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Name (required)
Email (required)
Phone Number (recommended)
Child's State of Birth
---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWashington D.C.West VirginiaWisconsinWyoming
Child Age
Length of pregnancy?
----32 weeks32–36 weeks37–40 weeks40+ weeksI don't know
Was labor induced?
---YesNoI don't know
Type of delivery?
---NaturalEmergency C-sectionPlanned C-sectionI don't know
Was electronic fetal monitor used?
Did the doctor use forceps or was a vacuum extraction performed?
Did the baby have seizures, shakes or tremors within 48 hours after delivery?
Was the baby transferred to the Neonatal Intensive care Unit?
Was the pregnancy high risk?
Your Story
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