Start Prenatal Care Form
Thank you for your interest in establishing prenatal and birth center care at The Midwife Center. Our goal is to offer you high-quality, client-centered pregnancy and wellness care. Please complete the form below once you've read the steps on the Start Prenatal Care page on our website. Our goal is to respond within 2-3 business days to your request to establish prenatal care.

If you are new to birth center care, please schedule an orientation if you haven't already. You may schedule by calling the Front Office at 412.321.6880 and pressing 3.

You do not have to establish care for pregnancy verification and can instead call the Front Office to schedule a verification appointment. Call 412.321.6880 and press 3.

As the only free-standing birth center in Western Pennsylvania, we welcome clients who desire to birth in our center. While most clients qualify for birth center care, please let us know if you have questions and a nurse will reach out to you to discuss. If you are seeking midwifery care in a hospital setting, we recommend the midwives at Magee Women's Hospital at (412) 641-6361 or the midwives at Jefferson Hospital at (412) 267-6600.


The information you provide in this form is kept confidential according to HIPAA law.
Last Name *
First Name *
Date of Birth *
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Phone Number *
Email Address *
We will use this email address to confidentially contact you about your care.
When was the first day of your last menstrual period? *
If you are unsure, have irregular periods, or know the date of conception, please write that in the box below.
Estimated due date?
NOTE: If you are 20 weeks pregnant or more, we must review medical records from your current provider before we can schedule your first prenatal appointment. This process can be lengthy at times. We recommend physically obtaining your records and bringing/faxing them to The Midwife Center as soon as possible. Our fax number is 412.321.7070.
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Have you previously given birth? *
Have you had a c-section in the past? *
Please note that The Midwife Center does not do Vaginal Birth After Cesarean (VBAC) at the birth center. We recommend you establish care with a hospital-based midwifery practice (Jefferson Hospital or Magee Women's Hospital).
Please enter your height (e.g. 5' 4") *
Please note that The Midwife Center can only allow admission to care for individuals with a Body Mass Index (BMI) of less than 40.
Please enter your weight at time of conception (e.g. 135lbs) *
Please note that The Midwife Center can only allow admission to care for individuals with a Body Mass Index (BMI) of less than 40. If you're unsure of your BMI, you can calculate it here: https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm
What is your health insurance carrier? *
The Midwife Center is in-network with most private insurance and medical assistance plans. If you do not have insurance, we can talk to you about your options including self-payment for services.
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How did you verify your pregnancy? *
Are you a previous client? *
If yes, approximately how long ago were you a client? *
Please list any names you have been previously known by within our care.
How did you hear about The Midwife Center?
Brief Notes:
Please note we cannot address medical concerns or answer clinical questions unless you are an established client. We appreciate your understanding.
What is your preferred form of communication? *
Is it okay to leave voicemails? *
Have you had any prenatal care for this pregnancy yet? *
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