How to Write a Birth Plan Without a Template: A One-Page Preferences Guide
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Blank birth-preferences preparation sheet

Adapt the prompts privately and discuss the page with your maternity team. The sheet is a writing aid, not a consent form or individual care plan.

Name/preferred name and identifying details requested by the service:
____________________________________________________________

Intended birth setting:
____________________________________________________________

Latest revision/review discussion date:
____________________________________________________________

Three things that matter most to me:
____________________________________________________________

Communication, support person and interpretation preferences:
____________________________________________________________

Comfort/facilities and pain-relief questions to discuss:
____________________________________________________________

After-birth contact, feeding and newborn-care questions:
____________________________________________________________

If the plan changes: communication/support preferences:
____________________________________________________________

Unanswered question / who to ask / where the answer is recorded:
____________________________________________________________

How the service wants the current copy shared or stored:
____________________________________________________________

Guide: https://pregnancycareguidebook.com/birth-preparation/birth-plan-without-a-template/
Updated: 4 November 2026
Educational preparation only; use your own care team’s instructions.
This blank file does not send or store answers on the website.