IF YOU NEED TO MAKE CHANGES TO YOUR CURRENT KIT, PLEASE SEND AN EMAIL WITH CHANGES TO [email protected].

THIS FORM IS FOR MIDWIVES SETTING UP A NEW KIT ONLY ONLY!



Due to individuals attempting to set up birth kits without being practicing midwives, simply to receive the discount, we’ve updated our protocol. Going forward, we require proof of active practice as a midwife before we can proceed with setting up a birth kit and providing a coupon.

Set up your custom kit with us and get a 10% coupon for one purchase with us WHEN YOUR FIFTH KIT GETS ORDERED! And don't forget, once we've received 10 orders of your birth kit, we send you an additional $100 Gift Certificate!!

Please include quantity, sizes and types in the fields provided. Anything you would like to be optional, instead of included in the main kit, write the word "optional" next to your choice. You can also add optional items in the last text box at the bottom.



Basic Underpads 23x24":

Basic Underpads 23x36":

Extrasorbs Air-Permeable Disposable Drypads 23x36":

Deluxe Underpads 23x36":

Alcohol Prep Pads - Choose from:
(1) Medium
(2) Large
Please include Size AND Amount:

OB Pads - Choose from:
(1) Non-Sterile with Adhesive, package of 12
(2) Non-sterile with wings and adhesive, package of 12
(3) Peach Contour OB pads, 7x13" in package of 20 OR as singles
The following Capris are available in singles, a half pack of 14 or full pack of 28:
(4) Capri Regular (Minis)
(5) Capri Large (Midis)
(6) Capri X-Large (Maxis)
NOW AVAILABLE - The Honey Pot Company Pads:
(7) Organic Regular Non-Herbal Pads With Wings, 20 Ct
(8) Organic Super Non-Herbal Pads With Wings, 16 Ct
(9) Organic Overnight Non-Herbal Pads With Wings, 12 Ct
Natracare Organic Pads:
(10) New Mother Maternity, 10/package
(11) Regular Pads, 14/package
(12) Super Pads, 12/package
(13) NightTime Pads, 10/package
(14) Regular with Wings, 14/box
(15) Super with Wings, 12/box
(16) Super Plus, 12/box
Rael Organic Pads:
(17) Rael Organic Cotton Cover Pads - Regular, 16 ct
(18) Rael Organic Cotton Cover Pads - Large, 14 ct
(19) Rael Organic Cotton Cover Pads - Overnight, 12 ct
Please include Type AND Amount:

Sterile Gloves PAIRS:

AVAILABLE IN S/M/L SIZES:
(1) Latex
(2) Synthetic
(3) Nitrile
(4) Medline Nitrile Extended Cuff
(5) Aloetouch 12"

AVAILABLE IN 6, 6.5, 7, 7.5, 8, 8.5:
(6) Perry Style 42 Latex
(7) NitriDerm Nitrile Extended Cuff
(8) Prestige Polychloroprene

Please include Size, Type, AND Amount:

Sterile Gloves SINGLES:

AVAILABLE IN S/M/L SIZES:
(1) Latex
(2) Synthetic
(3) Nitrile
(4) Medline Nitrile Extended Cuff
(5) Aloetouch Nitrile 12"

Please include Size, Type, AND Amount:

Rael Disposable Period Underwear
(1) 5 pack
(2) 12 pack
Please include Type AND Amount:

Perineal Packs - Choose from:
(1) Cold w/adhesive
(2) Warm w/adhesive
(3) Cold w/o adhesive
(4) Hourglass Cold w/o adhesive
Please include Type AND Amount:

Bulb Syringe - Choose From:
(1) Economy (2 or 3 ounce)
(2) Davol/Busse Brand (1, 2, or 3 ounce)
Please include Type, Size, AND Amount:

Digital Thermometer - Choose From:
(1) Standard - 60 sec
(2) Flexible tip - 9 sec
Please include Type AND Amount:

Paper Tape Measure - Choose From:
(1) 36"
(2) 72"
Please include Size AND Amount:

Isopropyl Alcohol - Choose From:
(1) 4 oz (70%)
(2) 16 oz (70%)
(3) 16 oz (99%)
Please include Size AND Amount:

Hydrogen Peroxide - Choose From:
(1) 4 oz
(2) 16 oz
Please include Size AND Amount:

Povidone Solution - Choose From:
(1) 4 oz
(2) 8 oz
Please include Size AND Amount:

Dyna-hex (Hibiclens) Solution - Choose From:
(1) 4 oz
(2) 16 oz
Please include Size AND Amount:

Lubricating Jelly - Choose From:
(1) Standard: 3g packet, 5g packet, 2 oz tube, or 4 oz tube
(2) Natural Medilube: All Natural Lube - 3g packet, 4 oz tube, or 16 oz tube
(3) Surgilube: 3g packet or 2 oz tube
(4) Aplicare: 3g packets
Please include Type, Size, AND Amount:

Ultrasound Gel - Choose From:
(1) 60 grams
(2) 8 oz
Please include Size AND Amount:

Mattress Cover (clients choose from California King, King or Queen):

Umbilical Cord Clamps/Tape/Bands - Choose From:
(1) Standard Cord Clamps
(2) Economy Cord Clamps
(3) Sterile Cord Tape
(4) Cord Bands by Cetro (Please specify which type: LATEX or NON-LATEX)
Please include Type AND Amount:

Emesis Basins and Bags - Choose From:
(1) Emesis Basin: Kidney-shaped
(2) Emesis Basin: 6-Quart
(3) Emesis Bag
Please include Type AND Amount:

Homebirth Certificate (clients choose from 8 styles):

Afterbirth Sitz - Choose From:
AVAILABLE IN PLASTIC JAR WITH SEALED PACKAGING:
(1) Lucy's Garden AfterBirth Sitz, 4 oz ($9.00)
(2) Lucy's Garden AfterBirth Sitz, 8 oz ($13.00)
(3) Lucy's Garden AfterBirth Sitz, 16 oz ($23.00)
PACKAGED IN SEALED FOIL/PAPER/BOX:
(4) Wishgarden Sitz, 3.17 oz ($12.49)
(5) Intimate Solutions, 4 oz ($10.00)
(6) Intimate Solutions, 8 oz ($15.50)
(7) Organic Herbal Sitz Bath by Earth Mama Angel Baby ($12.34)
Please include Type AND Amount:

Lansinoh Lanolin - Choose From:
(1) 0.25 oz
(2) 1.41 oz
Please include Size AND Amount:

Shoulder Length Gloves - Choose From:
(1) Regular style (Red plastic, no elastic band)
(2) Band-A-Sleeve (Clear with elastic band)
(3) DermAssist® Latex Elbow Length Surgical Gloves (Available in size 6.5,7.5 or 8.5)
Please include Type AND Amount:

Delee Trap - Choose From:
(1) DeLee Mucus Trap With Contro-Vac Valve - 8 Fr
(2) DeLee Mucus Trap With Contro-Vac Valve - 10 Fr
Please include Size AND Amount:

Oral Vitamin K for baby - Choose From:
(1) Bio-K-Mulsion
(2) Natal-K

Infant Lancet - Choose From:
(1) Tenderfoot Infant
(2) Tenderfoot Toddler
(3) Capiject
(4) MediHeel
(5) Quikheel
(6) Unistik® TinyTouch®
(7) Neat Nick
Please include Type AND Amount:

Floating Water Thermometer - Choose From:
(1) Animal Shape
(2) Poolmaster
Please include Type AND Amount:

Hose - Choose From:
(1) 25' Hose
(2) 50' Hose
Please include Size AND Amount:

Adapter - Choose From:
(1) Shower to Hose Adapter
(2) Faucet Adapter with Siphon
Please include Type AND Amount:

Sterilization Pouch - Choose From:
(1) 3.5 x 9"
(2) 5.25 x 10"
(3) 7.5 x 13"
(4) 9 x 15"
(5) 13 x 20"
Please include Size AND Amount:

Newborn Onesie (100% Cotton) - Choose From:
(1) Born at Home
(2) Midwife Helped Me Out!
Please include Type AND Amount:

Please include ALL of the following contact information:
  • Name
  • Email address (will not be publicly listed)
  • Business address (will not be publicly listed)
  • Phone number (will not be publicly listed)
Without this information, your kit CANNOT be set up!


Include here what you wish for your kit to be called:


Please feel free to embellish or further explain any selections above, ask any questions you may have, and look over our website and add any other items. We'd also like to hear about any other items that you'd like to see sold on our website.



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