Pregnancy Yoga
Birmingham
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0121 449 9803
or book online
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Name
Address
Postcode
Telephone No.
Mobile
Email
Please contact me via
Profession
Are you planning to go back to work?
If so when?
Baby's name
Date of birth
Birth weight
Unassisted vaginal birth
Induced labour
Assistance with forceps
Assistance with ventuose
Episiotomy
Tear? 1st/2nd/3rd degree
Stiches
Post partum haemorrhage
Planned C section
Emergency C Section
Place of birth
Length of labour
generally how do you feel in retrospect
How are you feeding
How is this going
How are you finding motherhood
SPD/Pelvic pain
Sacro-iliac/sciatic pain
Back pain
Piles
Stiff neck/shoulders
Joint pain
Anaemia
Mastitis
Details about the birth:
Pain relief:
Birth Pool
Tens
Hypnotherapy
Acupunture
Gas & Air
Pethadine
Spinal Block
Epidural
General Anaesthetic
Infection of stiches/scar
High/Low blood pressure
Depression
Anxiety
Exhaustion
Diastasis recti
Date
I agree by ticking this box for my own safety, to inform the teacher at the beginning of the class, should any changes in the above information occur, or if any medical, physical or emotional problems should arise at any time during my Post Natal Yoga preperation
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