Hypnobirth Tip#4: A Sample Birth Plan

by Kerry Tuschhoff, HCHI, CHt

Below is a sample birth plan based on the preferences of a typical hypno-birthing couple. Yours may vary, but consider the length and format as a guide. 2 pages is the longest it should be, and using bullet points or small paragraphs will help ensure it gets read. Your doctor or midwife will most likely want to talk to you about your labor and birth at the 36 week visit, but you can talk to them at any time now about your Birth Plan if you wish.

I advise my students to talk to their doctors/midwives every time they see them about their birth preferences, so that the seeds can be planted that you have special needs, and feedback can be given by the care provider. You will then be able to get an idea of how they feel about what you want.

Presenting it as a list of "preferences" instead of demands is crucial, and always with respect. Asking the doctor or midwife, "What do you think about ______" is always a good way to begin a discussion about any particular thing that is important to you. If you can, get your caregiver to sign it and then make 4 copies. One goes to the doctor for his files, and you can request that one be sent to the hospital you’ll give birth at with your chart. If this is done, the hospital will be much more likely to pair you up with a nurse who is natural/hypno-childbirth friendly when you arrive on your birthing day. The other two copies go to the hospital with you when you’re in labor, one to be presented to your L&D nurse or midwife, in case they don’t have it yet, and one to keep in your birth bag.

Sample Birth Plan

Mary and John Smith Birth Preferences
Anywhere Memorial Hospital

Dear Doctor Jones and Hospital Staff,

We have chosen you to attend the very special event of our child's birth. We trust in your expertise and in your sensitivity to our individual needs and wishes. Thank you in advance for your support and encouragement during our birth. The following is our "ideal" birthing. We ask that you consider each of our choices and accommodate them when possible.

IN THE EVENT OF AN EMERGENCY: In the event that the situation becomes life-threatening for either Mary or our baby, we will, of course, yield to any request for life saving intervention, upon the briefest of consultation. In the strong likelihood that we have the normal birth that we're expecting, we ask that you refrain from any routine interventions or measures that we have not previously agreed upon.


We would like to complete all forms prior to labor; and to stay at home as long as possible. If upon arrival to the hospital Mary is deemed to be in early labor (under 4 cm, with no complicating factors), we will decline admission until a later time when Mary feels to be more progressed.

Upon Admission

Hydration: We ask that Mary hydrate herself with water and juice as desired, and will be happy to accept a Heparin Lock. IV to be implemented only in the event of complicating factors.

Movement: We ask that Mary be allowed to move about freely, and to assume any position that she finds comfortable.

Monitoring: It is our desire to decline continuous EFM, but prefer intermittent monitoring when necessary. Internal monitoring , upon our consultation, to be used only in a life-threatening situation.

Room Environment: We will be performing various techniques of self- hypnosis and for this reason we ask to be allowed to bring soft music, use dimmed lighting, and ask for the staff to kindly use a low voice - avoiding references to "pain", "hurting" or "hard work". These words are disruptive to our hypnosis process, and we thank you for respecting our unique needs.

Photography: We would like to have the opportunity to record our baby’s birth with still photographs and video camera.

Birth Support: We, Mary and John, will be supported by our professional labor assistant, _____________. She is a certified Birthing Assistant and has attended many hospital and out of hospital births, including cesarean sections. We will require her continuous presence during our labor and birth. We authorize her to be present during any examinations or procedures.

Management of Labor: It is our strong desire to allow our birthing to proceed upon its natural course, in the absence of complications, without restriction to time. If an increase of oxytocin becomes necessary, we would like to use natural methods before our consent will be given for the use of Pitocin or AROM.

"Pushing": Because we are using hypnosis for childbirth pushing techniques, Mary will be using positions she finds effective, and this will be completely mother-directed. We ask that the staff respect our request and not direct us how to push, unless an emergency arises.

Perineal Massage: We ask that the staff assist us with warm compresses and olive oil massage of the perineum. We have been preparing for a birth with no episiotomy and appreciate your patience and support as our baby crowns.

Birth of our Baby: Please allow our baby to be born without pulling on his/her head or turning it unless there is shoulder dystocia. We also ask that the cord be allowed to stop pulsating before clamping or cutting, and John will cut it at that time. Mary will hold our child in her arms immediately upon birth, and she and I will dry and wrap our baby at this time to help maintain warmth. Mary will hold him/her against her skin and will ask for blankets to be placed over them both. We ask that you treat our baby with gentleness at all times, and that any newborn procedures be delayed until we have had some time to get to know one another - up to two hours. (bathing, eye drops, foot prints etc.)

Birth of Placenta: We ask that Mary’s placenta be allowed to deliver without the use of traction. We understand that this may take a few extra minutes and we certainly appreciate your patience with us.

Circumcision: If our baby is a boy, we will decline the surgical removal of his foreskin.

Breastfeeding: We will be exclusively breastfeeding our baby and request that no bottles of any kind, pacifiers or artificial nipples be given to our baby, and he/she will be rooming in with Mary. Thank you for all of the care we've received during our pre-natal visits and in advance for the respect and assurance we know we'll receive from you during our birthing.

Yours truly, (MARY, & JOHN) APPROVED - DR JONES_____________

Disclaimer: Hypnobabies Network, and Kerry Tuschhoff assume no responsibility or liability for the outcome of any pregnancy, labor, or birth. The content of the above information is in no way to be represented as medical advice, nor as a prescription for medical procedure. As always, you should seek the advice of a medical doctor or midwife to answer any health-related or pregnancy-related issues surrounding your pregnancy, labor and delivery, or before starting any new pregnancy-related program.

More Hypno-Birth tips...
Tip #1: Getting Started
Tip #2: Your Bubble of Peace
Tip #3: Why Create a Birth Plan?
Tip #4: A Sample Birth Plan
Tip #5: Laboring at Home
Tip #6: Do I need a Doula?
Tip #7: What to do in Early Labor
Tip #8: Getting everything You Want
Tip #9: Birthing Choices

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