Client Survey

A quick reminder about when you should contact me...

Please send me a text when you feel like labor is beginning. This allows me to think about the next few days with your birth in mind. I won’t get in my car, but I will make sure that my bag is packed and ready by the door.

Once contractions have intensified and you’ve decided it’s time to call your midwife or head to the hospital, please send me a message or give me a call. My goal is to arrive when you are in active labor. This ensures that my presence won’t distract you or prevent your labor from advancing. If you aren’t sure if you’re in active labor, your care provider will be the best gauge. Below are a few rough guides that can hint at active labor (but remember, active labor looks different for each woman!)

Contractions are 3-4 minutes apart, for one hour
Contractions are too intense to walk or talk through
Contractions are accompanied with rectal pressure
Dilated to at least 6 centimeters

Remember, I need at least one hour's notice. Please don’t hesitate to contact me once you feel like active labor has begun.

My phone number is (612) 991-6378.

If you can't get ahold of me, try reaching out to Bobby at (651) 307-2067.

name and phone number

birth partner's name and phone number

name of birth facility

include address if planning a home birth

estimated due date

month, day, year

this is my ___ birth

first, second, third...

please list sibling names and ages

if this is not your first pregnancy, please share any pertinent details about your previous births.

This will help me plan when to arrive at your birth. (early, overdue, c-section, birth plans, etc)

general birth preferences

do you have any specifics that are most important for me to capture? please share any additional information or special instructions that you may have for me!

(keep in mind that i will try my best to capture it ... but birth is unpredictable!)

how would you describe your ideal birth atmostphere?

if for any reason there is an emergency during your birth ... what would you like me to do?

if you are going to be transferred to another location during birth ... what would you like me to do?

others planning to be in attendance at your birth?

do you have any food allergies?

I sometimes bring snacks to births and would love to avoid anything that will cause problems.

anything else I should know?

are you interested in complimentary documentary mini-sessions?

These take place in your home a month before baby's EDD and a week or two after baby' birth. *No, we only want documentation at our birth *Prenatal photos only *Postpartum photos only *Prenatal and postpartum photos

who were you referred by?

are you interested in learning about my other services?

*No, but thanks! *Prints *Videography *Birth Doula Services *Postpartum Doula Services *Real Postpartum session