Post Birth Information for Placenta Encapsulation

Post Birth Information for Placenta Encapsulation
Congratulations!

We gather some data for safety and tracking. We can ask you these questions when we arrive, or you can fill this out and we'll get out of your hair sooner.

Please keep the placenta safe, clean, and cool until we arrive. Use a pink hospital container with some hospital ice if a cooler isn't available.

If you need to provide blood work, a nurse may be able to offer it verbally to us with your permission.

We can accept any payments when we arrive as well.

** Because of Covid 19, we may not be able to come to your room directly nor talk with a nurse to get HIV/Hep B status. We will get as close as possible while obeying your birth place's policies and staying safe.
Mother's Name *

First Name Last Name
Birth Place (with room number) *
When was baby born? *

Month Day Year
Date Hour Minutes AM/PM Option
How much did baby weigh?
If you've been happily cuddling your newborn and haven't gathered this, enjoy those snuggles.
What is baby's sex?

Female Male Prefer not to answer
How did your labor start?

Spontaneous labor Induced labor Planned cesarean Unknown / Prefer not to answer
How was baby born?

Vaginal - land Vaginal - water Cesarean Prefer not to answer
Did baby pass meconium (baby's first poo) before birth? (If so, we will use an apple cider vinegar rinse to wash the placenta.) *

No Yes Unknown
Was mother GBS (Group B Strep) positive? (If so, we recommend steamed prep only.) *

No Yes Unknown
Was mother showing any signs of infection, especially fever, during labor? (If so, placenta encapsulation is not recommended.) *

No Yes Unknown
Is there anything you think we should know about labor or birth that would impact placenta encapsulation?
We will see you shortly!
Should be Empty: