Agreement for Placenta Preparation/Encapsulation Services
Name
Your answer
Birth Companion Name
Your answer
Estimated Due Date
MM
/
DD
/
YYYY
Hospital/Birth Center
Your answer
Doula
Your answer
Mom's Phone Number
Your answer
Birth Companion Phone Number
Your answer
Home Address with Zip
Your answer
Email
Your answer
Payment Information
There is a $25 discount if you pay by cash or check on Venmo. Venmo ID is @Christal-Quick. You can also look it up under the email doulachristal@gmail.com. Please make check payable to "Christal Quick". Payment through PayPal can be made at the full price of $250 through our website at http://www.birtheducationcenter.com/Placenta_Pymt.html
Type of Preparation
Required
Notifying Me BEFORE & After the Birth
It is important that you contact me on my cell phone via TEXT Christal Quick – 760. 586.5887 as soon as you are in active labor(4 min apart). Then I have time to prepare and work out possible timing scenerios so I can get there as close to birth time as possible. After your baby has been born, please TEXT so myself or my backup can get your placenta picked up. If you deliver during the night, please call instead of text. A text would not wake me up during the night. . The encapsulation process should begin within 24 hours of the birth. If there are extenuating circumstances and we cannot begin within 24 hours, the placenta MUST be frozen by day 3 or it will begin to lose its nutritional benefits. However, the sooner you begin ingesting the placenta, the sooner you will feel the benefits.
Required
Fees and all paperwork
Fees and all paperwork including STI results are to be mailed in and paid in full at least ONE month prior to your estimated due date. Mail to Christal Quick at 476 Rancho Vista Rd. Vista, CA 92083.
Required
By writing my name and date below,
I agree and consent to receive placenta preparation services from Christal Quick. These statements have not been evaluated by the Food and Drug Administration. These services discussed here are not intended to diagnose, treat, cure or prevent any disease or condition.By choosing to utilize the encapsulation services you are choosing to do so after doing your own research and you take full responsibility for any and all outcomes.
Your answer
Placenta Handling Post-Birth
Please read each section and acknowledge.
Risks
The first part of ensuring that it is safe to consume your placenta is by making sure it is taken care of properly right from the beginning. It is extremely important that you know the risks of your placenta being handled in an improper way.The facility that you are birthing at may not understand or be familiar with placenta consumption. They may be unaware that the placenta must be kept cold (just like a piece of meat would need to be kept cold), or that it should be handled in the utmost sanitary conditions. It is pivotal that you let your care provider know well in advance that you are taking your placenta home. It is your option to tell them why or not as that is a privacy matter. There is no state law in California that prevents a mother from claiming and taking her own placenta home with her. Hospital policy is not state law. You may also request a copy of your hospitals labor and delivery policy if you would like to see what is written about your placenta. You have the right to decline testing on yourself or your body parts. If you choose to have a small piece sent to pathology, it can be taken in front of you either in the room or you can follow it to pathology and then bring it back with you. Parents that bring their placentas home have had much success just by standing firm and never letting it out of their sight.
Required
You need to understand that if it leaves the room for pathology or wherever else, you have no way of knowing:
1. Your placenta left the hospital for an outside lab (if the truck had refrigeration or what the labs practices are) 2. What tests are performed on your placenta or if all of the stem cells were drained and given for research or sold. 3. If your placenta was put on a board that was clean. 4. If the scalpel used on your placenta was right out of the autoclave or if that scalpel had been used on other placentas before yours since they are typically treated as medical waste. 5. Lastly, if formaldehyde or some other chemical came in contact with your placenta. If it has come in contact with any chemicals then it is no longer safe to consume and must be discarded.
Required
It is best to encapsulate within the first 48 hours, for both mother and placenta. Up to 72 hours in the refrigerator is acceptable but after that it must be frozen.
Your placenta should not sit for more than 4 hours at room temperature. As quickly as possible after birth, your placenta should be sealed in an airtight container or ziploc bag and placed directly into your WATERPROOF cooler(hard plastic) with ice. (Cloth coolers tend to leak and DO NOT keep placentas at a constant temperature).
Required
Hiring an encapsulationist is like hiring a personal chef with regards to the risks involved in the chef preparing your food versus you preparing your own. I am a fully certified encapsulationist.
A certified encapsulationist through Full Circle Encapsulation means that your placenta will be handled in the most sanitary way possible with OSHA standards. We have a state issued food handler's permit and have passed a Biologix blood borne pathogens course. NO placenta have ever been accepted if it has tested postive for bloodborn pathogens. Hiring a trained and certified encapsulationist is the second part of ensuring your placenta is handled in the safest way for consumption.
Required
Procedures:
Ensure all waivers, forms and bloodwork is turned in a month prior to birth. Ensure payment is made one month prior to birth and understand deposit is non refundable. Call/text the encapsulationist when labor is steady so she has time to clear her schedule. Arrange for drop off or pickup right after birth.
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The Encapsulationist will not sign anything out. This is the sole responsibility of the parents.
Please provide your hard plastic cooler to transport the placenta if the encapsulationist is picking it up directly from the hospital. Waiver must be submitted prior to the encapsulationist transporting. Please provide encapsulationist with a reliable drop location and contact information. Assume all responsibility on your own belief that the healing and nutritional properties of your placenta for consumption.
Required
Placenta services have not been evaluated by the FDA and are not intended to prevent, treat, or diagnose any disease, illness, or symptoms. Clients understand that they are assuming all risks and benefits on their own profound beliefs of the placenta's healing and nutritional properties
Placenta Handling after a C-Section
Be sure the OB knows that you are taking your placenta home with you and that you have the right to do so regardless of surgical birth
Also clear this with the nurses attending the operation so as to avoid confusion. Sign the release BEFORE the C-Section and return to the staff. Ensure that the placenta goes into a labeled bag either directly into your cooler or remains with the other parent. Ensure the nurses are aware that the placenta must be chilled until released and that it absolutely CANNOT come into contact with any chemicals. If testing is needed, they can cut off a piece to take directly in the OR. Please be friendly and understanding to the hospital staff as this is not an everyday occurrence in their work environment and you'd like them to respect your choice.
Required
Please print this waiver: https://docs.google.com/document/d/1RluHEwoN7m9Fs-dkE6ckVctZDUxxS8LebFDtOR-aEkY/edit?usp=sharing and gather STI information from your care provider
Please print, sign and return the above hyperlinked waiver along with payment and STI paperwork to Christal Quick. Mail to Christal Quick at 476 Rancho Vista Rd. Vista, CA 92083.
Required
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