Placenta Encapsulation Contract

Complete this form to hire Michelle Rickard of Puget Sound Placenta as your encapsulation specialist.

Your Name*
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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. I adhere to strict OSHA guidelines and follow proper food safety standards. The placenta capsules that are being prepared are for your personal consumption only and are not designed to reverse medical conditions or aliments from pregnancy, to treat postpartum depression, to ensure normal milk supply or to replace medical attention.
Please checkmark by each to confirm you have read the following:*
- I am not a licensed medical professional such as a care provider or physician and I am not able to diagnose, treat or prescribe for any health condition. Services and fees are for the service of encapsulating your placenta, not for the sale of these capsules. Each woman will react to her placenta capsules in different ways. Some of the ascribed benefits of placenta consumption are supported by ongoing research; however these benefits have not been evaluated or approved by the United States government or Food and Drug administration. It is your responsibility to determine whether using placenta capsules can be beneficial to your wellbeing postpartum.
- It is your responsibility to notify me within 1 hour of the birth so that we can work together to make arrangements for pickup or drop off. Failure to do so may result in delayed placenta preparation and encapsulation and encapsulation and may cause decreased potency of nutrients, hormones, and other beneficial attributes of the placenta. Improper storage of the placenta prior to pick up or drop off may result in spoilage. It is your responsibility to discuss release of your placenta from the facility where you will give birth during the prenatal period and to ensure proper storage of your placenta in a refrigerator or cooler. This can be done by placing the placenta on ice until it can be retrieved for preparation and encapsulation.
- It is also your responsibility to inform me of any known blood-borne illness (es) (such as HIV, hepatitis, etc.) that could place me or any others who may come into contact with your bodily fluids (specifically maternal and fetal blood as well as amniotic fluid) at risk.
- My responsibility includes maintaining client confidentiality, committing to preparing and returning your capsules within 48 hours of receiving your placenta, and upholding the highest standards of cleanliness, safety, and quality of professional placenta preparation services. I will provide a backup placenta specialist who is capable of providing services, should this ever be necessary.
- It is important to understand that there may be circumstances in 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. Once the placenta has been released to Pathology, I will not be able to encapsulate without an additional waiver. Other conditions, such as signs of infection in the mother during labor, may mean that consuming your placenta could be harmful to your health. I will always consult with you prior to making a choice on whether or not your placenta is viable for ingestion. It should be possible to claim your placenta after caesarean birth. It is important that you let me know if you have any health concerns or conditions which may affect the health of your placenta or the health and safety of anyone who may come into contact with your placenta.
- Photo Release – I give permission to The Baby Lady (Michelle Rickard) to photograph my placenta before, during and after processing and to use those photographs as she desires for marketing, advertising, educational or promotional reasons in print or online.
Placenta Encapsulation Processing Methods - Choose ONE ($250)*
- High Yield ~ This method of preparing the placenta for the encapsulation skips the steaming process and is set for dehydration after the sliced while “raw”. Some people choose this way because they are raw food activist and believe the cooking or steaming process destroys some of the nutrients. The placenta is never heated above 115 degrees and is therefore compatible with those practicing a raw foods diet. This process is only used within the first 48 hours after birth to ensure freshness. It takes 12- 24 hours to dehydrate.
- Simply Dehydrated ~ This method also skips the steaming process and the placenta is sliced while still “raw”. It is dehydrated at 160 degrees according to USDA safety recommendations for dehydrating meat. At this temperature, bacteria and enzymes are destroyed. It is believed that essential hormones are retained and the iron content is made more bio-available through healing.
- Steamed & Dehydrated (TCM inspired) ~ This method also known as the Traditional Chinese Method or TCM. This method of preparing the placenta for encapsulation involves steaming the placenta gently with lemon, ginger and jalapeño pepper. Adding these in the steaming process is thought to bring out the placenta’s natural healing properties. It is dehydrated at 125 degrees. Lemon~ Balance PH, vitamin C, detoxifying, cleansing, strengthen blood vessels. Ginger~ improves absorption of nutrients into the body, digestion, nausea, gas, cramps, inflammation and depression. Jalapeno Pepper ~ Migraines, congestion, heart health, cancer, inflammation and weight loss.
Capsule Preference - Choose ONE*
- Berry
- Grape
- Lime
- Orange
- Strawberry
- Tutti-Frutti
- Vegetarian
Add On Services
- Placenta Tincture $25 - A Tincture is used for energy, transition, and stress and hormone stabilization.
- Placenta Salve $25 - A Salve is used for hemorrhoids, tears, sore nipples and diaper rashes.
If you are a Doula client you are entitled to a $25 discount on placenta preparation services or multiple services discount for non-doula clients. Make payments to: The Baby Lady, 10102 232nd Ave E. Buckley, WA 98321
Consent*
I have read, understood, and agreed to the above information.
I accept the responsibility of gaining possession of my placenta, and notifying my placenta specialist within 2 hours of my birth. I understand the importance of appropriate handling and storage of the placenta. By signing below I authorize the release of my healthy placenta to Michelle Rickard CD (DONA) for the purposes of Placenta Encapsulation and keepsake preparation for my own personal use.
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