Birthing Parent Support Registration Name * First Name Last Name Email * If you have previously brought a baby home to care for, please list the date(s) that that has happened for you and/or your partner and how baby(ies) came to be with you (pregnancy and birth, partner pregnancy and birth, surrogacy, adoption, foster care, etc). (If not applicable, write N/A). * Please tell me about your experience caring for above mentioned baby(ies). Please focus on baby care here only. What was most challenging? What seemed to come easily to you? (If not applicable, write N/A). Are there any unresolved challenges or traumas from caring for previous babies? What was the most challenging? What would you have liked more help with? (If not applicable, write N/A). If you have recently birthed a baby(ies) (the one(s) we will focus on for our time together), please tell me what you would like me to know about your experience recovering from birth. (If not applicable, write N/A). In both birth & previous baby care, did you feel supported in any way by your partner (if applicable)? In which ways specifically? (If not applicable, write N/A). Did you feel supported in any way by extended family? In which ways specifically? (If not applicable, write N/A). In which areas could your partner or family have been more helpful? (If not applicable, write N/A). What are your hopes and plans for your upcoming birth? How are you feeling about the upcoming birthing experience? (If not applicable, write N/A). Do you have anything unresolved in any relationships in your life currently? Feel free to share anything that you want me to know. Moving forward in this postpartum period and caring for new baby(ies), what are you most concerned about? What are you looking forward to? What do you think you need the most help with? Do you have any intentions around how you will feed baby(ies)? If so, please share. Are you diapering? If so, what kind of diapers (cloth or disposable)? If you have a partner, what do you think you would like to ask your partner to manage the most? What do you think they need the most support with? What do you think they are looking forward to with this new baby? If you have a partner, how are you with conflict resolution? Do you have different cultural backgrounds? Do those create challenges in communication and resolution? Share anything that may help me understand the dynamics. Do you think it will be helpful for me to offer suggestions if I notice some conflict around baby care or after birth care in the home? Or would it be best for me to give space and wait for someone to ask if I can offer suggestions? Who else will be in the home to help take care of the family? This could be extended family members, babysitters, baby nurses, house keepers etc. Please list names, phone numbers, and anything I should know when interacting with them. What do you hope to get out of me being a part of your postpartum care team? List any and all things that apply. Are there any religious, spiritual, or cultural traditions that you would like to incorporate into your postpartum period? What are your most important goals to work towards our time together? Looking forward, what do you envision your family will look like when our time together comes to an end? Thank you! Allison will be in touch soon.