Birth plans have a reputation problem. On one side, some providers dismiss them entirely. On the other, some birth plans include preferences that are either not evidence-based or are presented as rigid demands rather than informed preferences. The useful middle ground is a document that captures your informed decisions about the interventions and practices that the research shows actually matter — and communicates them clearly to your clinical team.
What the evidence supports
Delayed cord clamping. The 2021 Cochrane systematic review, conducted for the International Liaison Committee on Resuscitation (ILCOR), found substantial evidence supporting deferred cord clamping of at least 60 seconds for term and preterm infants. The benefits include increased haemoglobin and iron stores in the newborn, reduced need for blood transfusion in preterm infants, and improved survival outcomes.1 ILCOR's 2025 update maintained this recommendation and extended it to include infants who are not vigorous at birth. WHO, ACOG, NICE, and RCOG all recommend delayed cord clamping of at least one minute as standard practice.2
Immediate and sustained skin-to-skin contact. The 2025 Cochrane Review confirmed that skin-to-skin contact immediately after birth is beneficial for both mother and newborn regardless of the mode of delivery — including caesarean section. The evidence shows that skin-to-skin contact promotes exclusive breastfeeding, supports thermoregulation, reduces infant crying, and facilitates maternal-infant bonding.3 The evidence is strong enough that skin-to-skin should be the default unless there is a specific medical reason to separate mother and infant.
Continuous support during labour. A Cochrane Review examining continuous one-to-one support during labour (from a doula, partner, midwife, or other trained person) found that it reduced the likelihood of caesarean birth, the use of pain medication, the length of labour, and negative birth experiences. Women who had continuous support were more likely to have a spontaneous vaginal birth.4 This is one of the most consistent findings in maternity care research.
Freedom of movement and upright positioning. The evidence supports allowing women to move freely and adopt upright positions during the first stage of labour. A Cochrane Review found that upright positions and mobility reduced the duration of the first stage of labour by approximately 1 hour 22 minutes and reduced the likelihood of caesarean birth and epidural use.5
The epidural decision
Epidural analgesia is the most effective form of pain relief during labour. A Cochrane Review of 52 studies confirmed that epidurals provide significantly better pain relief than other methods. The trade-offs: epidurals are associated with a longer second stage of labour, an increased likelihood of instrumental delivery (forceps or ventouse), and the need for urinary catheterisation. They are not associated with an increase in caesarean section rates in randomised controlled trials.6
The decision to use an epidural is not a moral one. It is a clinical one, informed by your pain tolerance, the progression of your labour, and your informed understanding of the benefits and trade-offs. A birth plan that states a preference — either for or against epidural — is valid. A birth plan that presents the decision as irrevocable in either direction is not, because labour is unpredictable.
What to include in a birth plan
The most useful birth plans are brief, flexible, and focused on the decisions that evidence shows affect outcomes. They typically cover: preferences for delayed cord clamping; immediate skin-to-skin contact; labour support preferences; pain management preferences and the conditions under which you would reassess; positions during labour; preferences regarding episiotomy (the evidence does not support routine episiotomy); feeding intentions (which affect early support); and circumstances under which you consent to interventions (e.g., continuous foetal monitoring, artificial rupture of membranes, oxytocin augmentation).
Include a section on emergency scenarios. If a caesarean becomes necessary, what are your preferences? Skin-to-skin in the operating theatre is increasingly available. Delayed cord clamping is possible during most caesarean deliveries. Stating these preferences in advance means they can be accommodated even in urgent situations.
What a birth plan cannot do
A birth plan cannot guarantee how your labour will proceed. It is a communication tool, not a contract. The most effective birth plans include language that reflects this: "My preference is..." rather than "I will not..." This framing communicates your informed choices while acknowledging that clinical circumstances may require adaptation.
The evidence is clear on this: women who feel informed and involved in decision-making during birth report better birth experiences — even when their birth does not go as planned. The plan itself matters less than the process of becoming informed.
