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:

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:

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) Cord Clamps (Standard or Economy)
(2) Sterile Cord Tape
(3) Cord Bands by Cetro (Available in LATEX and 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)
(4) Wishgarden Sitz, 3.5 oz ($10.00)
PACKAGED IN SEALED FOIL/PAPER/BOX:
(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:

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

Lansinoh Lanolin - Choose From:
(1) 1.41 oz
(2) 0.25 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:

Infant Lancet - Choose From:
(1) Gentleheel
(2) Tenderfoot Infant
(3) Tenderfoot Toddler
(4) Capiject
(5) MediHeel
(6) Quikheel
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 contact information including:
  • Name
  • Email address
  • Business address
  • Phone number
Include here what you wish for your kit to be called. 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 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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