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!


Please be mindful that with all the allocations in the marketplace, we have to be modest with birth kit amounts. Please be mindful of the amounts you choose, and if they need to be lower, we will let you know.

Set up your custom kit with us and get a coupon for 10% off your next purchase with us WHEN YOUR FIRST KIT GETS ORDERED! And don't forget, once we've received 5 orders of your birth kit, we send you an additional $30 Gift Certificate!!

Please include quantity, sizes and types in the fields provided.


Underpads can be chosen in any amount, from one individual pad to several packages. Write in the amount of INDIVIDUAL PADS you want in the checkbox, not the number of packages.
Basic Underpads 23x24" (Pkg of 5, get any amount from 1 pad to 50!):
Basic Underpads 23x36" (Pkg of 25, get any amount from 1 pad to 50!):
Extrasorbs Air-Permeable Disposable Drypads 23x36" (Pkg of 10, get any amount from 1 pad to 50!):
Deluxe Underpads 23x36" (Pkg of 10, get any amount from 1 pad to 50!):
Deluxe Underpads 30x36" (Pkg of 10, get any amount from 1 pad to 50!):
Extrasorbs Air-Permeable Disposable Drypads 30x36" (Pkg of 10, get any amount from 1 pad to 50!):
Alcohol Prep Pads:
Plastic Sitzbath:
Plastic Backed Sheet, 40" x 72":
OB Pads: Choose from (1) Sterile, pkg of 12, no adhesive; (2) Non-sterile without adhesive, pkg of 12; (3) Non-Sterile with Adhesive, pkg of 12; and (4) Non-sterile with wings and adhesive, pkg of 12; and (5) Peach Contour OB pads, 7x13" in pkg of 20 OR as singles; (6) Capri Regular (Minis), (7) Capri Large (Midis), and (8) Capri X-Large (Maxis) in any amount combination. Capris are available in singles, a half pack of 14 or full pack of 28. Please include Type AND Amount:
OB Pad for Heavy Afterbirth, 13" wide, 27" in length:
Sterile Gloves PAIRS:
AVAILABLE IN S/M/L SIZES: Latex, Synthetic, Nitrile and Aloetouch.

AVAILABLE IN 6, 6.5, 7, 7.5, 8, 8.5: Perry Style 42 Latex, Medline Signature Latex, NitriDerm Nitrile Extended Cuff and Prestige Polychloroprene.
Please include Size, Type AND Amount):

Sterile Gloves Single: AVAILABLE IN S/M/L SIZES:Choose Latex, Synthetic, Nitrile, and Aloetouch and Please include Size, Type AND Amount:
Mesh Panty (any amount) and/or Protection Plus Underwear (Depends-style), any amount: Please include Type AND Amount:
Perineal Bottle:
Perineal Packs: Choose (1) Cold w/adhesive; (2) Warm w/adhesive, (3) Cold w/o adhesive and (4) Hourglass Cold w/o adhesive Please include Type AND Amount:
Bulb Syringe, Economy available in 2 or 3 ounce, Davol/Busse Brand in 1, 2, or 3 ounce: (1, 2 or 3 ounce) Please include Size AND Type:
Digital Thermometer (Standard - 60 sec or Flexible tip - 9 sec):
Sterile Gauze: (1) Post-op Sponges 4x4", (2) 4x4"- 8-ply, (3) 4x4"- 12-ply, (4) Tray of 10, 4x4"- 12 ply, (5) Curity Cellulose Nonwoven Fabric 4x4"- 12-ply, (6) Dynarex Non-woven Sponges 4x4"- 4-ply, (7) Avant Gauze NON-Woven Sponges, 4x4"- 6-ply, (8) Avant Gauze Woven Sponges, 4x4"- 12-ply, (9) Kerlix Gauze Roll, (10) 2x2"- 8-ply Please include Type AND Amount:
Straws - Choose Regular Flexible Plastic (7-3/4"), Compostable Plastic, or Flexible Plastic (Assorted Colors, 10.3"):
Paper Tape Measure, 36 or 72":
Newborn Hat: Choose Economy or 100% Cotton and indicate number desired Please include Type AND Amount:
With 100% Cotton Hat, clients can choose white, blue or pink.
Povidone Solution (Choose from 4 oz or 8 oz):
PeriClens by Shonda Parker:
Povidone Scrub Brush:
Dyna-hex (Hibiclens) Solution (4 oz. or 16 oz.):
Dyna-hex (Hibiclens) Scrub Brush:
Lubricating Jelly: Choose Standard 3g packet, 5g packet, 2 oz tube, and 4 oz tube; Medilube All Natural Lube in 3g, 4 oz and 16 oz; Surgilube in 3g packet or 2 oz tube, Aplicare in 3g packets. Please include Type AND Amount:
Mattress Cover (clients choose from California King, King or Queen):
Cord Clamps (Standard or Economy), Sterile Cord Tape, Cord Bands by Cetro (Available in LATEX and NON-LATEX) Please include Type AND Amount:
Emesis Basin (Choose Kidney-shaped or 6-Quart) or Emesis Bag:
Fracture Bedpan:
Kleenprint Footprinter:
Homebirth Certificate, clients choose from 8 styles:
Afterbirth Sitz. AVAILABLE IN PLASTIC JAR WITH SEALED PACKAGING: Choose from Lucy's Garden Soothing Sitz, 4 oz ($8.50), 8 oz ($12.00) and 16 oz. ($20.50) - PACKAGED IN SEALED FOIL/PAPER BAG: Intimate Solutions (4 or 8 ounce, $10 and $15.50 respectively) or Wishgarden Sitz, 3.5 oz in canister for $10.00:
Olive Oil in 4 or 8 oz:
Infant Heel Warmer:
Lansinoh Lanolin, 1.41 oz or 0.25 oz:
Birth Pool Liner, specify type Oasis Round, Oasis Elite, Oasis Oval, Oasis Elite Grand, Mia Via, BPIAB Regular, BPIAB Mini, La Bassine Maxi, or La Bassine. For All Pools: Oasis Generic - Small or Large, (higher quality than Eco) or Eco Generic (Small or Large):
Birth Pool, specify type Oasis Round, Oasis Oval, Oasis Elite, Oasis Elite Grand, Mia Via, BPIAB Regular, BPIAB Mini, La Bassine or La Bassine Maxi:
Shoulder Length Gloves: Regular style (Red plastic, no elastic band), Band-A-Sleeve (Clear with elastic band) and/or DermAssistŪ Latex Elbow Length Surgical Gloves (Available in size 6.5,7.5 or 8.5). Include type and amount of pairs:
Waterbirth Net:
Delee Trap (8 or 10 Fr), Available in Medline with contro-vac valve Please include French Size AND Amount:
Oral Vitamin K for baby - Bio-K-Mulsion:
Amnihook:
Amnicot:
Amnicator:
Infant Lancet, choose from these lancets:
Floating Water Thermometer, Choose Animal Shape or Poolmaster:
25' Hose:
Shower to Hose Adapter or Faucet Adapter with Siphon:
Sterilization Pouch (Choose from 3.5x9", 5.25x10", 7x13", 8x16", & 12x15") ":
Newborn Onesie (Choice of 2 100% Cotton styles, Born at Home or Midwife Helped Me Out! ):

Please include contact information including name, email address, business address and phone number. Our system sends this email so your email address is never recorded. Without this information, your kit CANNOT be set up! :


Please feel free to embellish or further explain any selections above, ask any questions you may have, and feel free to 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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