Sample Birth Plan and Intention

Lay the Foundations for Your Dream Birth with our Sample Birth Plan 

Yoga is always about the seen and the unseen; the outer and the inner; the expression and the feeling; educating and meditating. 

You might be looking for a sample birth plan so you can convey your preferences for all the choices that have to be made on the windy path of labor.

You might not have thought about expressing the inner experience you want. For that, we’ll help you get started with your Birth Intetions. 

A tool like our sample birth plan is useful when you want to explore the pro’s and con’s of all of your options, and make educated choices before you’re in that vulnerable, highly focused space of labor.

sample birth plan

As you re-write this sample birth plan to fit your own personal preferences, remember to be respectful and kind even as you’re being clear about what you want.

Our sample birth plan isn’t written to tell people how to do their job.

It’s about politely requesting that if possible, you’d prefer x over y. It’s good to use phrases like, “as long as labor is proceeding within normal limits.”  We want to respect the nurses and other professionals who are all simply doing their jobs, and not expect them to suddenly stop caring about their responsibilities.

And, since birth rarely goes as planned, it is also useful to establish your Birth Intentions, or qualities that you want to connect to and embody, no matter what direction things go in. 

This first step in using our sample birth plan is to visualize.

Before we take action in yoga, we sit, close our eyes, and listen lovingly inward. 

Since most of us remember our labor experience for our whole lives, it’s worth treating it with the same care and attention. 

Creating your Birth Intentions can increase the chances that you will create an uplifting memory, because we tend to remember the feels of an event more than the details.

To prepare to use the sample birth plan, lets start with visualizing. You might some outer details clearly – others, you might not know enough about your options yet.

The important parts are the inner qualities you’re aligning with: 

  • Close your eyes and sit. Exhale away the day.
  • Picture your birth going even better than expected.  Where are you? What does it look like? Even more important – what does it feel like to be you? What words would you use to describe your experience right now?
  • Picture yourself breathing into contractions, moving your body intuitively like you’re diving into a powerful current to let it take you downstream.

  • Notice who’s around you (and who’s not). Sense into the powerful sensations moving through you and tools you are using to cope with the intensity.

  • Now, picture yourself pushing in your own rhythm, and then baby skin to skin, being warmed by your body.

  • Picture you and baby learning how to breastfeed in the next couple hours with the help of your support people.

  • Picture yourself telling someone oyou love about how empowering, transformative and surprisingly do-able it all was.
  • Name the qualities of your being you felt (calm, clear, strong).
  • These are your intentions. Write them down so you can be sure to remember your intentions.
  • Now, close your eyes again and picture your birth not quite going as planned.

    Maybe you have back labor, and the pain is so intense that your doula has to push on your sacrum every contraction.  Maybe you had to get pitocin, and with that, an epidural seemed best.  

    Maybe you had to get a Cesarean because the baby was not handling contractions well.

  • sample birth planSee yourself going through this challenge with those same qualities that you mentioned above.  If this is not happening for you, that’s ok – that’s why we practice.

Each day, close your eyes to connect to your intenetion yourself; with each breath imagine embodying them, no matter what happens and how things unfold.

Go to prenatal yoga and practice breathing through intense sensation and continuing to embody your intentions.

Your intentions will become a source of power for you.  

Your intentions are there to remind you that you are the Divine Feminine, and her power, wisdom, and nurturing energy are there no matter what the conditions

Setting your intentions can make it more likely that you’ll experience a successful, beautiful birth experience where you feel full prepared, supported, and in your power – no matter what direction your birth goes.

Ready? Copy, paste and print this sample birth plan.

Next, just copy the sample Birth Plan below the line, paste in a doc and re-write to your satisfaction.

Hopefully you got some insights from our visualization, and the rest you can learn about in a birth prep course

Remember, what’s in the sample birth plan are just ideas – some people like them, some people want something different. 

Use them to help guide you to YOUR most empowering birth.

Birth Plan for ____________.

I know that my health, and the baby’s health, come first and I trust in your expertise. This birth plan is an attempt to communicate our desires if labor is moving within normal limits. 

We would appreciate being kept informed of all procedures being offered to the baby and mom before and after delivery.

Whenever possible, we would like to participate in all decisions to intervene with the natural process of labor, immediate skin-to-skin once baby is born, and breastfeeding.

The following are our preferences if the situation allows:


Monitor – If you believe it is necessary for the health of me or the baby, monitor continuously. If not, I would prefer to be monitored intermittently every hour, so that I can try walking and sitting in the shower.

sample birth plan

IV – As long as my labor stays within normal limits, I would appreciate it if you could hold off on the IV until/unless it becomes necessary. I would prefer a heparin lock if possible.

Pain Meds – I would like to avoid pain medication if possible. Please support me in my effort, and offer pain management options only if I ask for them.

Positions – Please feel free to offer different positions for labor if you know any that might help.

Other – Please wait to rupture my bag of waters as long as possible. Also, please inform me of any interventions you deem necessary, such as antibiotics, augmentation with pitocin, or internal monitoring.


Pushing – When it is time to push, please encourage different positions such as side lying, squatting with the bar, or sitting upright at the edge of the bed with the bottom lowered.

Cord cutting – If circumstances allow, I would like my partner to cut the cord, and then to have baby at my breast as soon as possible.

Emergency Cesarean – If this becomes necessary, I would like my baby to be skin-to-skin with my partner while the procedure is completed.


Nursing – I would like to breastfeed my baby. If possible, we’d like to avoid bottles and pacifiers. If we need to supplements, we would like to talk to a Lactation Consultant about using a dropper at the breast.

sample birth plan

Other – I would like to donate my cord blood to Children’s Hospital (if this is an option).

If you have any questions, please contact:
(Your Provider Name)

Thank you for taking the time to read my birth plan – we very much appreciate your expertise and care and look forward to taking the journey with you!

Want more tips for making an authentic and empowering birth plan? Read these 3 tips for writing your own birth plan

Thank you for spreading the Ma love!

Related Posts

The Yoga of Birth Outline

Discover the ingredients of an authentic, empowering birth and postpartum.