Contact Midwife Sasha Midwifery Consultation Midwifery Consultation Name * First Name Last Name Email * Phone * (###) ### #### Estimated Due Date or Last Menstrual Period * MM DD YYYY Is Your Pregnancy Considered Low Risk? * What does low risk mean? In general, it means that when you have not experienced the following prior to or during pregnancy: -Insulin dependent diabetes -Thyroid disease -Active tuberculosis -Chronic lung disease -Severe anemia, especially congenital -Epilepsy -Clotting abnormalities -Rh negative with antibodies -Acute viral infections -Congenital heart disease -Renal disease -Hepatic disease -Bleeding in third trimester -Fetal anomaly detected during pregnancy that may compromise baby if born at home -Eclampsia, HELLP, pre-eclampsia, or persistent hypertension -Premature labor (before 37 weeks) -Placenta previa at term If you have NOT experienced any of the above conditions, let’s continue on to the consultation process. If you have experienced any of the above conditions, let’s chat about other birthing options for you. Yes No Unsure How Did You Find Us? * Message * Thank you for your message! We will be in touch soon! Lactation Consultation Lactation Consultation Name * First Name Last Name Email * Phone * (###) ### #### Message * Thank you for your message! We will be in touch soon!
