Feminine Bond Waitlist

All information provided in this form is for exclusive use of the Conservative Midwives Organization and will not be shared with third parties. IMPORTANT If you are 20 weeks pregnant or over at the moment of filling out this form, or you reach 20 weeks of pregnancy without hearing back from us, we recommend that you do not wait for us and visit a midwife or obstetrician meanwhile. You might be able to change providers later when hearing back from us. For safety reasons, most midwives have a cutoff of pregnancy weeks to take new clients (this cutoff varies among midwives).

First name *

Email Address *

Phone (optional)A phone number where we can contact you when we find your match. We will send you an email too.

State/Province *

ZIP / Postal CodeThis will help us locate the closest midwife.

Optional: Tell us your birth wishes (Mark all that apply)I am not pregnant or trying to conceive. I am looking for gynecologic, primary care, or other services.Hospital birthHome birthWater birthDrug-free birthAnesthesia or drugs for labor painHypnobirthHave family present in the birth (other than the father)Not sure what I want yet

Other birth wishes

Optional: Are you interested in any of these services?Primary care & Well-woman carePrenatal classes/preparation for birthSupport person during labor (birth doula)Help and support at home after the birth (postpartum doula)Breastfeeding help and support (Lactation Consultant)

Other services

If you prefer a midwife that speaks a language other than English, please type here your preferred language:

Terms and Conditions (Mark all before submitting, otherwise your application will be rejected). *I understand that The Conservative Midwives Organization is not a healthcare agency and it's only facilitating connection between me and a provider.I understand that it is recommended to see a pregnancy and labor provider by 20 weeks of pregnancy. I understand that The Conservative Midwives Organization does not guarantee that there will be a midwife match for me and that any midwife found will contact me and evaluate my case before deciding to take me as a new client.I understand that, although there is a screening for the midwives participating in this program, The Conservative Midwives Organization is not responsible of the actions of the midwives and providers contacted through the organization, and the organization cannot be held accountable for liability related to the provider.I understand that I will not be receiving any free or discounted healthcare services unless otherwise agreed between me and the contacted provider.I understand the Conservative Midwives Organization will not answer any health or birth related questions and that all communications will be limited to the purpose of finding a provider for my case.