Most of our pregnancy guides are about food, starting with the pregnancy food safety checklist. This one is about the day itself. A birth plan is not a contract and nobody marks it. It is one page that tells people you may never have met what matters to you.

What a birth plan is for

The NHS describes a birth plan as a record of what you would like to happen during labour: where you give birth, who is with you and which facilities you would like to use. The NHS offers a free template as a Word document.

The NHS is clear that birth does not always go to plan and things may change at the last minute. The real value is the conversation: the NHS asks you to talk your choices through with your midwife so they can advise you.

When to write it: the NHS appointment timeline

There is no fixed week for writing a birth plan, but your antenatal appointments are built around these conversations. The NHS appointment schedule says your midwife will:

• 8 to 12 weeks (booking): give you information about your options for giving birth.
• 25 weeks (first babies): talk about your choices and preferences for giving birth.
• 28 weeks (everyone): give you information about labour and birth, including newborn screening.
• 31 weeks (first babies): discuss preparing for the birth, your preferences for birth and knowing when you are in labour.
• 34 and 36 weeks (everyone): the same discussion. At 36 weeks your midwife also feels your bump to check your baby's position.
• 38, 40 and 41 weeks: discuss your choices if you are still pregnant after 40 or 41 weeks, which is where induction comes in.

A practical approach: draft it in the early 30s, take it to your next appointment, and settle it by 36 weeks. The NHS says you can change your mind about where to give birth at any point.

The plan, section by section

These ten sections cover all 13 NHS checklist points, plus the "what if" topics the checklist leaves out: induction, tears and caesarean birth.

You can give birth at home, in a midwifery unit (also called a birth centre) or in hospital. What is right depends on your health, your pregnancy and what is available locally.

Doctors may recommend hospital in some situations, for example twins or a breech baby.

The NHS checklist asks three things: who you want with you in labour, whether you want company if you need a forceps or vacuum (ventouse) birth or a caesarean, and whether you are comfortable with midwives, nurses and doctors in training being present. For a closer look, see our guide: What to Eat in a Day When Pregnant.

A birth partner can remind you to breathe, help you change position, keep you fed and watered, and speak up for your wishes. The NHS asks partners to help write the plan, or at least know what it says. At a caesarean under a spinal or epidural, your birth partner can usually be with you; under a general anaesthetic they will not normally be present.

The section most likely to change on the day. Many people write a starting preference plus "and I would like to keep my options open".

Availability varies by unit. Ask your midwife what your chosen place offers.

Epidural: the trade-offs the NHS lists. In most cases it gives complete pain relief and should not make you sick or drowsy, which can help in a long or very painful labour. Against that:

• It takes 20 minutes or more to set up and work, and may need adjusting.
• Your legs may feel heavy, and you may find it hard to pee, so a catheter may be used.
• It can make the pushing stage longer. If you cannot feel contractions, your midwife will tell you when to push, and forceps or ventouse may be needed.
• About 1 in 100 people get a headache afterwards, which can be treated. Your back may be sore for a day or two, but it does not cause long-term backache.

The NHS says most alternative therapies, such as hypnosis or aromatherapy, are not proven to relieve labour pain; tell the hospital in advance if you plan to use one.

The NHS checklist asks about staying active, positions, and equipment such as mats, beanbags or a pool. NHS labour advice says staying upright and gently active in early labour helps, you can use any comfortable position in established labour, and for pushing you might sit, lie on your side, stand, kneel or squat. Kneeling on all fours may help with backache. Try positions before labour starts.

Not on the NHS checklist, but it affects how much you can move. In straightforward labour your midwife checks your baby's heart with a handheld device every 15 minutes and you can move around. Electronic monitoring (two pads on your bump) is used if there are concerns or you have an epidural. If it was for a concern, you can come off it once the heartbeat is shown to be normal. "Mobile" epidurals need wireless monitoring, which the NHS says many hospitals lack.

Worth a few lines in case labour does not start on its own.

• Membrane sweep. Usually offered after 39 weeks, before induction. A finger is swept around your cervix during an internal examination, which may start labour. It can be uncomfortable, with some cramping or bleeding. If labour does not start, you may be offered another sweep or induction.
• Induction. Offered if labour has not started by 41 weeks, because the risk of stillbirth and other problems rises, and sometimes earlier for health reasons such as diabetes or high blood pressure. It always happens in a hospital maternity unit. Hormones are usually tried first, and it often takes many hours.
• Pain relief is not restricted. The NHS says all the usual options, including an epidural or a water birth, should still be available if you are induced. Induced labour is usually more painful, and forceps or ventouse are more likely.
• It is your decision. Your midwife and doctor should explain the pros and cons. If you go past 42 weeks and decide not to be induced, you should be offered extra monitoring of your baby.
• Waters breaking. Call your midwife or maternity unit urgently. If your waters break after 34 weeks and labour has not started, you can choose induction or waiting with monitoring. The NHS notes the risk of infection rises if your waters break more than 24 hours before labour starts.

About 1 in 8 births need forceps or ventouse (vacuum), less often if you have had a vaginal birth before. Reasons include concerns about your baby's heart rate, your baby being in an awkward position or showing signs of distress. It usually happens in the birthing room, with a local anaesthetic if you have no epidural. Depending on the circumstances, your baby may be placed on your tummy and your birth partner may still be able to cut the cord.

Up to 9 in 10 first-time mothers having a vaginal birth have a tear, graze or episiotomy. In England an episiotomy (a small cut to widen the opening) is not routine. Things the NHS says can help:

• Perineal massage in the last few weeks of pregnancy can reduce the chance of an episiotomy; daily massage showed the most benefit.
• As the head appears, your midwife may ask you to stop pushing and pant gently so it is born slowly.
• Small tears are often left to heal on their own. Larger tears and cuts are stitched with dissolvable stitches, with a local anaesthetic or an epidural top-up, and you should be able to keep cuddling your baby.

A caesarean can be planned (usually from 39 weeks) or an emergency during labour.

• On the day. A spinal or epidural is usually used, so you stay awake and your birth partner can usually be with you. A general anaesthetic is used only if you cannot have one; your partner will not normally be present then. A screen is placed across your tummy, your baby is lifted up for you to see, and you can usually hold them straight away. NHS breastfeeding guidance says you should still be able to have skin-to-skin straight after delivery.
• Afterwards. Staff can help you breastfeed if you want to. If there are no complications, most people go home 1 to 2 days after surgery.
• Asking for a caesarean. You can ask for one without a medical reason. Your midwife or doctor should talk through the risks and benefits, and if anxiety about birth is the reason you should be offered support. If you still want one, you should be offered a planned caesarean or referred to a doctor who will do it.
• Birth after a previous caesarean. Most people can safely have a vaginal birth next time, though you may need extra monitoring in labour, and some are advised to have another caesarean. Talk this through with your midwife early, because it shapes the rest of your plan.

These choices happen fast, so decide them in advance.

1. Skin-to-skinYour baby can be placed on you as soon as they are born, before the cord is cut. If you would prefer, ask for your baby to be dried and wrapped first.
2. Cord clampingWith active management, the NHS says the cord is cut between 1 and 5 minutes after birth (sooner if there are concerns). With physiological management, it is left until it stops pulsing, usually 2 to 4 minutes.
3. Delivering the placentaActive: an oxytocin injection, the placenta usually out within about 30 minutes and a lower risk of heavy bleeding, but more chance of sickness and afterpains. Physiological: no injection; it can take up to an hour, switching to active if needed.
4. Vitamin KOffered to prevent a rare bleeding disorder in newborns. It is usually an injection; if you prefer, it can be given by mouth, but that needs further doses.
5. FeedingSay how you plan to feed your baby. If you plan to breastfeed, the NHS says skin-to-skin straight after birth is a great time for your first feed, and your midwife can show you how. If you plan to use formula, say so too, so staff know what you need. Our guides to making up a bottle of formula safely and storing expressed breast milk help you prepare either way.

This is not on the NHS checklist, but a short line at the top saves you explaining yourself in labour. Some ideas people find useful: the language you would like to be spoken to in, or whether you need an interpreter; any disability or access needs; religious or cultural wishes; and anything from a past birth or your health history that staff should know. Ask your midwife what your unit can arrange, and whether it should go in your maternity notes as well. You can browse every course and guide on the My Nutri Care home page.

Tap a preference above to start your summary.

Writing it so it bends

A few habits keep a plan useful when things change:

• One page, short lines. Put the three things that matter most at the top.
• Preferences, not rules. "I would prefer" leaves room for a conversation.
• Add an "if" for each big wish. If you need theatre, what still matters?
• Keep it with your notes. The NHS hospital bag list includes your birth plan and hospital notes. If your trust uses digital maternity notes, ask your midwife where your preferences should be recorded, and give your birth partner a copy.
• Revisit it at 36 weeks, when things may have changed.

Questions to ask your midwife before you finish it

These are the points where NHS guidance says the answer depends on your unit:

• Is the midwifery unit alongside the hospital or separate, and how long does a transfer take?
• Is a birth pool usually available, and what happens if it is in use?
• Are anaesthetists always available for epidurals here?
• Do you have wireless monitoring, so I can move with an epidural or monitoring?
• How does induction work here, and might I be able to go home during it?
• Is there anything in my health or pregnancy, such as a previous caesarean, that changes my options?

Planning ahead? See our infant feeding and postnatal courses, or the course finder.

Questions people ask