Client Code:CDP649

CDP Data Collection Form

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

Date of Referral: 08/24/2021

Doula: Heidi Donahue

Meet and Greet Date: 08/26/2021

Method: phone

Date of 1st Prenatal: 09/08/2021

1st Prenatal Attended By: Heidi Donahue

Location of 1st Prenatal: Clients home

Time: 1.5


introduction to what a doula is and does. asked her what kind of support would be helpful for her. talked about how she is going to be a single parent, and has limited social and family support, and she struggles with anxiety. talked about how the pregnancy has gone so far, and what she is finding the most stressful and the most enjoyable. we talked through her desire to have a unmedicated birth, and what I could do to hopefully help her achieve that. talked to her about healthy families, and she was open to thinking about it and wanted tog et back to me before me sending in a referral for her. Asked if there were any services she would like me to look into for her, and I discussed with her how I thought a childbirth education class would be really helpful for her and gave her information on where to find them

Date of 2nd Prenatal: 09/22/2021

2nd Prenatal Attended By: Heidi Donahue

Location of 2nd Prenatal: clients home

Time: 2


we talked through her desired birth plan, and wrote out what was important to her and the things she wanted to avoid e.g. fentanyl, hep b vaccine for baby, episiotomy.
talked about what postpartum support will look like for her, and how her mother plans to come by and help as much as she can in the first few weeks. we talked about what my support would look like PP as well, and I discussed the option to have 4 PP visits if she felt it would be helpful.
we discussed how she has been feeling, and her fears and anxieties about the labor and birth process, and I was able to answer many questions she had about what the process looks like normally. we talked about when to call me, and how I would help her walk through the early labor process and when to head to the hospital based on her wishes to labor at home for awhile.

Total Prenatal Hours With Client: 5

Date of Doula Arrival: 10/04/2021

Time of Doula Arrival: 12:00

Birth Attended By: Heidi Donahue

Date of Doula Departure: 10/04/2021

Time of Doula Departure: 23:00

Client birthed? Yes

Total Hours With Client: 11

Date of 1st Postpartum: 10/09/2021

1st Postpartum Attended By: Heidi Donahue

Location of 1st Postpartum: clients home

Time: 1.5


went over how the client was feeling physically, and how healing of stitches were feeling. the client had extensive tearing, and we talked about how the healing of that was doing. she was having a lot of anxiety over breastfeeding and baby was very sleepy so we spent most of the time going over breastfeeding basics, and I watched a feeding and helped ensure her that baby's latch looked great, but he was very sleepy so I gave her some tips on how to keep him awake and getting some pumped milk to feed in a bottle once he was too tired to keep nursing. we went over how to relieve engorgement, and basics on using the pump and I spent a lot of time encouraging her that she was doing an amazing job.

Date of 2nd Postpartum: 10/27/2021

2nd Postpartum Attended By: Heidi Donahue

Location of 2nd Postpartum: clients home

Time: 2


talked a lot about breastfeeding, and how she is doing amazing and all the right things and I encouraged her not to be too anxious because she is doing great and so is baby. talked about PP healing from the birth, her favorite parts of motherhood so far and her most stressful parts as well. talked about life stressors of relationships with her extended family and how they all want to see the baby but haven't showed interest in her life before this and how it is really hard. I showed her how to use her infant carriers and encouraged her to get out of house to take walks with baby using the carrier so to get fresh air, move around and straighten her back, get baby some fresh air etc. and how that alone can even help with anxiety. encouraged her that she looked like she was an amazing mother and how proud of her I was. we also talked a little bit about the birth itself, and gave her a chance to process things outloud.

Total Postpartum Hours With Client: 5

Date Created: October 28, 2021

Invoice Form (Credentialed Doulas)

Invoice Date: 10/28/2021

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

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: 10/01/2021

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?No

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?Yes, exclusively (no formula; includes pumped breastmilk given in a bottle)

Did client relinquish her baby after birth?No

On what date was baby born?10/04/2021

Just before labor, client was planning birth at: Hospital

Where was baby born?Lebanon hospital

Planned mode of birth: Vaginal Birth spontaneous onset of labor

Actual mode of birth: Assisted Vaginal Delivery

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

Baby's birthweight: 6.14 lbs

Entry date: October 28, 2021

Required Documents Checklist

CDP Data Collection Form:
  • Completed

Online Birth Data Survey:
  • Completed

  • Completed

Entry date: March 31, 2022