A birth plan is not a contract — it's a conversation starter with your care team Write it in advance; change it whenever the situation calls for it

A birth plan is a short document that tells your doctors, nurses, and midwives what you want to happen during labor and birth. The NHS defines it as "a way of letting your midwife, nurses and doctors know what you want to happen during your labour" [1]. NICE NG235 recommends discussing your preferences "as early as possible in pregnancy" and having them recorded [2].

The most important thing to understand from the start: a birth plan is not a binding contract. Your care team cannot guarantee that everything will go exactly as planned — labor has unpredictable variables. What a birth plan actually achieves is opening a dialogue, helping the team understand your priorities, and giving you a sense of participation in decision-making [1][2].

When to Write It

Best window: weeks 32–36

Weeks 32–34: Draft and gather information. Talk with your OB-GYN about hospital policies — can your partner be in the delivery room? Is epidural available, and are there restrictions on timing?
Weeks 34–36: Finalize the document. Keep it to 1–2 pages, easy to read quickly.
Week 36: Put copies in your hospital bag with your other documents.

Key tip: Talk to your doctor or midwife before finalizing the plan. Each hospital has different capabilities. There's no point requesting something the facility can't provide.

Thai Context: Public vs Private Hospitals

This is the practical reality that shapes what kind of birth plan to write.

Thai public hospitals serve high patient volumes; nursing staff often care for multiple women simultaneously. Common limitations:

Partners/support persons: Many public hospitals do not allow partners in the delivery room, though policies are gradually changing — always ask in advance.
Doulas: Not widely available or permitted at public facilities.
Pain management: Epidurals exist at some public hospitals but may require an additional fee or have timing restrictions.
Environmental control (lighting, music): Limited in shared labor rooms.

Approach: Keep the birth plan brief and focused on your top priorities. Use cooperative, not demanding, language.

Private Hospitals

Most Bangkok private hospitals — including Samitivej [6], Bumrungrad, Bangkok Hospital — offer private delivery suites, doula-friendly policies, and partner-inclusive rooms.

Approach: You can be more specific, but flexibility remains essential.

What to Include: The Core Sections

Section 1 — Basic Information

Name: _______________
Due date (EDC): _______________
Attending OB-GYN: _______________
Support person(s): _______________

Section 2 — Labor Environment

NICE NG235 states that women should be "encouraged and helped to move and adopt whatever positions she finds most comfortable throughout labour" and should avoid lying flat on their back [2].

Examples to consider:

Prefer dim lighting if possible
Would like to play soft music (I'll bring my own playlist)
Want to move freely — not confined to bed
Request that name be present throughout labor

Section 3 — Pain Management

List preferences in order, not as absolute demands. Options available in Thai hospitals:

Non-pharmacological (if possible first):

Want to try walking, position changes, or a warm shower/bath before medication
Would appreciate back massage from partner or midwife
Planning to use breathing techniques / Lamaze

Pharmacological:

Please explain the pain relief options available at this hospital before I decide
Happy to receive pain medication when I request it — no need to wait for me to ask multiple times
Would like to meet with the anesthesiologist before active labor if possible

Note: Specific medications and dosages are decisions for the anesthesiologist and care team. This plan does not specify doses — please discuss with your doctor directly.

Section 4 — Medical Interventions

NICE NG235 is clear that routine episiotomy is not recommended — it should only be performed when clinically indicated, such as for forceps/ventouse delivery or fetal compromise [2].

Examples:

Please explain any procedure before performing it (in non-emergency situations)
Regarding induction: want to understand the reasons and alternatives before agreeing
Regarding episiotomy: prefer to avoid if possible, but trust the doctor's clinical judgment when necessary
Regarding forceps/vacuum: would like an explanation before use

Section 5 — If a C-Section Becomes Necessary

Even if you plan a vaginal birth, preparing C-section preferences helps you stay calm if the situation changes:

Request that my partner be in the operating room if the hospital allows
Would like skin-to-skin with baby in the OR as soon as baby is stable
Request delayed cord clamping if safely possible
May I take photos in the OR? (check hospital policy in advance)

Section 6 — Newborn Care

This section has the strongest medical evidence, and most Thai hospitals are supportive:

Skin-to-skin within the first hour: WHO recommends placing the baby on the mother's chest immediately after birth (if baby is well) and offering the first breastfeed within the first hour. This contact stabilizes the newborn's temperature, improves breastfeeding success, and supports bonding.

Want skin-to-skin with baby immediately after birth (if baby is well)
Please weigh, clean, and measure baby after our first skin-to-skin time, not before

Delayed cord clamping (1–3 minutes): Evidence supports waiting 1–3 minutes before clamping the cord, allowing placental blood to transfer to the baby — this increases iron stores and reduces anemia risk.

Request waiting 1–3 minutes before clamping the cord, if baby is well
Would like partner's name to cut the cord (if circumstances allow)

Standard newborn procedures: Most Thai hospitals perform these routinely. Know them and give informed consent:

Vitamin K injection: prevents hemorrhagic disease of the newborn — I consent
Eye ointment/drops: prevents neonatal eye infection — I consent
Newborn screening (heel-prick test): screens for metabolic conditions — I consent

Section 7 — Postpartum

Breastfeeding:

Want to breastfeed as soon as possible after skin-to-skin
Would like a lactation consultant to visit my room
Please do not supplement with formula without consulting me first (unless medically necessary)

Rooming-in:

Want baby with me in my room at all times
Would like baby taken to the nursery for some periods so I can rest

Visitors:

Please limit visitors to names for the first 24–48 hours
I need private time with my immediate family first

Yu fai (Thai postpartum tradition): For families planning to practice yu fai after hospital discharge, this is a personal decision made at home — not part of the in-hospital birth plan. If you have perineal stitches and plan yu fai, discuss heat exposure near the healing wound with your OB-GYN first.

The Flexibility Statement (Most Important Section)

Always include this at the end:

"All of the above reflects my preferences in a normal situation. I understand that labor can involve unexpected changes, and I trust the medical team to make decisions that are safest for my baby and me. If plans need to change, I simply ask for a brief explanation of why."

Birth Plan Summary Checklist

Do:

Keep it short — readable in 2–3 minutes
Discuss with your OB-GYN before finalizing — confirm what's actually possible
Print 3–4 copies (nursing station, your own folder, partner's bag)
Include your name and due date on the first page
Note your coverage type (Universal Coverage, Social Security, private insurance) — this gives the team context

Don't:

Write as commands — use "I prefer" or "I'd like to" not "you must not"
Make it longer than 2 pages — staff won't have time to read everything during active labor
Request things the hospital can't provide — it sets everyone up for disappointment
Skip the flexibility statement

Birth Plan: How to Write One That Works in a Thai Hospital