Comfort Measures/Labor Positions Slides Documentation: Prenatal #3 Appointment date * MM DD YYYY Appointment start * Hour Minute Second AM PM Appointment location * client's home provider's office audio/video telehealth - client home audio/video telehealth - client other audio telehealth - client home audio telehealth - client other community location or shared space other Client name * First Name Last Name Date of birth * MM DD YYYY Estimated delivery date * MM DD YYYY Ball Techniques Birth ball techniques demonstrated * measuring the ball hip circles figure 8 seated bouncing forward rolling leaning (in corner or with partner) forward lunging squatting other Peanut ball techniques demonstrated * seated frog legs side lying exaggerated runner flying cowgirl other Notes Labor Positions Labor positions demonstrated * sitting position hands and knees open knee-chest (Miles circuit) exaggerated side lying (Miles circuit) stairs (Miles circuit) squatting side lying upright lunging reclining birth stool birth bar other Notes Comfort Measures Comfort measures demostrated * double hip squeeze sacral press rebozo sift/shimmy manual massage massage gun other The client has access to the following tub shower stairs outside/green space Notes Childbirth Education Childbirth education provided * prelabor signs early labor signs active labor transition pushing immediate postpartum Notes Labor/Delivery Day: Logistical Information The logistics of early to active labor were discussed * yes no Client appears to have all recommended materials for laboring at home * yes no unknown Doula tools (from tool kit) were shown to/shared with client * yes no Care plan for other children, pets and plants was discussed * yes no Client has hospital bag prepared * yes no Plan for transportation to/from hospital and carseat was discussed * yes no Postpartum Plan Plans for maternity leave from work or other obligations * Plans for partner parental leave from work or other obligations * Plan for nourishment * will purchase meal prep frozen foods food train requesting restaurant/delivery gift cards bulk grocery shopping applying for SNAP/food stamps established takeout budget family member batch cooking other Plan for care of other/older children * Counsel client on the importance of establishing a childcare schedule for the first 6 weeks. This can also include pet care. nanny grandparent(s) of children aunt(s)/uncle(s) of children babysitter daycare/preschool school extended school day add-on postpartum doula friends family neighbors other N/A Plan for home maintenance * cleaning service spouse/partner parent of birthing person relative friend neighbor older children other Plan for household supplies * bulk online order (Amazon, Walmart, etc.) automated orders/subscriptions designated shopping pickup person(s) manual weekly orders family contributions/donations gifts from baby shower/sprinkle other Information on breast pumps was provided * Counsel client on the ability to retrieve a breast pump through insurance, and/or the different types of breast pumps available for purchase. Advise client that wireless/wearable breast pumps should not be the primary breast pump. Recommend handheld pumps for convenience or emergencies. yes no Plan for breastfeeding * latching exclusive pumping pumping to refrigerate pumping to freeze/build stash bottle feeding passive capture (haakaa) other N/A Plan for newborn care * parents take short rotating shifts parents take long rotating shifts latching at night bottles at night latching during the day bottles during the day postpartum doula - daytime postpartum doula - overnight rotating schedule with family/friends - evenings rotating schedule with family/friends - overnight rotating schedule with family/friends - daytime assistance from older children other Plan for self-care * Counsel client on the importance of taking time for themselves every single day. This time should be uninterrupted/alone time, and can take place the same time every day. Remind client that taking a shower, cooking for the family, running errands for the family, etc. do not count toward self care! exercise/workout at home exercise/workout with trainer/gym psychotherapy nail appointment postnatal massage hair appointment shopping acupuncture coffee shop/library facial/spa yoga other Plan for bonding with partner * dinner (in home) dinner (restaurant) movie (in home) movie (theater) night out (lounge/hotel/casino) museum paint-and-sip friend's house/gathering host friends other N/A General Information Would client like a referral to a postpartum doula? * yes no Would client like for us to request a care extension through insurance? * MassHealth allows for care extensions to be requested for clients who have one or more pregnancy-related complications or conditions. yes no N/A Client's "safe" person * The client should appoint a person who should report any concerns with their physical or mental health to their doula and/or clinical provider for further escalation. General Concerns * Recommendations * Resources * Appointment end * Hour Minute Second AM PM Signed (doula provider) * Your changes have been saved.
