In a divergence from my heretofore usual material, here is a birth plan outline that I wrote to share with clients (I offer doula and childbirth education services). Feel free to alter it however suits you and share with whoever wants to use it.
Birth Plan Outline
Overview: The basic concept behind this birth plan is (EXAMPLE: to allow for as natural a birth as possible etc)
How would you like to be hydrated (through IV or otherwise)?
How often do you want vaginal exams performed (all exams are optional, you may refuse to be examined at any time)?
What are your wishes for pain management?
What are your wishes for mobility?
How do you want your baby monitored (continuously with the belly straps, intermittently with the belly straps, intermittently with a handheld doppler)?
Do you want to be directed to a birthing position or choose one for your own comfort?
Do you want to push with your body's urges or with direction from your care provider or nurse?
Do you want your placenta delivered by cord traction (pulling on the cord)? Do you want Pitocin used in its delivery?
What do you wish for pain control after delivery?
When do you want the umbilical cord clamped and cut?
Where do you want your baby to go immediately after birth (onto your belly, into the warmer etc).
Do you want your baby to sleep in your room with you?
Do you want your baby to be given bottles or pacifiers?.
Do you want a circumcision performed?
Should a C-section become necessary, how do you want it handled? Who do you want in the room with you? How soon do you want breastfeeding to be established? Where do you want your baby to go? If you wear glasses, do you wish to have them with you?
Should your baby be born premature or sick, how do you want it handled? When do you want to see your baby? When will you want to initiate breastfeeding?