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PLACENTA SERVICES DESCRIPTION & WAIVER

Placenta encapsulation is the process of preparing your placenta after the birth of your baby by dehydrating, powdering and placing it into capsules for you to use as you see fit. Where possible the umbilical cord is also dried and a placenta print are provided separately as a keepsake.

Limitations and Disclaimer
We are not able to diagnose, treat or prescribe for any health condition. Services and fees are for the preparation and encapsulation of your placenta, not for the sale of the pills. No specific benefits or effects are promised. Any benefits will vary from person to person. Some of the ascribed benefits of placenta consumption are supported by research; however these benefits have not been evaluated or approved by the American Medical Association. It is your responsibility to determine whether using placenta preparations may be of benefit to you. Always speak to your care provider regarding any questions about your health, safety and wellbeing. Placenta services are not meant to be a replacement for medical advice or prescription medicines. If you are experiencing symptoms of postpartum depression, low milk supply, or other medical concerns please speak to your midwife or doctor.

Client Responsibility
Please ensure that your placenta is kept fresh. It can remain at room temperature for 3-4 hours following the birth. Please call after the birth between the hours of 8am and 8pm to arrange for pick up. If you birth before 8am or after 8pm, you will need to refrigerate your placenta until it is picked up. To prepare your placenta for transport double bag it in two freezer strength ziplock bags. Then store it in a cooler with ice packs or the refrigerator until it is picked up.

If you are practicing some form of delayed cord cutting or lotus birth, ice packs may be wrapped up with the placenta to prevent spoilage. If it is going to be more than 4 or 5 days before the placenta can be prepared, it should be frozen. (A frozen placenta will take somewhat longer to prepare as it will need to be gently defrosted prior to preparation.)

There may be circumstances under which your placenta can not be used. Significant abnormalities of the placenta may necessitate your midwife or doctor to send your placenta to pathology for further examination. Other conditions, such as signs of infection during labor contraindicate consumption of your placenta. If you are not able to obtain and use your placenta for any reason, a full refund will be given.

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Name *

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Last

Partner's name *

First

Last

Due date (month/ day/ year) *

Email *

Address *

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City

State

Zip Code

Country

Phone number *

Partner's phone number *

Planned place of birth *

Are you taking any medications with this pregnancy (other than prenatal vitamins/supplements)? *

Placenta encapsulation & tincture are contraindicated if you are a smoker, as there are high levels of heavy metals in the placentas of people who smoke during pregnancy. Are you a cigarette smoker during this pregnancy? *

yes no

Does your placenta contain any transmittable diseases such as Hepatitis-B, -C or HIV/AIDS? *

yes no

I understand that by receiving an epidural, antibiotics or pitocin in labor makes my placenta unable to be encapsulated. *

yes

I agree to have my placenta handled in a manner appropriate for safe food preparation from birth until received by Fertile Moon Midwifery *

yes

I release Fertile Moon Midwifery from any and all liability and effects I may experience after choosing to take the capsules. *

yes

We view each placenta as a sacred connection between mother and child and will treat it accordingly. I will not hold Fertile Moon Midwifery responsible if my placenta is accidentally damaged in the encapsulation process. *

yes

Method *

Is there anything else you would like to share with us? *

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PLACENTA SERVICES DESCRIPTION & WAIVER