Tell Us About Your Birth Story
or leave a VM at 802-438-3696

First Name

Last Name

Email Address

What is your age?

City/State

Country (if outside USA)

Time Zone

If we may text you, please provide your cell

Please list your social media profiles

Where did you give birth?

Hospital with OB

Hospital with Midwives

Free-standing birth center

Home birth (unassisted)

Home birth (planned)

Other (please explain below)

check all that apply if you have multiple stories

If other, please explain here

Briefly describe your birth, including any special circumstances

Did you have a perinatal mood disorder (postpartum depression, anxiety, OCD)? If so, please explain in 2-3 sentences.

What unique perspective do you feel your story offers the audience?

We'd love to hear your story.
Please fill out the form if you are interested in being on the show.

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Tell Us About Your Birth Storyor leave a VM at 802-438-3696