Here's mine, if it helps
Birth Preferences for XXXXXXXXXXXX
Family:- Husband (XXXX) and children (XXXX) Other attendants:- Mum (XXXX), Doula (XXXX)
In the event of an emergency, if the situation becomes life-threatening for me or our baby, we will yield to any life-saving intervention on the briefest of consultation.
In the strong likelihood that we have the normal birth that we are expecting, please check before performing any procedures. This includes any touching/handling of the baby during and after the birth.
Please help us keep the atmosphere as calm and positive as possible; quiet voices, low lights etc.
I’d prefer to be left on my own, pretty much throughout (except for intermittent checks), other than anyone I have specifically asked to be in the room with me, with complete freedom of movement throughout.
There is a box of supplies under the mirror in the living room (shower curtains, towels, baby things etc.)
Please feel free to take some photographs with my camera if there is time and you want to. Help yourself to tea, coffee, biscuits etc. Thank you for attending us 
Assuming everything is going smoothly, I would like to:
- use my birth pool
- avoid drugs if possible – don’t offer, I will ask if I change my mind.
- keep any monitoring to the barest minimum.
- catch my baby & find out the sex myself. If I am unable to, or do not want to when the time comes, please give [DHNAME] this opportunity.
- have immediate, uninterrupted and undisturbed skin to skin.
- avoid early cord clamping. I’ll say when I’m ready to cut it.
- have a physiological 3rd stage
- be left alone with the baby in the moments after the birth.
- have all routine procedures delayed until at least an hour after delivery
- Please give [DHNAME] the opportunity to cut the cord.
- have my baby touched only by myself, my husband or my mother as much as possible.
- DECLINE Vitamin K. We may re-consider (oral drops) AFTER the baby has been born.
Please note: I will be keeping my placenta.
(^ ^ this is about an A4 page. On the reverse
 
In the event of a transfer - preferably I would like to:
- keep my baby with me and breastfeed on demand. If my baby is having some problems, I would like to consider Kangaroo Mother Care and avoid separation from my baby if at all possible.
- to be accompanied by my husband and doula at all times. This includes in the event of a C-section.
- let my older children meet their new sibling as soon as possible.
- exclusively breastfeed – NO BOTTLES or artificial teats and NOTHING but breastmilk.
Approved:____________________________________________________________________________
I also tried out a cool "traffic light" plan:
RED - "No thank you" (eg. lithotomy position, coached pushing, forceps, early cord clamping, seperation of me and baby, artificial teats),
ORANGE LIGHT – “Under certain conditions” (eg. VEs, g&a)
GREEN LIGHT – YES PLEASE! (eg. Birth at home in a calm atmosphere; low lights, quiet voices, Freedom of movement throughout, Labour and/or birth in water if I want to, Physiological 3rd stage, breast crawl.)