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