Name
*
First Name
Last Name
Email
*
Phone
(###)
###
####
Which doula are you working with?
*
Husband/Significant Other's Name
Husband/Significant Other's Phone Number
(###)
###
####
Home Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
What do you and your husband/significant other do for a living?
What is your estimated due date?
MM
DD
YYYY
What is appealing to you about your care provider and place of birth? What drew you to them? Why are they a good fit for you?
If you are planning on having your baby at home or birth center, who is your back-up physician and hospital?
Do you have any allergies? If yes, please list them here.
What does exercise look like for you right now?
Do you currently struggle with anxiety/depression?
Have you ever experienced any type of trauma or abuse?
We recognize this is a very personal question. Our experiences with trauma can impact our birthing and parenting journey. We ask this question so your can guide you through this journey to the best of their ability and get you connected to the best resources for your specific situation.
How many times have you been pregnant?
Do you have a history of miscarriage or infant loss?
Did you experience any complications with your previous pregnancies?
How many vaginal births have you had in the past?
How many cesareans have you had in the past?
Describe how your previous labors began. How far along were you with each?
i.e. induced at 38 weeks and 1 day with first, spontaneous at 40 weeks and 2 days with second
How long were your previous labors?
Did you have any type of intervention during your previous births?
How was your postpartum recovery period with previous births?
Did you experience any type of perinatal mood or anxiety disorders with any of your previous pregnancies?
This includes depression during pregnancy or postpartum, anxiety during pregnancy or postpartum, pregnancy or postpartum OCD, postpartum PTSD, bipolar mood disorder during pregnancy or postpartum, or postpartum psychosis
How were your previous feeding journeys? If you breastfed, how long did you breastfeed?
Are you having one baby or multiples?
Are you having a boy or a girl?
Do you have any current pregnancy related health concerns that you know of?
Do you have any health or physical concerns that may affect your pregnancy or birth in any way?
How are you planning to feed your baby?
Who else will be attending the birth?
What are your hopes and desires for this birth?
Are you having any fears or worries about this birth?
When you think about spiritual/religious preferences during your birth, what do you envision? Are you comfortable with your doula praying over you during labor?
What are your expectations for your doula?
Where has most of your knowledge about birth come from so far?
Family/Friends, Books, Documentaries, Childbirth Course, Instagram/TikTok Accounts, Podcasts, etc. Be specific!
Have you take a childbirth education class?
What brings you comfort when you experience stress or pain (such as, distraction, movement, prayer, bath/shower, music, massage, aromatherapy, nature, sleep, meditation, etc)?
How did you hear about Expectant?
Do you have any questions currently that you would like your doula to address during your prenatal meetings or anything else you think she should know about you/your upcoming birth preferences?
