Doula / Birth Support Person Request Form
The mission of the Alaska Native Birthworkers Community is to serve Native birthing families to feel supported, well cared for, and full of the information they need to make confident choices around reproductive health, birthing, and parenthood. As part of this, we offer a volunteer service to birthing parents to be present during birth as additional support.

Pregnant Native families are invited to complete the request form below if they are seeking the support of a doula or labor support companion during labor and birth. Completing this form does not guarantee that we will be able to match you with a volunteer, but we will try our best!

For more information please visit www.nativebirthworkers.org or www.facebook.com/nativebirthworkers. You can email nativebirthworker@gmail.com with any questions.
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Email *
Full name: *
Estimated due date: *
What do you like to be called?
Pronouns:
Age: *
Phone number: *
Mailing Address
Best method for communication:
Cultural / tribal affiliation: *
Where do you plan to give birth? *
Please briefly share about what support system you currently have, and what additional support you are looking for during and possibly after birth: *
Please share any other information you would like us to know about regarding your identity, family, reproductive history, current pregnancy, birth plan, postpartum care plan, etc.
Who is your emergency contact (name, pronouns, relationship, phone number, email address)?
How did you hear about us? *
Required
Please read and agree to the following: *
Required
The Alaska Native Birthworkers Community also provides other services to birthing families. Please indicate your interest in any of our other services below:
A copy of your responses will be emailed to the address you provided.
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