Planning for birth: choices to think about

A birth plan can say who you want beside you, what pain relief you would like to consider and which setting you prefer. It helps your care team understand what you want during labour. It can also be a starting point for questions you have not settled yet.

Put what matters most near the top. You might ask the team to explain decisions directly to you, give you time to ask questions where possible, or check before involving people you have not met.

Start with the setting and the backup plan

In the UK, the options can include home, a midwifery unit or hospital. What is suitable depends on your health, the pregnancy and available services. The NHS advises hospital birth for high-risk pregnancies or certain medical conditions because specialist care is available if needed.

For a straightforward pregnancy, a planned home birth may be an option. The NHS says a first birth at home carries a slightly higher risk of serious problems for the baby than a hospital birth. Discuss what a home birth would mean for you, including the transfer arrangements.

Midwifery units may be alongside a hospital or separate from one. A separate unit does not have immediate obstetric, newborn or anaesthetic care. Ask which hospital would receive you if a transfer were needed, how long that might take and who would travel with you.

These options describe UK services. In the US and elsewhere, ask your own maternity team which settings and services are available to you. ACOG advises discussing the pain relief available at your hospital or birth centre before labour starts.

Consider your pain relief options

Comfort measures can include breathing techniques, changing position, massage and a bath or shower where available. They can be used alongside medicine. Ask your birth companion which kinds of practical support they would feel comfortable helping with.

Medicine options include inhaled gas, opioid pain relief and an epidural. Gas and air contains oxygen and nitrous oxide; you hold the mask or mouthpiece yourself. Opioids may be given by injection or through a drip. An epidural delivers medicine through a thin tube in the lower back.

Each option has limitations and possible side effects. Opioids can cause drowsiness and affect the baby’s breathing for a short time. An epidural can give very good pain relief, but it may need adjusting and is not always completely effective. In the UK, it is not available at home.

Ask about monitoring, movement and what happens if your preferred option is unavailable or does not help enough. Your clinician can explain which options are suitable for you and how any health conditions affect your choices. ACOG says you can decide about pain medicine during labour, even after discussing it beforehand.

Write down who and what you want with you

Your birth companion might be a partner, friend or relative. The NHS birth-plan checklist includes who you would like present if an assisted birth or caesarean becomes necessary, preferences about positions and equipment, and skin-to-skin contact and feeding after birth. Ask what is possible in your chosen setting.

Write down what support means to you: quiet company, help asking questions or someone to keep relatives updated. Include any concerns you want discussed privately. You can leave preferences open if you haven’t decided yet.

Discuss induction and caesarean birth

Induction means using medicines or other methods to bring on labour. It may be recommended when continuing the pregnancy creates health risks for you or the baby. Ask why it is being proposed, what the alternatives are and what would happen if you waited.

A caesarean is an operation to deliver the baby through the tummy and womb. It may be planned or needed urgently. If you are considering requesting one, ask about the benefits and risks compared with vaginal birth, recovery and what it could mean for future pregnancies.

Ask for support with fear or changing plans

Book a conversation with your midwife or GP in the UK, your obstetric clinician in the US, or your local maternity team if fear of birth is troubling you. NHS guidance recommends offering support during pregnancy and labour to people who are anxious about giving birth.

Your preferences can change, and circumstances during birth may require a different plan. Talk it through with your midwife or doctor. Ask: “If this option becomes unsuitable, what choices would I have then?”