  • If assistance in delivery is necessary, please use suction rather than forceps;
  • Please immediately place baby on mother’s abdomen;
  • Please wait 15 minutes before clamping the umbilical cord;
  • Cord to be cut by husband (if he desires), and not until pulsing has stopped;
  • Baby to breastfeed immediately to assist in natural delivery of placenta. No Pitocin, uterine massage, or pulling on the cord;
  • If stitching of perineum necessary, please use local anesthetic;

After Birth

  • Please delay all routine exams to allow for bonding;
  • Please perform all physical exams and procedures in room with mother;
  • Please inform parents of every exam and procedure prior to administration;
  • Please do not give any shots to baby prior to discussing with parents;
  • If warming required, baby to be placed on mother’s chest with blankets;
  • Breastfeeding only; no bottles, pacifiers, artificial nipples, formula, or water.

We thank you in advance for your support and kind attention to our choices. We look forward to a wonderful birth.

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