Placenta Contract

Placenta encapsulation agreement

Thank you for your interest in placenta encapsulation! Please take a few minutes to read this agreement in full. Once you submit this form, you should hear back from me within 1-3 days to confirm your place on my calendar. If you haven't heard from me after that time, or if you have any questions, please contact me by email at monicadoula@gmail.com.

If you prefer to print and mail this agreement with your deposit, please click here [pdf].
Please note that, unless previously arranged, my service area is limited to Iowa City hospitals and births I attend.

Placenta Encapsulation Description
Placenta encapsulation is the process of preparing the mother’s placenta after the birth of her baby. The ingestion of the placenta is known as “placentophagy.” The purpose of placentophagy is to reintroduce beneficial vitamins, minerals, hormones, and other nutrients to the mother's body following labor and birth to help restore a more balanced body function, increase breastmilk production, shorten healing time, increase maternal energy levels, and provide an overall feeling of wellness to aid in the transition between pregnancy and the early postpartum period.

Limitations and Disclaimer
I am not a physician and I am 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. Benefits of placentophagy are supported by ongoing research but have not been evaluated by the FDA. Benefits will vary from person to person, and no specific benefits or effects are promised. I can supply you with relevant research on placentophagy. It is your responsibility to determine whether using placenta preparations may be of benefit to you. 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.

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Please initial here to indicate you have read and understood these limitations *

Client Responsibility
It is your responsibility to notify me as soon after the birth as possible to make arrangements for me to carry out the encapsulation. (I will give you further instructions on contacting me after I receive your information.) Failure to do so may result in delayed placenta preparation and may cause spoilage of the placenta, which could render it unusable for encapsulation. It is your responsibility to inform me of any known bloodborne illnesses or other health issues that may put me at risk of infection through contact with bodily fluids, such as HIV, Hepatitis, or STIs.

If birthing in the hospital: It is your responsibility to discuss release of your placenta from the hospital, and to ensure its storage in a cooler, refrigerator, or freezer within 3-4 hours following the birth. When I receive your information, I will send you further instructions based on which hospital you plan to birth in.

If birthing at home: Please ensure that your placenta is refrigerated within 3-4 hours following the birth. If you are practicing lotus birth or other forms of delayed cord clamping past 3-4 hours, the placenta may be wrapped up with ice packs to prevent spoilage. If it will be more than 4 days before the placenta can be prepared, it should be frozen.

Your placenta must not be treated with alcohol, formalin, or any other preservative.

There may be circumstances under which your placenta cannot be used. Significant abnormalities of the placenta may necessitate your care provider sending your placenta to Pathology for further examination. Other conditions, such as signs of maternal infection during labor, may mean that consuming your placenta will not be beneficial to you. If in doubt, I will consult with you before proceeding. It is usually possible to claim your placenta after a cesarean birth.

Please initial here to indicate that you have read and understand your responsibilities *

Service Description
I am an experienced placenta specialist, and have been encapsulating placentas since 2008.

I will pick up your placenta from your birthing location, carry out the encapsulation process in my home, and deliver your capsules to you. I do not currently offer encapsulation in the client's home -- I have found that I am able to more carefully maintain a properly sanitized environment in the dedicated space in my home that I have set up for placenta encapsulation.

I prepare the placenta according to Traditional Chinese Medicine principles. I gently steam the placenta, slice it thinly, and dehydrate it. When it is completely dry, I powder and encapsulate it. At no time are any other ingredients or additives introduced into the process. I maintain carefully sanitized equipment, and I have completed training in bloodborne pathogens. I carry out proper cleanliness and preparation precautions to ensure the highest quality of placenta encapsulation possible. When I deliver your placenta capsules, I will provide you with a detailed written explanation of the proper storing and handling of the finished placenta pills and suggestions for daily ingestion recommendations.

Service Area
My service area is limited to Iowa City, Coralville, North Liberty, and surrounding areas within 30 miles of Iowa City. If you are outside this area, please contact me so that I may refer you to an encapsulation specialist closer to you!

Fees
The fee for this service is $250, which includes the preparation and encapsulation of the placenta, a storage container for capsules, written instructions for storage and handling, and guidelines for taking your capsules. An umbilical cord keepsake is also provided where possible. For Mindful Birthing students and clients whose births I attend, I offer a reduced rate of $200. In all cases I request a deposit of $50 upon signing this contract, with the balance payable upon receipt of your finished capsules. Payments may be made online or by personal check.

Refunds
In the event your placenta is unavailable to you (e.g. sent to Pathology and not released) or if you change your mind and choose to terminate this contract prior to releasing your placenta to me, I will refund any fees paid, including the deposit. Once preparation has begun, payment will be due in full, even if you choose not to take the finished capsules.

I have read and understood the terms of this agreement.

Name *

First

Last

Estimated Due Date *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

Birthing at: *

Home University of Iowa Hospital Mercy Hospital Iowa City

Capsule preference *

Gelatin Vegetable No preference

Do you have any bloodborne illnesses? (This information is strictly confidential) *

Any other specific concerns, or anything you would like me to know? *

Who can I thank for referring you to me? *

By clicking Submit, you acknowledge that you have read and understood the terms of this agreement.

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Placenta encapsulation agreement

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