Breech Directory (public)
Breech Without Borders is creating a public Breech Provider Directory to help connect families expecting breech babies with local breech providers and allied health professionals. (If you'd prefer to be listed on our private directory, please visit bit.ly/breechdirectory-form.)
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Name *
Title and certifications (MD, midwife, traditional bith attendant, doula, chiropractor, etc) *
Country *
State/province/region (if not applicable, write "NA") *
City *
Email *
Phone number
Website
Social media contact info (FB, IG, etc)
Practice setting (mark all that apply) *
Required
If you accept insurance, are there certain insurance plans you can or cannot accept?
Do you accept late client transfers (e.g., someone who has discovered at 37 weeks that she has a breech presentation)? *
If you attend home births, how far of a radius do you serve? (Please specify whether miles or km)
If you are a birth attendant, are you able to travel (out of state/country) to attend VBBs? *
Do you accept clients who may be traveling from out of state/country to birth with you?
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Any other relevant information you'd like to share on the public directory
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