Get Birth Doula Data Collection Form - Dona International - Dona

Completing the Birth Doula Data Collection Form is essential for effective data collection on birth doula support. This guide provides straightforward instructions to help you accurately fill out each section of the form online.

Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to access the form and open it for completion.
2. Begin with the 'Referral Source' section. Select the applicable source by marking the appropriate box, indicating where the client learned about the doula services.
3. Proceed to the 'Place of Birth' section and select the location where the birth will take place, including options like home, hospital, or birth center.
4. In the 'Medications' section, provide details on any pain medications used during labor. Specify whether an epidural was administered and at what dilation. Use the dropdown options to make selections.
5. Complete the 'Payment' section by indicating how the services will be financed, including options such as private pay or third-party reimbursement.
6. Fill in the 'Caregiver' section by specifying the type of caregiver present during the birth, selecting from choices including midwife or OB doctor.
7. Next, enter the 'Method of Birth' by checking the relevant method chosen, such as spontaneous vaginal birth or planned cesarean.
8. In the 'Client Race' and 'Client Ethnicity' sections, please provide the client's racial and ethnic background by selecting the appropriate options available.
9. Fill out the 'Pregnancy' section by noting any pregnancy complications and relevant status details like high risk or gestational diabetes.
10. Move to the 'Childbirth Education Classes' section to record whether the client has attended any classes, marking yes or no as applicable.
11. Complete the 'Mother’s Information' section by providing details such as marital status, age, and pregnancy number.
12. Document the 'Length of Labor' by indicating the perceived duration of labor as experienced by the client.
13. In the 'Baby Outcome' section, specify any immediate health concerns regarding the baby, followed by the baby's birth weight.
14. Specify who attended the birth in the 'Attended By' section by checking all that apply—partner, family member, or doula.
15. Move on to the 'Interventions' section and record any medical interventions that occurred during the birth.
16. Finally, print the document if needed, and ensure to sign and date the form in the indicated fields. You can then save your changes, download the form, or share it as required.

Complete your Birth Doula Data Collection Form online to support vital data collection on birth doula services.