Template for a Birth Plan After IVF or IUI

You are between 28 and 34 weeks pregnant after IVF or IUI, and the generic template for a birth plan someone sent you is asking whether you want lavender oil in the room. You want something different. You want a one-page document that tells the labor team what you have already been through, what flexibility you have, and what you want them to know before the first contraction.

A birth plan is not a contract. It is a communication tool. The point is not to dictate what happens; it is to make sure the team meeting you in triage at 3 a.m. understands who you are, what your history is, and which preferences are firm and which are negotiable. Hospitals respond well to plans that name flexibility, and a well-written one-page document does work that you cannot do during a contraction. This post gives you a template, the reasoning behind each section, and the specific things to add because of an IVF or IUI conception.

Why a generic template for a birth plan falls short after IVF or IUI

Most online templates were written for low-risk, spontaneously conceived pregnancies. They ask whether you want music. They do not ask about the placenta position you have been monitored for since 20 weeks. They do not ask whether your last frozen embryo transfer is one of the reasons your blood pressure is being checked weekly.

After assisted reproduction, your file already has flags. Placenta location. GDM screening result. Growth scans. Maternal age, BMI, and sometimes a thrombophilia workup.

The birth plan should reference these, not re-create them, because the labor team will already have your notes. Repeating the information is not the point. Connecting it to your preferences is.

I have started using the language "birth preferences" rather than "birth plan" in clinic. The document is more useful when it is framed as preferences and history rather than as a list of non-negotiable demands. The evidence supports this framing. Hidalgo-Lopezosa and colleagues found that maternal satisfaction was higher among people who had written a birth plan, independent of whether the actual birth followed the plan.⁵ The benefit comes from the conversation, not from the compliance. ACOG's Committee Opinion 766 on approaches to limiting unnecessary intervention during labor emphasises the same point: communication and shared decision-making are the active ingredients, not the document itself.¹

The one-page birth plan, section by section

The most useful birth plan in my experience fits on a single page. Anything longer is not read in full by the team meeting you on arrival. Here is the structure I recommend, with what goes in each section.

Top block, identity and clinical context: your name, your partner's name (if you have one), your EDD, your conception method (IVF, IUI, FET, medicated cycle, or natural after a long road), parity (G/P notation if you know it, otherwise number of prior pregnancies and births), and known clinical factors that the team needs to see at a glance: placenta location, gestational diabetes, hypertension, prior surgery, group B strep status, allergies. This block is the thirty-second orientation for the nurse who walks in.

Section 1, labor environment: who is in the room with you. Photography and video preferences. Music. Mobility during early labor (walking, position changes, birthing ball). Monitoring preferences: intermittent versus continuous, with an acknowledgement of when continuous is required for safety.

Section 2, pain management: your preferences around epidural (yes, no, will decide in labor, only after a certain point), nitrous oxide if available, IV opioids, non-pharmacologic methods (water immersion, TENS, hypnobirthing, breathing). A sentence to cover the case where you change your mind: "If I ask for an epidural, please do not remind me of this plan."

Section 3, interventions: your stance on artificial rupture of membranes (AROM), augmentation with synthetic oxytocin if labor stalls, episiotomy (the modern default is restrictive, not routine), and instrumental delivery (vacuum versus forceps) if it becomes necessary.

Section 4, pushing and delivery: position preferences (upright, side-lying, hands and knees, semi-recumbent). Mirror if you want to see. Perineal support (warm compresses reduce severe tearing, well-evidenced). Immediate skin-to-skin after birth. Delayed cord clamping: the WHO and ACOG both recommend a minimum of 30 to 60 seconds, with longer durations producing better neonatal iron stores in term infants.^{2 3} Placenta disposition (most units now offer to show you the placenta if you want to see it; encapsulation has weak and mixed evidence, and is not something I recommend in clinic).

Section 5, if a cesarean is needed: this is the section most generic templates skip and that I most want you to write. A clear drape preference, your partner's location, immediate skin-to-skin in theatre if your unit offers it, delayed cord clamping at cesarean (now supported by ACOG Committee Opinion 814), and what you want to be told as the surgery proceeds.² Cesarean preferences live in the same plan as vaginal preferences; the team works from one document.

Section 6, newborn: feeding plan (breastfeeding, formula, combination, time you want to take to decide). Vitamin K (intramuscular is the standard; some parents ask about oral, which is less effective). Hepatitis B vaccine timing. Eye prophylaxis (erythromycin in the US, varies in the UK). Circumcision plan if relevant. Where your partner goes if you are separated from the baby for any reason.

Section 7, if something changes: who makes decisions if you cannot in the moment. What you want communicated to your partner first if you are separated. A line for the team: "Please tell me what is happening and why, even if there is no time to ask my preference."

Negotiable, often non-negotiable, and unit-variable

A useful birth plan distinguishes preferences from requirements. Hospitals have rules. Some of them are absolute, some are local, and some are presented as absolute when they are actually negotiable. Knowing which is which avoids two failure modes: a plan that gets ignored because it asked for the impossible, and a plan that gives away preferences you could have had.

Mostly negotiable in most hospitals: movement during early labor. Intermittent monitoring in low-risk labor (per ACOG, intermittent auscultation is appropriate for low-risk patients).¹ Who cuts the cord. Immediate skin-to-skin if no complications. Delayed cord clamping at vaginal birth (now standard). A heparin lock instead of continuous IV if you do not need fluids.

Often non-negotiable: continuous fetal monitoring once oxytocin augmentation is started. IV access in high-risk pregnancies. Certain medications during obstetric emergencies (for example, magnesium sulfate for preeclampsia, oxytocin for postpartum haemorrhage).

Unit-variable: vaginal birth after cesarean (VBAC) eligibility, water birth availability, doula access, visitor policies, immediate skin-to-skin in theatre at cesarean. Ask at your 34 to 36 week visit which is which at your unit.

The honest framing for the document is: "These are my preferences. I want you to know my history. I will defer to you on safety questions, but I want to be told what is happening and why." Labor and delivery teams respond well to this. They respond less well to plans that read as adversarial.

What to include specifically because of your IVF or IUI history

Several things on the plan are different after assisted reproduction. Naming them once on the page saves repeated conversations during labor.

Placenta location and any prior abnormality: Vermey and colleagues' meta-analysis found a modestly elevated rate of placental anomalies (placenta previa, abruption, accreta spectrum) after ART singletons compared with non-ART singletons.⁶ If your scan at 20 weeks flagged a low-lying placenta and the 32-week scan resolved it, that is worth a single line. If you have known previa or suspected accreta, the entire delivery plan changes (planned cesarean, blood products available, often a specialist unit), and the plan is built collaboratively with maternal-fetal medicine.

FET versus fresh: Maheshwari and colleagues' cumulative meta-analysis found that frozen embryo transfer is associated with a small but real increase in hypertensive disorders of pregnancy compared with fresh transfer.⁷ If you are FET, your BP monitoring threshold is probably already tight. A note on the plan ("FET pregnancy, BP monitoring tight, please check on admission and 4-hourly") helps the team on the night shift.

Donor egg or donor sperm: decide what you want disclosed on the plan and what you want kept off. This is a privacy preference, not a medical requirement. Some parents are open; others prefer that this is held outside the chart visible to non-clinical staff. The plan can say "see notes, do not discuss conception details in front of family" if that matters to you.

Recurrent loss before this pregnancy: name it. It changes how the staff communicate uncertainty. A team that knows you had three losses before this pregnancy will phrase things differently than a team that does not, in ways that matter to you in the moment.

Multiple-gestation history (including reductions): placenta histology may be relevant; the team should know.

The partner's role on the plan

The partner is on the plan. Not as decoration, as a named participant with a role.

Name what the partner does at each stage. Translating medical jargon back to you. Advocating if you cannot speak. Holding the camera. Leaving the room if you need them to. Asking the question you would have asked if you had not been in transition.

Name who calls the family, when, and at what level of detail. After a long TTC road, this often matters more than it would in a spontaneous pregnancy. Some couples want the family told only after the baby is in the room. Others want a running update. There is no right answer; there is your answer, and it should be on the page.

If a cesarean happens, name where the partner is. Most units allow the non-gestational partner into theatre for an uncomplicated planned or unplanned cesarean. General anaesthesia is usually the exception. Write down what your partner is told and by whom if you are separated.

Give your partner a specific phrase to use if they feel overruled by the team in a non-emergency moment. The phrase I suggest is: "Can we have five minutes to talk?" It is a legitimate request in labor, not an obstruction. Labor teams understand it.

When to write the plan and who to share it with

Draft the plan at 28 to 32 weeks. The third trimester is the right time; earlier, the picture is too uncertain, and later, you risk not having the conversations with your OB before delivery.

Review the plan with your OB or midwife at 34 to 36 weeks. Most clinicians will read it through and mark it up. This conversation is the most useful part of the whole process, because it catches the preferences that are unit-impossible and the preferences your OB had assumed without your knowledge.

Bring three printed copies to the hospital. One for the chart, one for the bedside nurse, one for your partner to keep. Update the plan if anything changes after 36 weeks: breech presentation, growth concerns, planned cesarean, sudden hypertension.

What to ask your OB before finalising

• "What is your unit's standard practice for monitoring in low-risk labor? Intermittent or continuous as default?"
• "Is delayed cord clamping standard at both vaginal and cesarean births here?"
• "If I want a clear drape at cesarean, do I bring my own or do you provide one?"
• "What is your induction protocol if I go past 41 weeks given my IVF history?"
• "Who is on call the weekend I am likely to deliver, and is there continuity of carer in your unit?"
• "What is the threshold at which you would convert from vaginal birth to cesarean, given my history?"
• "What is your unit's policy on partner attendance in theatre under regional and under general anaesthesia?"

A good answer set from a clinician you trust is the real "birth plan." The document is the artefact that captures it.

What to do this week

A useful template for a birth plan starts with five concrete actions, not a wishlist of preferences.

1. Write the top block first: your name, partner, EDD, conception method, clinical flags. That single block does most of the orientation work.
2. List five preferences you actually care about, and three you do not care about. Most plans are too long because every preference is treated equally. Hierarchy is information.
3. Book the 34 to 36 week visit specifically as a birth plan review. Tell the receptionist this; it changes how the appointment is scheduled.
4. Have one focused conversation with your partner about Section 7 ("if something changes"). This is the section most couples have not discussed and most need to.
5. Print three copies in a folder. Pack the folder in the hospital bag.

What's next

• If a cesarean is planned or being discussed: cesarean after IVF
• If anxiety about labor is intensifying: PAI anxiety in later pregnancy
• For the postpartum window that follows: postpartum after infertility
• For symptoms in the lead-up to labor: third trimester symptoms
• If labor or birth does not go as planned: when things don't go to plan

Sources

1. American College of Obstetricians and Gynecologists. Committee Opinion No. 766: Approaches to Limit Intervention During Labor and Birth. Obstet Gynecol 2019;133(2):e164-e173 (Reaffirmed 2021). https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/02/approaches-to-limit-intervention-during-labor-and-birth
2. American College of Obstetricians and Gynecologists. Committee Opinion No. 814: Delayed Umbilical Cord Clamping After Birth. Obstet Gynecol 2020;136(6):e100-e106. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2020/12/delayed-umbilical-cord-clamping-after-birth
3. World Health Organization. WHO recommendations: intrapartum care for a positive childbirth experience. Geneva: WHO; 2018. https://www.who.int/publications/i/item/9789241550215
4. Lothian JA. Birth plans: the good, the bad, and the future. J Obstet Gynecol Neonatal Nurs 2006;35(2):295-303. https://pubmed.ncbi.nlm.nih.gov/16620256/
5. Hidalgo-Lopezosa P, Hidalgo-Maestre M, Rodriguez-Borrego MA. Birth plan compliance and its relation to maternal and neonatal outcomes. Rev Lat Am Enfermagem 2017;25:e2953.
6. Vermey BG, Buchanan A, Chambers GM, et al. Are singleton pregnancies after assisted reproduction technology (ART) associated with a higher risk of placental anomalies compared with non-ART singleton pregnancies? A systematic review and meta-analysis. BJOG 2019;126(2):209-218. https://obgyn.onlinelibrary.wiley.com/doi/10.1111/1471-0528.15227
7. Maheshwari A, Pandey S, Amalraj Raja E, Shetty A, Hamilton M, Bhattacharya S. Is frozen embryo transfer better for mothers and babies? Can cumulative meta-analysis provide a definitive answer? Hum Reprod Update 2018;24(1):35-58. https://academic.oup.com/humupd/article/24/1/35/4569360