Placenta Encapsulation Contract

Thank you for purchasing placenta encapsulation. We strive to make the process simple and easy. Read the contract below, sign, and pay. We will then get your placenta kit to you.

Client agrees to:

  • Talk to your care provider during a prenatal visit about your intended birth place’s policies in regards to releasing the placenta. Sign any forms required and have them placed in your file. 

  • (If you are birthing in a hospital): remind your labor nurse upon arrival, and on change of shift if applicable, that you plan to take your placenta.

  • (Following the birth) place your placenta in a sealed container or double ziplock gallon-sized bags, labelled with your name, and placed on ice in your cooler.

  • be responsible for ensuring that you have met all the requirements of your birthing facility and completed the appropriate paperwork for release, if any.

  • be responsible for the safe handling and appropriate storage of your placenta prior to pickup by the specialist. If you intend to freeze your placenta for a time please have it double bagged before placing into any container to prevent freezer burn.

  • call or text message Rebekah at 859-533-4667 (between 8pm and 8am) after the birth to arrange a time to pick up the placenta or meet someone at your location. If you do not get a response, call Anna at 615-525-0707.

  • freeze the placenta until you are ready for your encapsulation to begin, if you are not able to contact us within 3 days of the birth and the placenta has been appropriately refrigerated since the birth. Encapsulation generally takes 1-2 days for a refrigerated placenta. A frozen placenta will take an additional 1-2 days so that it can be safely thawed. 

  • take the capsules in the manner labeled. Taking the capsules in any manner other than as labelled can have undesirable results. Your placenta specialist does not determine whether your placenta should be consumed and makes no guarantee of personal results from the capsules. The capsules should not be taken during times of illness, such as the common cold, flu, or mastitis

  • not hold my specialist responsible if my placenta is accidentally damaged during the encapsulation process. If accidental damage is done you will be refunded your payment. 

  • that I am paying for the encapsulation service only, which is not clinical, pharmaceutical, or intended to diagnose or treat any condition. No refunds for services will be given.

  • my placenta does not contain any transmittable diseases such as Hepatitis-B, -C or HIV/AIDS. My care provider and I have determined that my placenta is healthy and suitable for encapsulation.The placenta has been handled in a manner appropriate for safe food preparation since the birth.

  • If for some reason your placenta can not be encapsulated due to the care provider sending it to pathology, a parent will request 4 inches of the cord and place it on ice in the cooler. The encapsulist will then make a $120 sterling pendant with it and you will receive a $100 voucher to be used for other services within 6 months.

You placenta encapsulist agrees to:

  • view each placenta as a sacred connection between mother and child and will treat it accordingly.

  • provide you with a placenta encapsulation kit. 

  • not determine whether your placenta should be consumed and makes no guarantee

  • handle your placenta in a manner appropriate for safe food preparation

  • handle and encapsulate according to OSHA Bloodborne Pathogens Universal Precautions and Food Safety and Handling standards

  • process you placenta in this order: clean, steam, dehydrate, and put into capsule form in a sanitary and disinfected work space

  • make no guarantee of how many pills will be produced from your placenta. Each placenta is unique in size and shape.

  • take photos of your placenta or placenta products (if requested)

TRANSPORTATION:

Permission is granted for your specialist or her driver to transport your placenta for preparation and delivery of completed capsules. Your placenta will be handled and encapsulated according to OSHA blood-borne pathogens universal precautions and Food Safety and Handling standards.

 

FEES:

$290 is due at the completion of signing the placenta encapsulation contract. You may cancel this contract at any time prior to 36 weeks pregnancy and a refund will be given. If you cancel before the birth, but after 36 weeks of pregnancy, a $200 voucher will be issued for you to use for other Blissful Birthing TN services and no refund is given. If you cancel after we have picked up your placenta, we will return your placenta and give you a $100 coupon to be used for jewelry or other services within 6 months, but no refund will be given. If you cancel after the encapsulation process has begun, no refund will be given. Your retainer fee is non refundable. Payment plans can be arranged in advance, when necessary. 

PLACENTA PREPARATION:

Your placenta will be cleaned, steamed, dehydrated, and put into capsule form in a sanitary and disinfected work space. The specialist is not responsible or liable for any issues preventing provision of the services that are beyond her control (ex. car accident, detainment, placenta sent to Pathology Dept., etc). 

In the traditional method, organic myrrh and ginger are added to the water during the steaming process. Chinese medicine teaches that ginger provides added warmth to the placenta that is necessary for helping the body to heal during the immediate postpartum period. Myrrh is believed to aid in nutrients being retained in the placenta during the steaming process. Please indicate on the form below what you desire to be added during the steaming process.

A cord keepsake is included in your package. This is done by drying the cord and returning it to you in a pouch. Please indicate on the form below whether you would you like a cord keepsake or would prefer that the cord be processed and included in your pills. 

We make no guarantee of how many pills will be produced from your placenta. Each placenta is unique in size and shape. 

If for some reason your placenta can not be encapsulated due to the care provider sending it to pathology, a parent will request 4 inches of the cord and place it on ice in the cooler. The encapsulist will then make a $120 sterling pendant with it and you will receive a $100 voucher to be used for other Blissful Birthing TN services within 6 months.

PHOTOGRAPHY AGREEMENT:

Photos of your placenta or placenta products may be taken for educational, promotional, or record keeping purposes. No identifying information will be shared under any circumstances.  If you would like a copy of any photographs taken by your encapsulators, please note this request on the form below.

DISCLAIMER:

Your placenta specialist is not a pharmacy, pharmaceutical representative, holistic practitioner, herbalist, homeopath or medical doctor. Benefits of placenta encapsulation are supported by maternal experience and have not been evaluated by the Food and Drug Administration. Placenta Encapsulation or placentophagy is intended solely for ingestion by the mother who has birthed the placenta(s) and not for her family members, friends, or other individuals and is not guaranteed to produce specific results. The services offered are not clinical, pharmaceutical, or intended to diagnose or treat any condition. Families who choose to utilize the services take full responsibility of their own health and for researching and using the offered services. Your placenta arts specialist makes no guarantee as to capsule efficacy, but does guarantee the highest quality of service.

Always speak to your care provider regarding any questions about your health, safety and well- being. Placenta services are not meant to be a replacement for medical advice, medical care or medicine. If you experience symptoms of postpartum depression or anxiety, low milk supply, etc. please call your care provider to discuss your symptoms and how to feel better as well as treat any existing symptoms or potential conditions. While many women have found placenta encapsulation to be a wonderful and amazing gift, you are still encouraged to seek appropriate assistance and medical care when necessary. It is always okay to ask for help.

Please sign the form to indicate that you have read, reviewed and agree to the preceding information, as well as the following:
I have read, understood, and agreed to the above procedures, information, and statements of policy. By signing my name, I give my consent to release my healthy placenta to my specialist for the purposes of encapsulation. I accept the responsibility of gaining possession of the placenta after the birth, handling and immediate cooling/storage of the placenta appropriately prior to the specialist taking possession of it, and notifying the specialist of my birth within 72 hours while the placenta is being appropriately cooled and stored. I authorize the release of my placenta to my specialist and I authorize transportation of my placenta for preparation. I have honestly disclosed my health history and all pertinent health details and preparation preferences on this form. I understand that upon receiving the completed capsules, my specialist is not liable for the usage or effects of the capsules, including but not limited to any other person(s) ingesting my own placenta capsules. Upon receiving my completed placenta capsules, I waive any and all rights to hold my specialist responsible for any undesired effect or differing benefits of consuming the capsules. 

Your placenta specialist will keep this document on file as a record of our agreement. No copies will be released to any third parties and all client information will be kept strictly confidential. The information provided has not been evaluated by the Food and Drug Administration.

Nashville, TN 37221

© 2020 by

Blissful Birthing TN, LLC

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