Birth Story Questionnaire
Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Partner's Name
First Name
Last Name
Partner's Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Estimated Due Date
-
Month
-
Day
Year
Date Picker Icon
Location type
Hospital
Home
Birth Center
Other
Location Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What is your current birth plan?
Spontaneous birth
Induction
C-section
Current pregnancy: Check any that apply.
Normal with no complications
High risk
Some complications no concern yet
Other
Care Provider
Doctor
Midwife
Unassisted
Other
Name of Practice
Phone Number of Practice
-
Area Code
Phone Number
Who will be your attending birth workers?
Have you advised your team that you’ll have a professional photographer attending your birth?
Do you plan on having your children present at the birth? Please list names and ages.
Please list any other people who may be present during the birth. (Other family members, pets, videographer...)
Which particular elements of the labor and birth would you specifically like me to capture?
Partner Support
Baby's head as he/she crowns
Bonding moments with specific family members
The placenta
Labor
Family in attendance
Care providers (with permission)
Breastfeeding
Ideally, how would you like for me to capture the “crowning moment”?
From the side
From mama's viewpoint
Crowning view
No preference
Other
What other elements of the labor and birth are important to you for me to capture?
Are there any goals or details within your birth plan that you would like to share with me?
I am particularly sensitive to when it’s appropriate to be in the birthing space and when to step away. Would you like me to leave the room during particular situations or procedures?
Internal Examinations
Epidural
Vomiting
Emergency Situation
Other
If for any reason you are to be transferred from home to hospital or from one hospital to another for any reason, would you want me to:
Follow
Wait for instruction
Other
If any emergency situation does happen, do you want me to continue documenting?
Please specify any laboring techniques you will possibly use. (hypnobabies, birth pool, epidural, etc.)
Any specific practices that will be performed? (delayed cord clamping, lotus birth, etc.)
Lighting during birth is generally low and this affects the quality and clarity of images, such that they can appear grainy and sometimes very soft. I always prefer to use natural light but there are certain times when it may be preferable to bounce a flash to throw sufficient light into the shot to make the picture look less grainy and increase sharpness. Are you okay with flash being used sparingly in these situations?
As you probably know, social media is my greatest tool for sharing my work. I would love the opportunity to share your (non-revealing) birth images in my portfolio and with my followers. Obviously this decision is always up to you. How do you feel about images being shared on my website or social media? (There will also be a model release form where we can discuss this more in depth)
Birth Stories will be something you will treasure forever. What is most important to you for me to capture?
Is there anything else you'd like to add?
Submit
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