Example birthing request form

Whether you're having a vaginal or abdominal birth, you have more control than you think. You can have requests to make you feel more comfortable, like a birthing preferences form. If you're scheduled for a C-section and would like to feel more prepared as well as know your options, discover our caesarean empowerment guide here



Name: Laura Berkley 

DOB: 10/02/87

Birth partner/partners: Rick (my partner)


EDD: 03/05/21

NHS no: ************

Contact details: My number 078********

My birth partner: 076********

Important Information:
We would love to have a midwife/surgeon/team that are supportive & understanding of hypnobirthing & that would support a gentle section. Could someone please take photos/videos during surgery?

Please avoid:

  • Discussing “surgery” can we please discuss “birth”
  • Talk about discomfort rather than “pain”
  • Rubbing my baby – we would like amniotic fluid, vernix etc left on baby as much as possible as the benefits are important
  • Cutting baby’s cord before 5 minutes – WAIT FOR WHITE!
  • Cannula in LEFT hand. I’m right handed


  • Low lighting when possible
  • Use of our relaxation tracks during spinal & operation
  • Use of our aromatherapy & homeopathy
  • Quiet, calm & reassuring voices
  • Positive atmosphere/language & words


  • Happy for any necessary monitoring
  • Please can I have ECG monitors on my back/shoulders so my chest is clear & pads are not in the way for skin to skin once baby arrives

Comfort measures:

  • Headphones for relaxation music
  • Partner with me at all times
  • Hypnobirthing tools/techniques
  • Cannula in left hand as I am right handed

During birthing:

  • Keep voices quiet & calm as our baby is born
  • Low lighting whenever possible
  • Our music to be played as our baby is born
  • Allow baby to be born as gently as possible to mimic vaginal birth
  • To bring baby onto my chest for skin2skin

Additional notes:

(You can add any other important preferences here), medical history, if this is your 1st baby or not etc

You could look into vaginal seeding to support your baby’s gut microbiome

Feeding: (Depending on how you intend to feed your baby you can choose from the following options listed)

  • My hand expressed colostrum if needed
  • My colostrum from syringes I have with me
  • Support with breastfeeding
  • If baby needs any other milk I have colostrum but am also happy for baby to have formula if absolutely needed
  • To feed my baby formula (you can request that this is only you or your partner to feed baby)

Golden hour of power after birth:

  • Delayed cord clamping – WAIT FOR WHITE if baby is stable
  • Time & privacy alone to bond in recovery
  • Support with breastfeeding if I feel I need it – especially after surgery (if you intend to breastfeed)
  • No interruptions
  • Delayed newborn checks for at least an hour or 2
  • As much skin to skin as possible

Vitamin K injection to be given (check out Dr Sara Wickham for vitamin K info

p.s don't forget you got this mama!

Love Sophia x