Placenta Services Description & Agreement
Amanda Smith Birth Services, LLC
www.amandasmithbirthservices.com
601.818.6718
Since I am not your medical professional, I am not able to diagnose, treat, or prescribe for any of your health conditions. Services and fees are for the preparation of your placenta, not for the sale of the products. No specific benefits or effects are promised, as benefits vary from person to person. Some of the ascribed benefits of placenta consumption are supported by research; however these benefits have not been evaluated or approved by the FDA. It is your responsibility to determine whether or not using placenta products may be beneficial to you. *
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CLIENT RESPONSIBILITY
This section describes your responsibilities regarding the storage, handling, and transportation of your placenta.
It is your responsibility to notify me after the birth to make arrangements for pick up or drop off. Failure to do so may result in delayed placenta preparation and may cause spoilage of the placenta, which would render it unusable for consumption. If you are planning a hospital birth, it is your responsibility to discuss the release of your placenta and to ensure proper labeling and storage of your placenta in a refrigerator or cooler. Your placenta should not be treated with alcohol, formalin, or any other preservative. Please contact me if you need assistance with hospital release. You should contact the hospital directly, not just your doctor or midwife. Whether birthing at home, birth center, or in a hospital, please ensure your placenta is kept fresh. It can remain at room temperature for 3-4 hours following the birth. After that it should be refrigerated or otherwise kept cool. If it is going to be more than 3 or 4 days before the placenta can be prepared it should be frozen. A frozen placenta will take somewhat longer to prepare since I prefer to gently defrost it prior to preparation. Prepare your placenta for transport by placing it in 2 gallon-sized freezer strength Ziploc bags, a large plastic or glass airtight Tupperware-style container with lid. Most hospitals will provide a container or bag. Please do not place the placenta directly on the ice. It is important to note that there may be circumstances under which your placenta cannot be used. If in doubt, I will consult with you before proceeding. *
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If you are taking any medications regularly, other than prenatal vitamins, please list them in the space below. *
REFUNDS
The following section describes situations in which a refund might be applicable.
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, any fees paid MINUS the deposit will be refunded in full. If you choose to terminate this contract after releasing your placenta to me but before any preparation has begun, I will return your placenta to your for disposal. Your $50 deposit will be retained, but any other portion of the fee will be returned. There will be no refund once preparation has begun, even if you choose not to take delivery of the finished capsules. *
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PLACENTA PRODUCT OPTIONS
Your placenta is so beneficial to the postpartum healing process! Here are the descriptions of the products offered and their reported benefits.
PLACENTA ENCAPSULATION is the process of preparing the mother’s placenta after the birth of her baby by dehydrating, powdering, and placing it into capsules for the mother to use as she sees fit. First the placenta is drained of blood, rinsed, and steamed. Once steaming is complete, the placenta is thinly sliced, dehydrated, and ground. The ground placenta powder will be placed in to gelatin capsules to complete the process. PLACENTA TINCTURES are concentrated extracts prepared by soaking a small piece of placenta in alcohol. Only 100 proof Vodka will be used, so all of the tinctures that I prepare are gluten and dairy free. Since tinctures have an indefinite shelf life, many women use them for extra support after they finish their capsules, for when menstruation returns after birth, and some even save their tincture to use during menopause. PLACENTA SALVES can be used to treat a variety of skin ailments including cesarean scars, perineal tears and hemorrhoids, sun-spots, wrinkles, and stretch marks, sore or cracked nipples from breastfeeding, and they make a great Diaper Rash Cream that’s safe for cloth diapers! Salves are made from organic coconut oil, olive oil, shea butter, beeswax, and a special combination of healing oils and herbs. *
Do you have any questions regarding the placenta products listed above?
PLACENTA PACKAGE OPTIONS
All package fees include picking up your placenta from the birth place and delivering your products to your home. Clients of Organic Home Birth and Peak Midwife Collective also benefit from a $50 discount off of any package.
Premium Package - $225: Includes Placenta Encapsulation, Tincture, Salve, Print, Cord Keepsake, and picking up the placenta from you and dropping off the finished products at your home.
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Standard Package - $175: Includes Placenta Encapsulation, Tincture, and Cord Keepsake.
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Basic Package - $150 : Includes Placenta Encapsulation and Cord Keepsake.
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Which capsules would you like? *
PERSONAL INFORMATION
First and Last Name: *
Home Address *
Phone Number *
Estimated Due Date *
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Delivery Location *
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How did you hear about Placenta Processing with Amanda Smith Birth Services? *
CHECK OUT: To complete your order, please list the email address that you would like your invoice to be sent to. *
Thank you for trusting me with your precious placenta!
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