Perinatal Case Review
For those seeking a better understanding of the medical events surrounding their birth or perinatal experience. All cases are reviewed by board-certified perinatal physicians with expertise in the type of medical event you experienced. This consult is meant to help you process the events surrounding your perinatal experience in a way that supports your healing and reproductive decision making.
Account ID (Ouma Direct)
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Non-Surrogacy
Non-Surrogacy
Name
First Name
Last Name
Date of Birth
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Month
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Day
Year
Date
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Format: (000) 000-0000.
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Occupation
How did you hear about us?
What is the primary question you would like answered by this second opinion consultation? What do you hope to get out of your Perinatal Case Review or Consultation?
Allergies to medications?
Current medications?
Have you been formally diagnosed with any perinatal mood disorder, including but not limited to postpartum depression, postpartum anxiety, or post traumatic stress disorder? If yes, please explain.
Do you have any preexisting medical conditions that affect your daily life or for which you take daily medications?
Height (in inches)
Weight (in pounds)
List past pregnancies: Include year of delivery, vaginal or c-section, complication (ie. preeclampsia, gestational diabetes, accreta, postpartum hemorrhage) for each pregnancy. Include pregnancy losses. (e.g. 2008- c-section, 38 weeks gestation, postpartum hemorrhage with blood transfusion)
Who were your key supporters during your birthing experience?
Do you feel that you experienced a traumatic birth? If yes, please describe.
As part of your health planning, are you considering pregnancy again in the future?
Please provide any medical records you would like our clinician to review to better understand the reason you are being seen.
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