Creating a birth plan helps convey to your care team what your priorities and concerns are during your labor and with your new baby. While birth plans are less crucial at home or birth center deliveries, they're important to have for hospital births. Generally there's a standard protocol for hospital staff to follow, so having your wishes in writing can help facilitate communication about your requests. Plus in the middle of your labor you're not going to want to be answering questions repeatedly - having your wishes already typed up helps ensure everyone is on the same page.
Birth plans can be short and sweet - a half page with bullet points is great! Be sure to discuss these hopes with your midwife or OB in advance. No matter what your birth plan says, during your labor some wishes may not be possible until your doctor gives approval to the staff. If you feel strongly about something - like using a labor tub - then be sure to talk this over with your doctor, and ask how that will be handled when you arrive in labor. There's standing orders for most doctors, and until your doctor calls in something different you'll often not be allowed to deviate from those orders. (An example - standing orders may require continuous monitoring, and until your OB says otherwise the staff will expect you to comply and stay in bed. Sometimes they'll be understanding and let you up - other times they'll be not so kind about demanding you stay in bed.)
If your pediatrician has hospital privileges then it can be helpful to also share your birth plan with them during your consultation (or if you have older children simply bring your birth plan to one of their check ups and discuss it with your doctor.) Having your OB and pediatrician sign the birth plan in advance can help when dealing with any requests outside the norm - staff can see the doctors were aware already of your requests and agreed. However, some doctors resist the idea of signing a "plan" as it may imply they are agreeing to these requests and in labor all bets are off - things may change, and they may not be comfortable signing off on something they truly have no control over. Remember that signature is not in any way a promise, and if they are not comfortable signing it then don't think that means they don't agree with it. Just use that as a chance to discuss your concerns further!
Some items to discuss and include:
Monitoring, whether intermittent or continuous?
IV vs. saline lock?
Food & drink during labor?
Use of the shower or tub?
Vaginal exams - limit, how often, by whom?
Getting out of bed, walking (outside of L&D or only inside) and use of birth ball?
Pushing positions, any time limits on pushing length, episiotomies, pitocin or other options for bleeding after the birth, etc?
Newborn care: eye ointment, vitamin K, Hep B, bathing, circumcision, delaying any procedures, rooming in, offering pacifiers or bottles, etc?
Hopefully this gives you some ideas to get the discussion going. I have a form I discuss with clients (the "Things to Consider" PDF) and it has more in depth details. It's good to discuss your plan with your doula and care team as there may be some things standard at your hospital and you can just leave those points off the plan entirely. One of our local hospitals does a saline lock now standard (vs. IV) so parents don't need to stress about including that. One hospital has labor tubs in two rooms, the other has one they keep locked up and have been claiming is broken for two years now. 🙂 One hospital allows parents to bring in a birth ball but doesn't carry them anymore, the other hospital has them but not in every room. Your doula can give you some insights into situations like those.
Regardless of how things may change during your labor, immediately postpartum the staff will have questions and I think a "nursery plan" for baby is very important. Do you want the baby to have vitamin K, erythromycin eye ointment, Hep V, be bathed, keep the placenta or have them dispose of it, etc? No matter how things unfold with your birth, you do need to discuss with your partner in advance what your plans are for your postpartum and newborn care.
I say "birth plan" because that's the term often used these days, but I think "birth hopes" or "birth wishes" is more fitting. You can plan all you want, but ultimately birth is full of surprises. I do think it's important to know your options in advance and discuss them with your care team, recognizing that as your birth unfolds you'll need to make some adaptations. But if you don't know your options you limit your options. Do your research, talk with your care team, and write up your hopes for your birth! But be aware that some things may not be possible depending on circumstances and be prepared to be flexible. I think it's wise to prioritize your list - what are your TOP priorities, what are lower concerns? Try to keep the focus on those top goals, so you can invest your energy on the issues that matter most to you.