Client Code:CDP548

CDP Data Collection Form

EDD: 09/09/2021

First Pregnancy?
  • No

Where did the client give birth? Corvallis Birth Center

Provider: Andrea, Kourtney

Primary Insurance: IHN

Secondary Insurance: N/A

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

Date of Referral: 04/15/2021

Doula: Ellen Tappon

Meet and Greet Date: 04/17/2021

Method: Phone

Date of 1st Prenatal: 06/04/2021

1st Prenatal Attended By: Doula, client

Location of 1st Prenatal: Outside client's house

Time: 1.25


Second time client. Discussed COVID-19 and pregnancy. how things have gone since last birth, general physical, mental and oral health. No accidents, surgeries, health or issues. Children doing well and enough support. Pregnancy going fine except for back pain, sent referrals for PT. Discussed Healthy Families and sent in referral.

Date of 2nd Prenatal: 07/28/2021

2nd Prenatal Attended By: Doula, client

Location of 2nd Prenatal: Outside client's house

Time: 1.5


Discussed birth preferences, logistics, postpartum, birth control, COVID-19 vaccination and pregnancy. Still having back pain. Did some body balancing and discussed movement patterns, PT and sleep. Lent her a birth ball. Met with Tia again on 8/19 and 8/25 via phone to discuss vaccination again- she got vaccinated 8/25. Met with her again Sep 24th to do body balancing and give emotional support.

Total Prenatal Hours With Client: 2.0

Date of Doula Arrival: 09/27/2021

Time of Doula Arrival: 08:45

Name of hospital staff adding your arrival time to the chart notes: Alice Heinz

Birth Attended By: Midwives Adrea and Kourtney , doula

Date of Doula Departure: 09/27/2021

Time of Doula Departure: 18:45

Name of hospital staff adding your arrival time to chart notes: Kourtney Hanks

Client birthed? Yes

Total Hours With Client: 10

Date of 1st Postpartum: 10/10/2021

1st Postpartum Attended By: doula, client

Location of 1st Postpartum: outside client's house

Time: 1.5


Birth review: it was longer and more painful than she expected. She thought it would be like her last birth where she arrived at birth center and pushed baby out fairly soon after arriving. Didn't understand about pushing early. Felt totally supported and "mothered". Her Mom had been with her for ~ 1 month and she felt stressed since her Mom is going through a lot. Her Mom has been super helpful but she is feeling the burdern of helping her Mom through her issues. She's more tired since she was past due and had a longer, harder birth along with the stress. Having issues with breastfeeding. Discussed latch, supply and strategies. Recommended she talk with Debbie Alba at birth center. Physically she is feeling fine and healing well. No referrals needed.

Date of 2nd Postpartum: 10/25/2021

2nd Postpartum Attended By: doula, client

Location of 2nd Postpartum: phone, client's home

Time: 1.25


10/17/21 - phone: had mastitis and plugged ducts. Discussed heat, massage, pumping, rest, hydration. Cleared up.
10/25/21Baby is doing fine, but she's having a hard time figuring out what he needs when he's fussy. Discussed baby cues, OMT/CST for sucking issues, again discussed getting help from Birth Center for latching issues, nipple shields. Send references on baby cues, developmental milestones, videos on infant massage, rocking and suck exercises for breastfeeding Discussed contraception, postpartum recovery. She is feeling better and more relaxed since her mom left. Still having some back pain. Discussed possible ways to address it. She feels she has enough support. Did one additional Postpartum on Nov 17. She feels recovered and has started working again. Nipple shield is working and she feels she is in a really good place. Returned borrowed items.

Total Postpartum Hours With Client: 2.5

# of telehealth/in person visits during course of care: 6

# of text messages during course of care: 75

# of phone calls during course of care: 4

# of emails during course of care: 6

Date Created: December 28, 2021

Birth Summary


Tia was expecting the baby to arrive early. She was very stressed about going beyond 41 weeks as she would have to go to the hospital rather than the birth center. She had been having some contractions and hadn't slept well for a couple days. I did some body balancing with her and she lost her mucus plug at 3 days past due. At 7:25 she let me know she was heading into the Birth Center at 5 days past EDD in labor- she was at 4 cm She texted me at 8:30 contractions were picking up and getting quite painful. I was her only support person other than the midwives and I felt we had a powerful connection. At her last birth, I had gone to her house and helped her in early labor. We did balancing and she felt baby turn and we had to hurry to the Birth Center and she started pushing less than an hour after we arrived. She expected the same this time and kept trying to push even though the midwives and I explained it wasn't time yet and she wasn't getting the urge, just trying to make it quicker. At 7cm in the tub, she had a bit of a labor stall- she was very tired she had a honey stick and some fruit juice and walked around and used a birth stool. She had a hard time getting into her zone. After a couple hours, she had progressed some, but cervix was puffy. we did some resting positions, body balancing and jiggling. Baby came down and she progressed but wanted to speed things along. At 9cm she had a front lip. We balanced some more and she had AROM. 50 minutes later she had a beautiful water birth. We did a lot of massage, joint breathing and vocalizing together. We felt very bonded. The midwives were great. She was really surprised how long and intense it was and was very grateful for all the support. We talked about all the differences between this an the last birth. It was a very moving and rewarding experience to be the sole support person and feel such a profound connection.

Date Created: December 28, 2021

Invoice Form (Credentialed Doulas)

Invoice Date: 12/28/2021

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

Required Documents Checklist

CDP Data Collection Form:
  • Completed

Birth Summary:
  • Completed

  • Completed

Entry date: April 15, 2022