Client Code:CDP637

CDP Data Collection Form

EDD: 10/21/2021

First Pregnancy?
  • No

Where did the client give birth? home birth

Provider: mid valley birthing

Primary Insurance: IHN

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

Date of Referral: 07/16/2021

Doula: Heidi Donahue

Meet and Greet Date: 09/01/2021

Method: phone

Date of 1st Prenatal: 09/10/2021

1st Prenatal Attended By: Emma, Wyatt, Heidi Donahue

Location of 1st Prenatal: clients home

Time: 2 hrs


introductions. explanation of what services a doula provides and what we do not, how the CDP works. Emma let me know what kind of support she feels like would be helpful for her during her pregnancy, and also during labor especially since she plans a home birth and has anxiety about the pain that will come during labor and birth. we talked about some of the physical comfort measures I could provide, as well as emotional things I could do to help her and Wyatt during the birth. talked about healthy families and what some benefits of the program are. they declined the referral and felt they were well equipped with knowledge and family support for when baby comes.
we discussed what our communication would look like going forward.

Date of 2nd Prenatal: 10/16/2021

2nd Prenatal Attended By: Emma, Wyatt, Heidi Donahue

Location of 2nd Prenatal: clients home

Time: 2 hrs


discussed the birth videos they have watched and information they have learned over the last month, wrote out a birth plan together, and I showed Wyatt how to do counter pressure during contractions and they practiced together. gave them some "homework" of trying our different early labor positions together and having fun practicing things such as slow dance, and also see what feels the most natural for them. Wyatt was feeling really encouraged that he had some tools to use to help her during contractions before I get there. discussed positive affirmations, and writing some out for us to say to her during labor. talked about the things she wanted to buy for the labor and postpartum period.

Total Prenatal Hours With Client: 7

Date of Doula Arrival: 11/02/2021

Time of Doula Arrival: 06:00

Birth Attended By: Liz Baer

Date of Doula Departure: 11/02/2021

Time of Doula Departure: 15:30

Client birthed? Yes

Total Hours With Client: 9.5

Date of 1st Postpartum: 11/07/2021

1st Postpartum Attended By: Emma, Wyatt, Heidi Donahue

Location of 1st Postpartum: Clients home

Time: 2 hrs


feeding/latching issues. babies weight loss. talked about tongue ties. discussed physical healing from the birth.

Date of 2nd Postpartum: 11/10/2021

2nd Postpartum Attended By: Emma, Wyatt, Heidi Donahue

Location of 2nd Postpartum: Clients home

Time: 2 hrs


did a weighed baby feeding, mom felt very encouraged knowing baby was getting good amount of milk from the feeds. discussed baby care basics, emotional health with feeding issues.

Total Postpartum Hours With Client: 4

# of telehealth/in person visits during course of care: 5

# of text messages during course of care: 60

# of phone calls during course of care: 1

# of emails during course of care: 1

Date Created: November 11, 2021

Birth Summary


Birth reflection CDP637

I had been talking with Emma by text throughout the night and early morning as her labor progressed, and I was talking her through her anxiety and restlessness. I urged her to try to take a walk around 4am, because the contractions had slowed down a bit and she wasn’t able to lay down and rest, and then at 5:00 her partner sent a text that they had called their moms to head over, and Emma would like me to come as well. When I got there at 6:15 she was well into active labor and having consistent contractions every 4-5 mins. At 7:00, the midwife showed up and shortly there after she checked Emma/s cervix and she was 7-8 centimeters. I spent the next 2 hours reliving Emma/s partner Wyatt and took over doing slow dancing with her though the contractions with her, and doing some counter pressure. Wyatt and I took turns doing pressure and massage while she stayed in the slow dance pose with me. By this time the birth pool was filled and Emma wanted to get in right away. Once in the tub, the other 2 midwives showed up and Emma’s contractions had slowed down a bit but they were very intense. I poured the water from the tub over her back and arms while she was kneeling in the water, and gave her shoulder and back massages and gave her juice after every contraction. Around 10:30, her body started to naturally push and we helped her get into a couple different position changes during the time her body was bearing down and pushing. Baby boy was born at 11:30 in the water and placed immediately on moms chest. Baby was doing great and breathing fine and cried almost immediately. After just a few mins we helped mom get out of the tub and walk to the bedroom to get on the bed and deliver the placenta. Placenta was delivered 10 mins later, and was intact. Cord was cut after about 30 mins, by dad.
The next couple of hours were spent getting Emma comfortable, getting her juice and food, and working on latching baby to the breast. The midwives did their assessment on baby boy and I helped Emma to the bathroom to urinate and get cleaned up and in some fresh clothes.
I I helped clean up things around the house from the birth and did a couple loads of towels, and when I left at 3:30, mom was snuggled in bed with boy and attempting to take a nap. Dad was in bed with them and everyone was happy and well.

Date Created: November 11, 2021

Invoice Form (Credentialed Doulas)

Invoice Date: 11/10/2021

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

Client Confidentiality Release Form

Doula's name: Heidi Donahue


Date signed: 09/10/2021

Date of birth: 03/29/1995

Media Release


Date signed: 09/10/2021

CDP Letter of Agreement

Client signature:

Date signed: 09/10/2021

Required Documents Checklist

Confidentiality Release Form:
  • Completed

CDP Data Collection Form:
  • Completed

Birth Summary:
  • Completed

Media Release:
  • Completed

  • Completed

Entry date: March 31, 2022