What to put in a hospital transfer birth plan

This is a full set of birth preferences, written for the case where the birth moves to hospital. It covers the same ground any birth plan covers — pain relief, monitoring, pushing, the placenta, your baby’s first hours — and it is aimed at a room of people who have never met you, on the worst ten minutes of your day.

Write it for someone reading it in thirty seconds

Whoever picks up your plan on the ward is standing up, mid-shift, with other things happening. They will read the first half of the first page properly and skim the rest. That single fact should shape everything about how you write it.

Short declarative lines against clear labels get read. A preamble about your birth philosophy does not, and a numbered list of thirty items of equal weight defeats itself. If everything is emphasised, the allergy gets the same attention as the music.

The top of the page should carry your name, your due date, the name of your midwife, your blood group if you know it, your allergies, and whether you have had a caesarean before. That block gets read by everyone. Everything else is below it.

The nine parts of it

These are the sections Birth Bridge works through, in the order it asks them. Sixty-eight questions sit under them and you will not see all of them; some only appear if they apply to you, and the tool hides the rest.

1. Your voice and your body

How you want consent asked for while you are labouring, how you want to be spoken to and spoken about, what should happen if you change your mind on the day, and anything in your history the team needs to handle carefully. Four questions, and the most useful four on the page.

2. The transfer and arrival

Who rides in the ambulance. Who talks to staff. What role your midwife has once you are through the door. Then the things a hospital does almost automatically on arrival and rarely explains: a vaginal examination to see where you are up to, continuous monitoring, a cannula. Also students and observers, the birth space itself, and whether you can eat and drink.

3. Pain management

Which methods you want available and in what order, and separately where you stand on opioids. An order is far more use to a midwife than a list.

4. If labour needs support

Waters breaking before labour starts. Labour that slows, or energy that runs out. What happens if two hours pass and nothing has picked up. Whether you want an oxytocin drip, and how you want the continuous monitoring that comes with it handled when the belts slip.

5. If things move quickly

A monitor trace that looks concerning without being an emergency. Instrumental birth, and episiotomy, and what you would prefer if the first instrument does not work. Meconium. Heavy bleeding after birth. Fundal pressure. A placenta that will not come away. These are the ones there is no time to answer later.

6. Pushing and vaginal birth

The position you want to push in and whether you want to be coached or left alone. Warm compresses, hands on or hands off, your general position on episiotomy, and how you want a tear repaired if you have one. Water immersion. Then the cord: how long it stays, who cuts it, what happens with your baby in the first seconds, and how you want the first hour handled.

7. Unplanned caesarean

Who else can be in theatre or recovery, what anaesthesia you would prefer, how you want the birth itself handled, what happens with the cord, and who holds your baby first. There is more on this one here.

8. Third stage

Whether the placenta is actively managed or left to come on its own, and how you want that handled given interventions usually make active management the recommendation. Whether you want to keep it. Anti-D, if you are Rh negative.

9. Newborn care

The longest section, and the one most often decided without anyone asking. Resuscitation if your baby needs help starting. Vitamin K and hepatitis B. The first bath. Who gets to say whether it is a girl or a boy. Group B strep. Then everything around special care: who goes with the baby, who consents to procedures while you are still recovering, your colostrum plan, feeding if your baby needs one before you can give it, the postnatal ward, when you go home, and whether you want a debrief afterwards.

What to leave out

Anything the hospital cannot act on. A plan that says you will not consent to any intervention will be read as a plan that has not thought about the case where one is needed, and the rest of the page loses credit with it.

Blanket advance consent is the same problem from the other direction. A line agreeing in advance to whatever turns out to be necessary is not consent in any meaningful sense, and it gives away the one thing the document exists to protect.

Leave out anything you do not really mind about. Every preference you write down competes with the ones you actually care about.

Print it, and print it more than once

One copy in the top of the bag. One with whoever is driving. Your midwife will usually want a copy in your notes. A phone is not a plan; it locks, it goes flat, and it will not be in your hand when you need it.

Go through it with your midwife

This is the step that turns a document into something useful. Your midwife knows which hospital you would go to, what that hospital does as standard, and which of your preferences will need a conversation in advance rather than on the night. An hour at an appointment is worth more than anything written on your own, including this page.