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 birth support companion during labor and delivery. 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.
* Required
Full name:
*
Your answer
E-mail address:
*
Your answer
Phone number:
*
Your answer
Preferred method of communication:
E-mail
Phone call
Text
Video call (i.e. zoom, FaceTime)
Other:
Clear selection
Cultural affiliation:
*
Your answer
Estimated due date:
*
Your answer
Where do you plan to give birth?
*
Your answer
Please briefly share about what support system you currently have and what additional support you are looking for during and possibly after birth:
*
Your answer
Please share any other information you would like us to know about regarding your pregnancy history, birth plan, postpartum care plan, etc.
Your answer
Please read and agree to the following:
*
I understand that the Alaska Native Birthworkers Community is a volunteer community led effort to support families, and filling out this form does not guarantee I will be matched with birth support on the day my baby is born.
I understand that the role of an ANBC birth companion is to offer emotional, physical and informational support during pregnancy, birth and postpartum, and that medical care decisions should be discussed with my midwife, doctor or provider team.
Required
The Alaska Native Birthworkers Community also provides other services to birthing families. Please indicate your interest in any of our other services below:
I would like to participate in virtual talking circles to connect with other Native birthing families and birthworkers.
I would like to connect with a Native birthworker to gain additional support during my pregnancy.
I am interested in receiving training to become an Indigenous doula.
I am interested in receiving training to become a certified Indigenous breastfeeding counselor.
Other:
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