Maternal Love - Low Income Form: Doula, Lactation & Postpartum Support 2024
Research significantly shows that having a doula can reduce the risk of a cesarean surgery, the use of augmentation and the length of labor is shortened. Those who breastfeeding and are supported during the postpartum period are more likely to have:
  • Less anxious and depressed
  • More satisfied with partner
  • More likely to be breastfeeding
  • Bonding more with their new baby
 Maternal Love wants to provide access to you and your family! We are well aware that the expense to afford a doula, lactation and postpartum support can be costly, but we believe ALL birthing people especially those of color deserve to have a doula and continuous support! Don’t let your income determine your outcome. Please complete this form to see if you qualify for the same care as any other birthing person, but at a reduced rate! We are truly committed to serving our community and changing birthing outcomes for those who face disparities.

Please allow up to 72 hours to receive a response. There will be a follow up meeting to discuss your vision, options and needs. All documents must be submitted within 5 business days following our agreement. If you are limited on resources to provide these documents, we can arrange a plan to meet your needs!

*All information provided is confidential*
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Name *
Age *
Due Date *
MM
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DD
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YYYY
Phone Number *
Email *
Birthing Location *
Do you have a labor support team? (Ex. Partner, parent, in law, etc.) *
Household Income (based in Louisiana) *
Do you currently receive any of the following benefits: Medicaid, SNAP or WIC? *
Required
Please check of the box of services needed *
Required
Documents must be provided to prove income or housing status. Are you willing to submit verification documents? *
Why would you like to have a doula assist your birth? Please share any other details about your expectations of a doula. *
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