Informed Disclosure for Midwifery Care (Updated 4/12/18)

Katlyn Carter (Student Midwife)

Midwife’s Training & Experience

Katlyn Carter of K4 Birth Services is a student midwife at Midwives College of Utah. She plans

to graduate in December 2020 with a Bachelors in Midwifery and become a Certified

Professional Midwife (CPM). She will then seek licensure in the state of Washington. She plans

to participate in peer review. Katlyn is CPR and NRP certified. She is also a doula and childbirth

educator.

Katlyn has attended ___ births over the course of ___ years as a student midwife. She has been

in practice for ___ years. Katlyn has experience with a variety of specialized birth experiences

including the following:

 vaginal births after cesarean(s) (VBAC/VBA2C)

 teen pregnancy
 pregnancy with a deployed spouse
 pregnancy after loss
 mental health variability in pregnancy and postpartum

Philosophy of Practice

As a midwife, I believe all women should have physical, emotional, and social support during

their pregnancy, birth, and postpartum. I believe that pregnancy, birth, and breastfeeding are

normal, healthy events that have the potential to be strengthening and empowering to all women.

I believe that, within the bounds of safety, all women have the right to birth how, where, and with

whom they choose. I believe in the importance of prenatal education, planning, and shared
decision-making with my clients. I strive to build relationships with my clients built on trust,

respect, and understanding.

Services Provided

Services provided by K4 Birth Services include the following:

 24/7 midwife availability for urgent needs

 A complete medical and obstetrical history, physical and pelvic examination including lab
work
 Nutritional assessment and counseling
 Prenatal visits once monthly until 28 weeks, every two weeks until 36 weeks and then
weekly until birth
 A prenatal home visit at approximately 36-37 weeks
 Attendance at your home during active labor, birth and immediate postpartum
 An initial newborn examination that takes place shortly after birth
 Visits after birth including two home visits in the first 5 days, then office or phone visits
at 10-14 days and 3-4 weeks, and a final office visit at 6-8 weeks postpartum
 Availability for lactation support or referral, if needed

Transfer/Consultation Protocols

Some conditions may arise during pregnancy, labor, birth, after birth, or with the newborn that

outside the scope of practice of a midwife. These conditions include, but are not limited to,

gestational diabetes not controlled by diet, twins, breech, etc. The midwife will consult with the

appropriate care provider or provide referral should the need arise. A comprehensive list is

available upon request.

Transport Plan

NARM Accountability Process

HIPAA Privacy & Security Disclosures

I have read and understand the content of this Informed Disclosure.

Client (full name)_________________ Signature:________________________ Date:________

Other (full name)_________________ Signature:________________________ Date:________

Midwife ________________________ Signature:________________________ Date:________