Class Registration Form
Placenta Encapsulation Agreement
Indicates required field
Estimated due date
Partner/Support Person's Name
Who will be calling to let me know your placenta is ready for pick-up.
Address (for delivery of completed capsules)
Partner/Support Person's Phone Number
Care Provider's name (Midwives, Doctor, OB)
Planned Place of Birth (hospital, home)
$250 for Placenta Encapsulation Services, including pick up of placenta and delivery of capsules within Squamish.
$50 additional fee for pick up of placenta and delivery of capsules
outside of Squamish.
Fees include the preparation and encapsulation of the placenta, a storage container for completed capsules, written instructions for storage and handling, and guidelines for taking your capsules. An umbilical cord keepsake is also provided where possible.
A deposit of $50 is due with this contract. The balance of $200 is due when I receive your placenta for processing.
Fees are payable to Kimberly Daniels with cash or etransfer to:
In the event your placenta is unavailable to you (eg. sent to Pathology) any fees paid including 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 you for disposal. Your $50 deposit will be retained, but any other portion of the fee you may have paid will be returned. There will be no refund and payment will be due in full once preparation has begun, even if you choose not to take delivery of the finished capsules.
Placenta encapsulation is the process of preparing the mother’s placenta after the birth of her baby by steaming, dehydrating, powdering and placing it into capsules for the mother to ingest. The purpose of ingestion of the placenta is to reintroduce beneficial hormones, proteins, and other nutrients to her body following labour and birth to help restore physical and emotional balance, prevent or lessen the risk of “baby blues” that may lead to postpartum depression, increase breast-milk production, shorten healing time, increase maternal energy levels, and provide an over-all feeling of wellness to aid in the transition between pregnancy and the early postpartum period.
Limitations and Disclaimer
I am not a licensed medical professional and I am not able to diagnose, treat or prescribe for any health condition. Services and fees are for the preparation and encapsulation of your placenta, not for the sale of the pills. No specific benefits or effects are promised. Any benefits will vary from person to person. Some of the ascribed benefits of placenta consumption are supported by ongoing research; however these benefits have not been evaluated or approved by Health Canada. It is your responsibility to determine whether using placenta preparations may be of benefit to you.
It is your responsibility to notify me as soon after the birth as possible to make arrangements for pick up or drop off.
Phone 604-722-0108 between 8am to 9pm, email firstname.lastname@example.org after 9pm to 8am.
Failure to do so may result in delayed placenta preparation and encapsulation and may cause decreased potency of nutrients, hormones, and other beneficial attributes of the placenta, and even spoilage of the placenta which would render it unusable for encapsulation.
It is your responsibility to discuss release of your placenta from the hospital where you give birth
and to ensure proper storage of your placenta in a refrigerator or cooler with the placenta placed on ice until it can be picked up.
Lunamama Doula Services does not determine whether or not the placenta is suitable for consumption; it is your responsibility to discuss this with your care provider.
It is also your responsibility to inform me of any known blood-borne illness(es) or other health issues (such as HIV, hepatitis, etc.) that could place me or any others who may come in contact with bodily fluids (specifically maternal and fetal blood and amniotic fluid) at risk. In the interest of safety for myself and my clients, I choose not to work on any placentas if these illnesses are present.
Whether birthing at home or in a hospital, please ensure that your placenta is kept fresh. It can remain at room temperature for 3 hours following the birth. After that (or sooner if possible) it should be refrigerated or otherwise kept cool. If you are practicing some form of delayed cord cutting, ice packs may be wrapped up with the placenta to prevent spoilage for up to 3 hrs postpartum. Placenta encapsulation cannot be done after a traditional lotus birth. The placenta should be frozen if the placenta encapsulation process cannot start within 48 hours of the birth. Frozen placentas are best if prepared by 4 weeks, however frozen placentas up to 6 months old can still be used. You can prepare your placenta for transport by placing it in a couple of large, freezer strength ziplock bags or in a large plastic yogurt or ice cream container, then into a cooler with ice packs or into a refrigerator.
It is important to note that there may be circumstances under which your placenta can not be used. Significant abnormalities of the placenta may necessitate your midwife or doctor sending your placenta to Pathology for further examination. Other conditions, such as signs of infection in the mother during labour, may mean that consuming your placenta will not be beneficial to you. If in doubt, consult your care provider before proceeding. It should be possible to claim your placenta after caesarean birth.
By selecting the "I Accept" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting "I Accept" you consent to be legally bound by this Agreement's terms and conditions.
Do you accept the terms and conditions of this agreement
Class Registration Form