Choose the place of birth
Identify the intended place of birth and a facility that can provide the level of care appropriate to the pregnancy. Know the route and where to report when labour begins or an emergency occurs.
Pregnancy • Birth • Emergency Planning
Birth Preparedness & Complication Readiness
A practical, person-centred plan for preparing for childbirth and responding quickly if a maternal or newborn complication occurs.
WHO-aligned
Skilled care at birth
Emergency referral planning
Family & support planning
The core plan
Eight practical elements of birth preparedness
WHO guidance describes birth preparedness and complication readiness as a way to improve the use of skilled care and timely facility care when complications occur.
Identify skilled care and support
Record the health worker or maternity team who will provide care and identify a companion and additional family or community support according to the woman’s preferences.
Plan transport
Decide how the woman will reach the facility day or night. Keep a primary option and a backup option, especially where travel time or transport availability may be unpredictable.
Prepare funds and essential documents
Plan for expected and unexpected expenses. Keep identification, health records, investigation reports, prescriptions and other locally required documents accessible.
Save important contacts
Keep contact details for the maternity facility, health worker, transport provider and trusted support people in the phone and in a written form.
Arrange practical support
Plan who can accompany the woman and who can look after children, older family members, the home or other responsibilities while she is away.
Know the blood-donor plan where relevant
Where local services require or recommend it, discuss how compatible blood could be accessed quickly during a serious emergency. Follow the facility’s current blood-bank procedures.
Write the plan down
A written plan helps the woman, family and care team understand preferences, practical arrangements and what to do if labour or a complication occurs.
Emergency readiness
Build a plan that still works when something changes
The purpose of the plan is not to predict every complication. It is to reduce avoidable delays in recognizing a problem, deciding to seek care, reaching care and receiving appropriate care.
1
Recognize
Know the pregnancy, labour, postpartum and newborn warning signs discussed by the maternity team.
2
Decide
Agree in advance who will make or support the decision to seek care while respecting the pregnant woman’s autonomy.
3
Call
Contact the maternity facility or appropriate emergency service promptly when a danger sign occurs.
4
Transport
Activate the planned transport without waiting for a situation to become worse.
5
Refer
If the first facility cannot provide the required level of care, follow the referral pathway to the appropriate higher-level facility.
6
Communicate
Take health records and communicate important history, gestational age, medicines, allergies and the reason for referral.
Facility and referral plan
- Intended birth facilityWrite the facility name, address and maternity contact number.
- Emergency facilityKnow which facility can provide the higher level of care needed for a complication.
- Route and accessKnow the route, approximate travel time and alternatives if the usual route is unavailable.
- Referral communicationAsk how referrals are coordinated and which records should accompany the woman.
Contacts and support
- Maternity teamKeep the health worker/facility number accessible.
- TransportHave a primary and backup transport option where feasible.
- CompanionIdentify the woman’s preferred companion for labour and childbirth, subject to facility policy.
- Family responsibilitiesPlan childcare, household support and other responsibilities during admission or referral.
Danger signs
Know when to seek urgent care
The exact advice should be individualized by the maternity team. These warning signs should never be used to delay professional assessment.
Vaginal bleeding
Bleeding during pregnancy, labour or after birth can require urgent assessment. Do not wait for it to become heavy before seeking care.
Severe abdominal or persistent pain
Severe, persistent or unusual abdominal pain needs prompt clinical assessment.
Severe headache, visual symptoms or convulsions
These may indicate a serious pregnancy complication and require urgent medical assessment.
Difficulty breathing, chest pain or collapse
Breathing difficulty, chest pain, fainting or collapse are emergency symptoms.
High fever or feeling severely unwell
Fever with marked illness, weakness or other concerning symptoms needs prompt evaluation.
Reduced or absent fetal movement
A noticeable reduction or absence of fetal movement should be assessed promptly according to local maternity guidance.
Watery fluid leaking before or during labour
Possible rupture of membranes should be discussed with the maternity team, particularly when it occurs before established labour or is accompanied by concerning symptoms.
Labour concerns or prolonged difficulty
If labour begins or there are concerns about its progress, contact the maternity care team and follow the planned referral pathway.
Emergency principle: If the woman is severely unwell, has heavy bleeding, convulsions, difficulty breathing, loss of consciousness, or another immediately life-threatening symptom, activate emergency medical care without delay.
Labour and childbirth
Prepare for normal labour while remaining ready for referral
A birth plan can express preferences while recognizing that the woman’s and baby’s clinical condition may require a change in plan.
| Plan ahead | What to clarify | Why it matters |
|---|---|---|
| Place of birth | Where is the intended facility and what maternity services are available there? | Supports timely use of skilled care and appropriate referral when needed. |
| Arrival plan | When should the woman contact the maternity team or travel to the facility? | Reduces uncertainty when labour starts or symptoms change. |
| Companion and support | Who will accompany the woman and who will manage responsibilities at home? | Practical support can make it easier to reach care promptly. |
| Emergency referral | Which higher-level facility will be used if additional care is required? | Helps reduce delay when the first facility cannot provide the required level of care. |
| Records and medicines | Where are antenatal records, investigation reports and current medicines documented? | Supports continuity and communication during transfer or admission. |
| Preferences | What are the woman’s preferences for communication, companion, mobility, comfort and respectful care? | Supports person-centred care while allowing clinically necessary changes. |
Antenatal review
Keep the plan updated throughout pregnancy
WHO recommends antenatal care as a platform for health promotion, screening, prevention, counselling and timely identification of problems. Birth preparedness should therefore be reviewed during ongoing antenatal care.
WHO ANC contact framework
WHO's 2016 ANC guideline recommends a minimum of eight contacts, with the first contact in the first 12 weeks and subsequent contacts around 20, 26, 30, 34, 36, 38 and 40 weeks.
| Contact | Timing |
|---|---|
| First | Up to 12 weeks |
| Second | 20 weeks |
| Third | 26 weeks |
| Fourth | 30 weeks |
| Fifth | 34 weeks |
| Sixth | 36 weeks |
| Seventh | 38 weeks |
| Eighth | 40 weeks |
Review checklist
- Risk statusHas anything changed that requires additional monitoring or referral?
- FacilityIs the intended place of birth still appropriate?
- TransportIs transport available, including at night?
- ContactsAre facility and support numbers current?
- RecordsAre health records, medicines and reports organized?
- Emergency planDoes the woman and family know the warning signs and first action?
Practical checklist
What to keep ready
Adapt this checklist to the maternity facility, local health system and the woman’s individual needs.
Health records
Antenatal record, investigation reports, ultrasound reports where applicable, prescriptions and relevant medical history.
Contact list
Maternity facility, health worker, transport, support person and emergency contacts.
Home support
Childcare, household support, companion arrangements and a backup plan if the woman needs admission.
Financial plan
Plan for routine and emergency expenses according to local services and family circumstances.
For midwives, nurses & educators
Use BPCR as a counselling and continuity tool
The plan should be a conversation, not just a form. Check understanding, invite questions, respect autonomy and update the plan when circumstances change.
Counselling approach
- AskAsk the woman what she understands about labour, birth and possible emergencies.
- ExplainUse clear language to explain the facility, transport, danger signs and referral pathway.
- PlanWrite down practical arrangements with the woman and her chosen support people.
- Check understandingUse teach-back: ask the woman or family to explain what they would do if a warning sign occurs.
Respect, autonomy & safety
BPCR should support the woman’s informed choices and autonomy. Family involvement can be useful when the woman wants it, but planning should not replace respectful communication, informed decision-making or access to appropriate clinical care.
Continuity principle: Review the plan across antenatal, intrapartum and postnatal care, especially when risk status, residence, facility capacity or transport arrangements change.
Frequently asked questions
Birth preparedness questions
What is birth preparedness and complication readiness?
It is a practical plan made during pregnancy to prepare for childbirth and for the possibility of an obstetric or newborn complication. It includes the place of birth, skilled care, transport, finances, supplies, support people, emergency contacts and actions to take when warning signs occur.
Should every pregnant woman have a plan even if the pregnancy is low risk?
Yes. Complications can arise unexpectedly, so preparedness should be part of routine antenatal care for all pregnant women and families. The plan can be individualized according to the woman’s circumstances and level of risk.
What should be included in a birth preparedness plan?
The plan should identify the intended place of birth, skilled care, route and transport, expected expenses, essential supplies and records, a labour/birth companion, practical family support, emergency contacts and the pathway for referral if complications occur.
When should the birth and emergency plan be made?
Planning should begin during antenatal care and be reviewed as pregnancy progresses. The plan should be updated when the expected place of birth, risk status, transport arrangements, contact information or other important circumstances change.
What should I do if a danger sign occurs?
Seek urgent medical assessment and activate the planned emergency pathway. Contact the maternity facility or appropriate emergency service, arrange transport and take the woman’s health records. Do not delay emergency care while trying home remedies.
Does having a birth plan mean the birth will happen exactly as planned?
No. A plan prepares the woman and family for common arrangements and possible changes. Clinical decisions during labour or an emergency must be based on the woman’s and baby’s condition, informed communication, the woman’s preferences and the capabilities of the facility.
Guideline references
Evidence base
Key WHO resources used for this educational page.
WHO recommendations on antenatal care for a positive pregnancy experience (2016)
Global ANC guidance covering health promotion, screening, prevention, counselling and health-system interventions.
WHO guideline
WHO recommendations on health promotion interventions for maternal and newborn health
Includes the recommendation on birth preparedness and complication readiness and describes key plan elements such as place of birth, skilled attendant, transport, funds, supplies, support and blood-donor planning.
WHO evidence and recommendations
WHO: Making plans for childbirth when pregnant (2022)
Practical information for creating a written birth preparedness and complication readiness plan.
WHO practical guide
WHO recommendations: Intrapartum care for a positive childbirth experience (2018)
Evidence-based intrapartum care emphasizing woman-centred care, communication, monitoring and appropriate referral.
WHO intrapartum care guideline
Educational information: This page is for general health education and does not replace individualized antenatal, intrapartum or emergency medical care. Pregnancy and childbirth plans should be discussed with the woman’s qualified maternity care team and adapted to her health status, gestational age, preferences, local referral system and available services. In an emergency, seek urgent medical care rather than relying on this webpage.