TLC Doula Service

  • Birth History Discussion Sheet

    The purpose of this form is to help you explore your past birth experiences and future birth hopes, then be able to articulate these feelings to your partner & care team. Make your answers as long or short as you want.

  • Full Name*
  • How do you feel about the care you received from your OB or Midwife?
  • How do you feel about your previous birth location(s)?
  • How do you feel about the members of your previous birth team?
    Meaning your personal support team, husband, mom, friend, etc.
  • What aspects of your birth happened the way you wanted them to?
  • What parts of your birth did not happen the way you wanted them to?
  • What things surprised you?
  • How did you cope with contractions?
  • Did you have time to make decisions?
  • Did you feel pressured by anyone or anything?
  • How did you feel about the active stage of your labor?
  • How did you feel about the pushing stage?
  • How do you feel about the hours immediately after birth?
  • How do you feel about your recovery?
  • In what ways would you like this birth to be different?
  • In what ways would you like this birth to be similar?
  • Was there anything extra special or meaningful that staff members or someone on your support team did or said?
  • Security Code*

     

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