Creating and Evaluating Your Birth Plan (Includes Sample Letters)

As you prepare for the birth of your baby, you may have heard some personal stories of moms who experienced some awkwardness in the delivery room or later in the hospital. It may be helpful to tell your doctor what kinds of statements make you comfortable or uncomfortable, with suggestions as to how to talk to you after your baby is born. You can ask your doctor to share it in advance with the labor and delivery staff, and bring a few copies with you just in case.

Sarah shared with us the following about the positive impact of clearly conveying expectations with all members of the medical team:

“I have had the privilege of supporting a few expectant parents from a professional role. One expressed concern that the hospital staff wouldn’t know what to do or say so I offered to contact them in advance to express her wishes for her baby’s birth. I contacted the nurse manager who was eager to meet and learn more. This turned into a nice opportunity to teach many on the staff about Down syndrome. We shared with them that the parents had chosen to welcome this child and they didn’t want anything but celebration at her birth. Their hospital experiences were very positive and the staff was grateful for the experience as well. So as you’re thinking about discussing your wishes with your doctor, consider contacting the birth center staff as well.”

In the “Creating and Evaluating Your Birth Plan” section of our book, we discuss writing a letter to your health care provider which addresses your birth plan desires, any concerns you have, and a request that all medical professionals use appropriate language. Because pregnant women have very different ideas about birth plans, these letters will vary drastically in content. We have samples below based on actual letters from two expectant moms to their doctors, and the letters reflect their specific personalities and situations. These letters do not reflect our personal concerns or what we believe you should be concerned about. Other women may create individual letters that reflect very different concerns based on their individual needs; however, the idea is to establish an open line of communication with your medical team to establish the tone you want for your pregnancy and birth experience.

As you look at these examples, we urge you to create your own unique letter based on your desires and concerns. Please feel welcome to use these letters as templates for your own.

Our Resources

See Also: Creating and Evaluating Your Birth Plan chapter in our book, “Diagnosis to Delivery: A Pregnant Mother’s Guide to Down Syndrome.”

Birth Plan Letter to Your Doctor

The following letter is from a mom who recently received a diagnosis and had many questions and wanted to set expectations and a positive tone for her birth experience and prenatal care.

Dear Dr. Caring,

We were so thrown by the news about our baby that we are still a little confused and dazed. I know you talked about a pregnancy plan, but I have to be honest that I was not absorbing much. I hope that by writing down some of my questions I can take good notes at our next visit and get a better idea of what to expect.

The following are my questions/concerns:

  1. Is my birthing facility an appropriate hospital at which to give birth, i.e. high level NICU if needed, etc.? If they can not meet emergency medical needs, what is the procedure for getting my baby proper care?
  2. What are the specific risks to the baby in terms of causes of miscarriage, stillbirth, or other problems? What can we do prenatally or at birth to help protect my child?
  3. Is there a higher risk of problems at birth that may not be predictable by ultrasound? What steps should be taken in the hospital after birth to detect and treat these issues? Will a cardiologist come in to do an echocardiogram?
  4. Is there a greater chance of premature or early labor? How should this risk alter pregnancy treatment or birth plans?

I also would like to put on paper my desires for the birth experience and get your opinions about whether or not these are realistic expectations:

  1. I understand many prenatally diagnosed moms have an early, induced birth. Is this something we will be doing? What are the medical reasons for early delivery/ induction for a DS pregnancy?
  2. I would like to try to have the baby via natural vaginal birth and hopefully without an epidural. Is there anything that may interfere with those desires (specifically with regard to Down syndrome)?
  3. I would like to have skin-to-skin contact and try to begin nursing the baby as soon as she is born. We would like to avoid any separation from the baby. I know there is a possibility of intervention after the baby’s birth, but I would like all medical personnel to be aware of my wishes so that they will make every effort to meet them short of endangering the baby. Is it absolutely necessary for the baby to go to the NICU?

I would like a warm, supportive atmosphere for the birth of my baby. Please advise all medical personnel that I am well aware that my child has Down syndrome. Please instruct them not to say “I’m sorry” or “bad news” or any other negative phrases that could potentially tarnish this experience. I can feel myself moving from a point of emotional turmoil to excited anticipation of my baby’s arrival. I do not want anyone to ruin my first few days with my child by making comments that seem pitying or by stepping on eggshells around us. Let us know of any complications kindly and gently, but please remember to congratulate us on the birth of our beautiful baby.

Thank you so much for your time, expertise and especially your patience with this concerned patient!


Expectant Mom

Letter to Doctor Continuing to Offer Termination

Dear Doctor,

As you know, I am now 22 weeks along with my son NAME who has been diagnosed with Down syndrome. As I have explained, we are aware of all of our options, and we have made a conscious and final decision to welcome NAME into our family. This decision will not change.

Despite our clearly expressed intentions, I continue to hear you speak of my options concerning my pregnancy.

Despite the fact that we are certain of our path, pregnancy post-diagnosis has left me emotional and vulnerable. Your insistence on discussing other pregnancy options is contributing to that emotional state in a very unhealthy way. I do not wish to have to cope with perinatal depression, so please stop making comments and instead show me your full support.

Also, due to my history of pre-term labor, we had previously spoken of an aggressive preventative plan. Those plans seem to be receiving much less attention since NAME was diagnosed.

Please understand that not only do I wish every protection for my son NAME that any other child would receive, I would also hope my pregnancy would receive even more attention due to the Down syndrome diagnosis, which may trigger pregnancy complications.

Thank you for reading this letter. I feel confident we can get past this uncomfortable (at least for me) time and get back to the doctor-patient relationship which always gave me so much reassurance in the beginning of the pregnancy.


Expectant Mom