​AthensBorn Birth Services - Placenta Services Agreement

    Thank you for allowing AthensBorn Birth Services, LLC to care for your placenta. We strive to always handle each client's placenta with safety at the forefront, followed by respect for the work your placenta has done in nourishing the life of your baby and the healing and work it can continue to do through placentophagy. 
    ​Placenta encapsulation is the act of taking a fresh, raw placenta, washing the placenta, steaming or slicing the placenta raw, dehydrating, grinding and putting the placenta powder into consumable capsules. All processes are done with respect and education of that placenta and in a sanitary environment. This  business is adhering to strict OSHA guidelines and following proper food safety standards. 

    Limitations and Disclaimer 
    Your AthensBorn representative is not a licensed medical professional and we are 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 research; however these benefits have not been evaluated or approved by the FDA. It is your responsibility to determine whether using placenta preparations may be of benefit to you. Placentophagy, (as it pertains to this contract agreement, is for natural nutritional supplementation and is intended solely for ingestion by the person who has birthed the placenta(s) and not for their family members, friends, or other individuals), is a natural nutritional supplement and as such cannot be guaranteed to produce specific results. The placenta capsules that are being prepared are for your (owner of the placenta) consumption only and are not designed to reverse medical conditions or ailments from pregnancy, to treat postpartum depression, to ensure normal milk supply or to replace medical attention.

    Service Description
    • AthensBorn will complete the full placenta preparation and encapsulation process after your placenta has been received. Proper cleanliness and preparation precautions for ingesting the placenta will be carried out to ensure the highest quality of placenta encapsulation possible for the age and storage methods of the placenta before the encapsulation process.
    • Within 5 days of receipt of the placenta: AthensBorn will deliver your completed pills to your home, if within our services area, or to a designated location if you aren't located within our services area. 
    • AthensBorn will provide a detailed explanation of the proper storing and handling of the finished placenta products and suggestions for ingestion recommendations. 
    • AthensBorn makes every effort to prepare each placenta in a timely manner. However, since we operate as birth doulas, in the event we are called to a birth or have another client’s placenta preceding yours there may be a delay of 1-2 days or more in preparing your placenta. This delay will not negate the safety or effectiveness of your placenta, and we will contact you with information about proper storage guidelines if this is the case. 
    • By signing this agreement, you agree to give AthensBorn permission to photograph your placenta throughout the process of any services purchased and use the photos for informational and promotional purposes.

    Client Responsibility
    • It is your responsibility to deliver your placenta to Becca's home in Statham (12 miles from Piedmont Athens Regional Medical Center, 11 miles from St. Mary's Hospital) after your baby has been born.  Address and exact instructions for dropoff will be provided once forms and payment are received. 
    • It is your responsibility to deliver your placenta in a timely manner (within 1-2 days of birth) and to keep it at a food-safe temperature until delivery is complete. 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 also your responsibility to discuss release of your placenta after your birth from the hospital/health care provider and to ensure proper storage of your placenta in a refrigerator or cooler. Your placenta should not be treated with alcohol, formalin, or any other preservative. Please contact me if you need assistance with hospital release. You should contact the hospital directly, not just your doctor or midwife.
      ​*Your placenta may be kept at room temperature for 2-3 hours following your birth. After that, or as soon as possible, it should be placed in a food-safe container in a cooler full of ice or in a refrigerator. If you are practicing a longer form of delayed cord cutting or lotus birth, ice packs may be wrapped up with the placenta to prevent spoilage. You can prepare your placenta for transport by placing it in a couple of gallon-sized, freezer strength Ziploc bags or in a large plastic container with lid, then into a cooler with ice packs or into a refrigerator. Many hospitals will provide a container or bag. Please do not place the placenta directly on the ice. If it is going to be 3 or more days before your placenta can be processed, it should be frozen. A frozen placenta may require 1­-2 additional days for processing since it must be gently defrosted prior to being dehydrated. 
    • If baby has already been born, please note it may be refrigerated up to 3 days before it starts to spoil (and become unsafe to ingest). If you can't deliver it to me within 3 days, you may put it in the freezer. Encapsulation time for frozen placentas increases up to 2-3 days to allow for safe, gentle thawing.  
    • It is also your responsibility to inform us if you have been diagnosed with any blood-borne illness(es) or other health issues that we may become infected with through contact of bodily fluids (specifically maternal and fetal blood and amniotic fluid), such as HIV, hepatitis, STD’s, etc. For your safety and the safety of others, if you have ever had any of these blood­borne diseases, AthensBorn may be unable to process your placenta. 
    • It is your responsibility to understand that the act of ingesting placenta in any form has not been tested, nor approved by the FDA, and you ingest this at your own risk. Furthermore, you release AthensBorn Birth Services, LLC and Becca Crowe from any liability. 
    • It is your responsibility to know that there may be circumstances under which your placenta cannot be used. Significant abnormalities of the placenta may necessitate your doctor or midwife sending your placenta to Pathology for further examination. Other conditions, such as signs of infection in the mother during labor, may mean that consuming your placenta will not be beneficial to you and could be harmful. If in doubt, we will consult with you before proceeding.
    • It is your responsibility to provide AthensBorn a detailed list of any other medications you are taking regularly in your Placenta Services Registration Form.

    Payment
    The total payment for your placenta services is due upon registering for services. We are not obligated to provide any services before we have received your complete payment.  

    Refunds
    ​    In the event your placenta is unavailable to you (e.g. sent to Pathology) or if you change your mind and choose to terminate this contract prior to 2 weeks before your due date, all fees paid excluding a service fee of $50 will be refunded in full. If you choose to terminate this contract after releasing your placenta to us but before any preparation has begun, we will return your placenta to you for disposal. A service fee of $50 will be kept, but any other portion of the fee will be returned. There will be no refund once preparation has begun, even if you choose not to accept delivery of the finished capsules.

    ​If you agree to this offer, please respond by filling out this forms below. If you have any additional questions please contact us. We look forward to working with you!

    Release from Liability

    In signing the Labor Doula Services Agreement, the Lactation Consultation Agreement, the Placenta Services Agreement, and/or the Postpartum Doula Services Agreement with AthensBorn Birth Services I hereby acknowledge that during the performance period of this contract, services may be provided to me in my home, traveling to a medical facility, hospital, and/or other various locations. 

    I understand that AthensBorn Birth Services has a limited role pursuant to the description of tasks outlined in the above-referenced agreements wherever services are provided to me. 

    AthensBorn Birth Services has not represented to me that contracting for their services guarantees in any way a risk-free or emergency-free prenatal, labor and birth, or postpartum experience. AthensBorn representatives will not make medical or nursing decisions on your behalf, and it will be your decision to seek medical care at a hospital when support services are provided in your home. 
    ​
    When services are performed in a medical facility, I acknowledge that AthensBorn Birth Services is not responsible for the performance of clinical tasks to include medical or nursing decisions regarding the inclusion or exclusion of treatments available to me and my baby. 

    Now, therefore, in consideration of the above acknowledgements, I (both jointly and separately) on behalf of myself, ourselves, my heirs, administrators, personal representatives, executors, and assigns to release and forever discharge AthensBorn Birth Services from all damages or causes of actions, either at law or in equity, which I may have or acquire or which may accrue to me, my heirs, administrators, personal representatives, executors or assigns as a result of using any services provided by AthensBorn Birth Services. I intend this to be a complete release and discharge them from all liability whatsoever.
    Fees
    Package A - Placenta Encapsulation, Print,  & Cord Keepsake - $210
    Package B - Placenta Encapsulation, Print, Cord Keepsake, & 4-oz Placenta Tincture - $260
    A la carte - Print & Cord Keepsake - $100
    A la carte - 4-oz Placenta Tincture - $100
    ​After you submit this form, you'll be taken directly to our Registration Page, where payment information will be provided.
    ​If you agree to the terms of this services agreement, please enter your name and submit.