Birth Preferences: What to Actually Write (and What Your Midwife Wishes You Wouldn't)

The average midwife has about 30 seconds to read your birth plan before things get busy. That single fact should change everything about how you write one.

Most birth plan templates floating around online are five pages long, include sections on aromatherapy playlists, and read more like a wedding checklist than a medical document. There is absolutely nothing wrong with wanting lavender diffused during labour. But if the one thing your midwife actually needs to know (like the fact that you have a needle phobia) is buried on page four, it might get missed.

Here is how to write birth preferences that genuinely help your care team help you, without turning it into a 3,000-word dissertation you will never look at again. 📋

Birth Preferences, Not Birth Plan

The word "plan" implies control. And labour is, to put it gently, not something you can control. You can prepare for it, inform yourself about it, and communicate what matters to you. But the moment you treat your document like a rigid contract, you set yourself up for disappointment.

Calling it "birth preferences" is not just trendy midwife speak. It is a genuinely useful mindset shift. Your preferences are things you would like, conditions permitting. Your plan is what you and your birth partner understand about your options so you can make good decisions when those conditions change.

Because they might. And that is completely fine.

What Your Midwife Actually Needs to Know

Keep it to one side of A4 if you can. Bullet points, not paragraphs. Think of it less like an essay and more like a cheat sheet for someone meeting you for the first time in a high-pressure situation.

Your medical essentials

Allergies, existing conditions, anything that might affect care decisions. If you have a strong phobia (needles, for example), this goes right at the top. Your midwife needs to know about these before anything else.

Pain relief preferences

This is the section most people spend the most time thinking about, and for good reason. Consider what you would like to try first, what you are open to if needed, and what you would prefer to avoid.

Some options worth considering:

• Gas and air (Entonox)
• TENS machine - buy or hire one in advance and start using it in early labour at home
• Warm water (bath or birth pool)
• Birthing comb or acupressure tools for natural pain management
• Pethidine or diamorphine injection
• Epidural - if you want one, say so clearly; if you would rather try other options first, note that too

A TENS machine is one of those things worth sorting well before your due date. Most work best when you start using them in early labour, so having one charged and ready at home means you are not scrambling to find one when contractions start at 2am.

Birthing combs might sound unusual, but the acupressure principle behind them is solid. Gripping one during contractions activates pressure points in your palm that can help your brain process pain differently. Worst case? It gives your hands something purposeful to do.

Who is in the room

Your birth partner, obviously. But also think about whether you want student midwives present (you absolutely can say no), whether your partner should stay for the whole thing or step out at certain points, and what role you want them to play.

Some partners are natural advocates. Others need explicit instructions like "remind me to drink water" or "hold my hand and do not speak." Both are completely valid. Tell your partner which one you need before the big day.

After baby arrives

Skin-to-skin immediately or after a quick check? Who cuts the cord? Do you want delayed cord clamping? Are you planning to breastfeed, formula feed, or see how it goes? Would you like the vitamin K injection or oral drops?

These decisions feel overwhelming now, but a quick bullet point for each is genuinely all your care team needs.

If things change

This is the section most templates leave out entirely, which is baffling because it is arguably the most important one. If you need an emergency caesarean, what matters to you? Would you like the screen lowered so you can see baby being born? Do you want skin-to-skin in theatre if possible? Should your partner stay with you or go with baby?

Writing these preferences is not "planning for failure." It is making sure you still have a voice even when the situation shifts. 💜

What to Leave Out

This bit might sting slightly, but it comes from a place of genuine usefulness.

Your birth preferences document is not the place for:

• Long explanations of why - your midwife does not need the three blog posts that led you to prefer delayed cord clamping. A simple "delayed cord clamping please" covers it.
• Music and lighting requests - bring your own speaker and fairy lights by all means, but these do not need to be on the medical document.
• Instructions for things that are standard practice - most hospitals already do skin-to-skin and delayed cord clamping unless there is a medical reason not to. Check your hospital's standard approach before adding it to your list.
• "Do not offer me an epidural" - a better version is "I would like to try other options first, and I will ask if I want one." The first wording can leave you feeling too embarrassed to change your mind mid-labour.

The Flexibility Mindset

Somewhere between "birth plan is sacred" and "just go with the flow" is the sweet spot. You want to be informed enough to know your options and relaxed enough to adapt when your baby has other ideas.

The most helpful birth preferences documents have a line at the top that says something like: "These are our preferences, conditions permitting. We understand things may change and we trust our care team to keep us informed."

That single sentence tells your midwife three crucial things: you have thought about this, you are reasonable, and you want to be involved in decisions. It immediately sets a collaborative tone that works in everyone's favour.

When to Write It

Around 34 to 36 weeks is the sweet spot. Early enough that you are not panicking, late enough that you have done your antenatal classes and have a reasonable idea of your options.

Write a first draft, then talk it through with your midwife at your next appointment. They can flag anything that might not be possible at your particular hospital or birth centre, and suggest things you had not considered.

Then give a copy to your birth partner. They need to know it as well as you do, because there may be moments during labour when you are not in a position to advocate for yourself. That is literally what they are there for.

One Last Thing

Your birth preferences are not a test you pass or fail. If nothing goes according to your document, that does not mean you did it wrong. It means birth is unpredictable, your baby made their own decisions, and your care team adapted to keep you both safe.

The real value of writing birth preferences is not the document itself. It is the thinking you do along the way: the conversations with your partner, the questions you ask your midwife, the quiet confidence that comes from understanding your options even if you never use half of them. ✨

Still pulling your registry together while you think about all this? Your BubsNest wishlist is a good place to keep track of the practical stuff (like that TENS machine) so you can focus on the bigger decisions.