Client Code:CDP612

CDP Data Collection Form

EDD: 12/09/2021

First Pregnancy?
  • Yes

Where did the client give birth? Corvallis hospital

Provider: Maggie (Midwife)

Primary Insurance: IHN

Priority Medicaid Populations (check all that apply):
  • Under 21 yrs. of age
  • Limited/No family support

Date of Referral: 11/17/2021

Doula: Heidi Donahue

Meet and Greet Date: 12/22/2021

Method: phone

Date of 1st Prenatal: 10/02/2021

1st Prenatal Attended By: Miranda tasker

Location of 1st Prenatal: phone

Time: 45 mins

Date of 2nd Prenatal: 11/18/2021

2nd Prenatal Attended By: Heidi Donahue

Location of 2nd Prenatal: zoom

Time: 1 hour


talked through clients desires for her birth, wrote out a birth plan. explained my role as a doula, what I do/do not do. talked through boyfriends fears and nervousness, he asked multiple questions and is afraid of passing out and so we talked through how I could help him during the labor process and be there for Maggie if he needs to sit out etc.
offered the healthy families program, they said they weren't interested.
asked if they felt like they had everything they needed, or if any referrals would be beneficial.
talked with Maggie about her plans for feeding baby.

Total Prenatal Hours With Client: 3 hrs

Date of Doula Arrival: 11/29/2021

Time of Doula Arrival: 16:00

Name of hospital staff adding your arrival time to the chart notes: Chris RN

Birth Attended By: Heidi Donahue

Date of Doula Departure: 11/29/2021

Time of Doula Departure: 00:00

Name of hospital staff adding your arrival time to chart notes: Maggie CNM

Client birthed? Yes

Total Hours With Client: 8 hrs

Date of 1st Postpartum: 12/08/2021

1st Postpartum Attended By: Heidi Donahue

Location of 1st Postpartum: clients home

Time: 1.75 hrs


talked for quite awhile about breastfeeding success and challenges. asked about her healing from the birth, how she was feeling emotionally, etc. talked with her partner as well, about how he is handling the new role of father. Maggie asked general newborn questions. asked again about healthy families referral and she felt she didn't need it,

Date of 2nd Postpartum: 12/17/2021

2nd Postpartum Attended By: Heidi Donahue

Location of 2nd Postpartum: phone

Time: 1 hour


general new born questions, client was having issues with her milk supply so I talked her through some things she could try and encouraged her to reach out to the LC at the hospital or her pediatricians office.

Total Postpartum Hours With Client: 4.25

# of telehealth/in person visits during course of care: 4

# of text messages during course of care: 120

# of phone calls during course of care: 2

# of emails during course of care: 0

Date Created: December 29, 2021

Birth Summary


Birth reflection CDP612

Maggie had called and let me know she was in labor, and was headed to the hospital. I told her to update me once she got there. She was checked and dilated to 6 cm. And they admitted her. I left right away to meet her there. I arrived at 4:00pm and baby was the on call midwife and the nurse was Chris. When I got to the hospital the anesthesiologist was just walking in the room t do an epidural, so I waited until she was done and then came into the room to be with her. Her boyfriend, and his mother were there as well.
I gave her a hand massage using almond oil. The midwife ket her know that she was completely dilated, but encouraged her to let her body continue to work to bring baby down lower since baby was doing well with his heart rate. Maggie thought that was a good idea as well. And we spent time talking and distracting her until she finally felt some pressure.
Midwife came in and said baby was extremely low and set up to deliver. Maggie pushed for 20 mins, and Baby was born around 10:30 pm. He was 7 lbs 8 oz. and was very healthy.
I helped make sure Maggie ate and drank after delivery, helped her get Baby Saige latched on and breastfeeding, and took some pictures of the new family of 3.
I left at Midnight, and mom was just falling asleep while Dad was snuggling with Saige.

Date Created: December 21, 2021

Invoice Form (Credentialed Doulas)

Invoice Date: 12/29/2021

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

Client Confidentiality Release Form

Doula's name: Heidi Donahue

Date signed: 11/23/2021

Date of birth: 08/19/2002

CDP Letter of Agreement

Client signature:

Date signed: 11/23/2021

Required Documents Checklist

Confidentiality Release Form:
  • Completed

CDP Data Collection Form:
  • Completed

Birth Summary:
  • Completed

  • Completed

Entry date: March 31, 2022