Bethany Collins, AAHCC        Bradley Certified Natural Childbirth Educator and Labor Assistant

502-314-2260 or email:beginningnaturally@insightbb.com

Date:_____________________

Beginning Naturally

Bethany Collins, AAHCC Certified Bradley Educator & Doula

6116 Whispering Hills Blvd Louisville KY 40219

www.beginningnaturally.com  email:Beginningnaturally@insightbb.com

502-314-2260

Class Information/ Pre-registration Form

The BRADLEY® METHOD of natural childbirth is a 12 week series of classes that cover topics such as: nutrition, exercise, relaxation, stages of labor, effective coaching, breastfeeding, and much more.   It prepares couples to feel empowered by the natural process of birth. 

Class will be held in my home located in the Highview area, on Tuesdays from 6:45 8:45.  Please be on time- there is a great deal to cover.  You will need to dress comfortably, and bring two pillows, as we will be practicing relaxation techniques and exercises on the floor. 

Classes are kept small (maximum 8 couples) so that I can provide individualized attention. Classes do tend to fill quickly. 

The fees for the class are $225.00*, and cover the AAHCC student workbook, access to a  copy of  the book Natural Childbirth the Bradley® Way by Susan McChutcheon, and a binder.  There is a $50.00 deposit.  Make checks payable to Bethany Collins. *Some insurance companies may reimburse for childbirth classes.

 

Class Dates Requested:______________________________________________

Mother’s Name:____________________ Birth Date:____/____/____   Due Date____/____

 

Health Status:_________________    Occupation:____________________   Smoker:  Y  /  N

 

Coach’s Name:___________________ Relation to Mom:___________ Birth Date:___/___/___

 

Health Status:_________________   Occupation:____________________   Smoker:  Y  /  N

 

Address:______________________________City:_________________State:______Zip:_______

 

Home( ____ ) _____-______   Work/Cell (____)_____-______     E-mail______________________

 

How did you hear about this class?_________________________________________________

 

OB/ Midwife:________________________________  Delivery location:____________________

 

Number of children:______   #Medicated:______  #Unmedicated:______  C-sections:______

 

Complications with previous pregnancies or births?__________________________________

 

Complications in this pregnancy?___________________________________________________

 

Do you plan to breastfeed?   Y  /  N          Familiar with La Leche League:  Y    /   N

 

Do you plan on using a doula?  Yes (name)_______________________/   No     /    Not sure

 

The following is a list of additional recommended reading.  After I receive your $50 deposit, you may borrow any of these.  *Husband Coached Childbirth      *Womanly Art of Breastfeeding    *The Birth Book     *Thinking Woman’s Guide to a Better Birth   *Natural Childbirth the Bradley Way (provided)

List any you’ve read: