Client Code:CDP584

CDP Data Collection Form

Priority Medicaid Populations (check all that apply):
  • Limited/No family support

Doula: Heidi Donahue

Meet and Greet Date: 06/10/2021

Method: phone

Date of 1st Prenatal: 07/07/2021

1st Prenatal Attended By: Heidi Donahue

Location of 1st Prenatal: Starbucks in Albany

Time: 1.5

Notes:

discussed how she has felt throughout her pregnancy so far, and how she has been feeling emotionally and physically. we talked about her fears of depression for postpartum, and her current anxieties surrounding childbirth and postpartum times. I gave her some resources for childbirth education classes and newborn care classes. we talked about what my role as a doula is, and how I could support her throughout this process, as well as what I don't do. she asked questions about medication options for labor and we discussed them. talked about breastfeeding and formula feeding and what her ultimate feeding goals are, and her fears around things getting too stressful and hard for her and how she fears she wouldn't be able to continue trying to breastfeed. discussed PP depression and putting plans into place for that, since she has a history of depression.

Date of 2nd Prenatal: 09/01/2021

2nd Prenatal Attended By: Heidi Donahue

Location of 2nd Prenatal: clients home in Albany

Time: 1.5

Notes:

Clients partner Zach, and clients mother were at this prenatal. they both plan to be at the birth. Client has been having back pain, so I gave her some referrals to a couple of chiropractors in the area that take her insurance. she says baby is in a "tough position" and we talked about different things she can do to try and get her body feeling more comfortable. we made a birth plan and talked about pain relief options that the hospital provides, and pain relief things I can do to help her in early labor. we talked about what to expect at the corvallis hospital when she goes there in labor, and what the experience is like. she got diagnosed with a blood disorder recently, as well as gall bladder issues and we talked through her emotions about these. the client battles negative body image, and depression and we talked about those and her fears for them getting worse postpartum. we talked about making sure she has her therapy set up for after baby arrives, as well as being honest with her doctor and asking for a medication increase PP if she is feeling the depression suddenly getting worse, she is excited to have access to 4 PP visits, and feels that will be extremely helpful for her. I gave them the information about healthy families, and they declined a referral to them.

Total Prenatal Hours With Client: 8

Date of Doula Arrival: 09/30/2021

Time of Doula Arrival: 05:30

Birth Attended By: Heidi Donahue

Date of Doula Departure: 09/30/2021

Time of Doula Departure: 11:30

Client birthed? Yes

Total Hours With Client: 6

Date of 1st Postpartum: 10/07/2021

1st Postpartum Attended By: Heidi Donahue

Location of 1st Postpartum: phone

Time: 1 hour

Notes:

talked with client about her PP depression setting in and her fears around "being able to do this". discussed breastfeeding and pumping and how feeding is going and her new feeding goals. talked about her partner going back to work and the stressors around that. clients mom is coming to stay and help her. also discussed how she is healing from the cesarean.

Date of 2nd Postpartum: 10/20/2021

2nd Postpartum Attended By: Heidi Donahue

Location of 2nd Postpartum: zoom

Time: 1 hour

Notes:

discussed feeding struggles, and the amount she is feeding him and him still being extremely fussy and waking each hour at night many nights, she feels exhausted and stressed out. talked about struggles with depression, but how she is doing all the right things like her phone therapy and upping her medication. we talked about soothing techniques for baby, and how to try and get him on a more regular feeding schedule now that she has switched to exclusively formula feeding. talked about how breast-feeding was causing to much stress and anxiety and how switching to formula only has helped her a lot.

Total Postpartum Hours With Client: 4

Date Created: October 22, 2021

Baby's Date of Birth: 09/30/2021


Edinburgh Postnatal Depression Scale (EPDS)

In the past 7 days:

I have been able to laugh and see the funny side of things: 1

I have looked forward with enjoyment to things: 1

I have blamed myself unnecessarily when things went wrong: 3

I have been anxious or worried for no good reason: 0

I have felt scared or panicky for no very good reason: 0

Things have been getting on top of me: 3

I have been so unhappy that I have had difficulty sleeping: 0

I have felt sad or miserable: 2

I have been so unhappy that I have been crying: 0

The thought of harming myself has occurred to me: 0

Total Score:10

Administered/Reviewed By: Heidi Donahue

Date: 11/10/2021


Invoice Form (Credentialed Doulas)

Invoice Date: 10/22/2021

Check All Services Provided:
  • Global Package: 2 Prenatal, Birth, 2 Postpartum


Client Confidentiality Release Form

Signature:

Date signed: 07/07/2021

Date of birth: 01/18/1999


Media Release

Signature:

Date signed: 07/07/2021


Online Birth Data Survey

Primary doula: Heidi Donahue

Insta-doula birth: No

Back-up: Yes, but provided no services on their own

Racial/ethnic minority: No

Limited/no English: No

Homeless/underhoused: No

Client is <21: No

Limited/no social support: Yes

Medically high risk: Yes

Due date: 10/07/2021

Primipara (first birth): Yes

Had client ever had a prior cesarean?No

Had client ever had a prior vaginal birth?No

Was this pregnancy multiples (twins, etc.)?No

Was the baby breech?Yes

Prior to birth was client planning to breastfeed/chestfeed?Yes

Went to Emergency room during pregnancy?No

Was the baby admitted to the NICU?No

Did the client and baby go home from the hospital at the same time?Yes

After discharge was the baby readmitted to the hospital?No

After discharge was the client readmitted to the hospital?No

After birth, did the baby go to the Emergency Room?No

The last time you saw the client was the baby being breastfed/chestfed?No (all formula feeding)

Did client relinquish her baby after birth?No

Just before labor, client was planning birth at: Hospital

Where was baby born?Corvallis hospital

Planned mode of birth: Scheduled (planned) cesarean

Actual mode of birth: Cesarean

Was the baby born: Within a week of the due date

Baby's birthweight: 8 lbs. 14 oz.

Entry date: October 22, 2021


CDP Letter of Agreement

Client signature:

Date signed: 07/07/2021


Required Documents Checklist

Confidentiality Release Form:
  • Completed

CDP Data Collection Form:
  • Completed

Online Birth Data Survey:
  • Completed

EPDS:
  • Completed

Media Release:
  • Completed

Invoice:
  • Completed

Entry date: March 31, 2022