Make a referral

Health professionals can refer clients or you can request to use our services yourself.

Our programs are provided for free to people living in greater Melbourne and surrounds who are experiencing economic disadvantage and meet our eligibility criteria (see below).

Please Note: We are now fully booked for September & November due dates. We are unable to accept any further referrals for birth support or extended postnatal support, for people who are due to give birth in those months. Our Volunteer Doula team is at capacity. Thank you for your understanding.

Make a referral below

Email *

What type of referral is this *I am referring myselfI am referring a client

Your Eligibility

Our service is available to people who are experiencing economic disadvantage. We define economic disadvantage as not having sufficient ongoing access to financial resources to cover necessities such as food, accommodation, clothing, medical treatment and education. Click here for more information about this. Are you experiencing economic disadvantage?

Your Eligibility *YesNo

Other services

Birth for Humankind only offers volunteer doula support services to people experiencing economic disadvantage.

Please click here for information about alternative doula support options for people who can afford to pay for doula services.

Please tell us about the support you would like to receive from Birth for Humankind.

YOUR DETAILS

Client First Name: *

Client Surname: *

Preferred Name and Pronouns:

Phone Number: *

Date of Birth: *

Email Address *

Street Address *

City *

State *

ZIP / Postal Code *

First Language *

If 'Other' first language was selected above, please indicate which one. If you speak more than one language, you can list additional languages here.

Do you require an interpreter? *Yes, alwaysYes, for complex discussionNoUnsure

Have you used this service before? *YesNoUnsure

Estimated due date *

Hospital or homebirth booked: *

If 'Other' hospital was selected above, please indicate which one:

Which support services ARE YOU most interested in receiving from a volunteer doula?

Please note that a Birth Support service includes antenatal support and childbirth education.

Client Eligibility

Client Eligibility *YesNo

Other services

Client Information

Please Note: It is important to have gained a client's consent prior to completing a referral and sharing confidential client information. In completing this referral, you are consenting to de-identified client information being collected, held, and used to perform our functions as an organisation. While all information will be kept confidential, information provided may be used for statistical purposes to further our work.

Please tell us more about you client's experience of the above criteria.

Client Information

Client First Name: *

Surname: *

Preferred Name and Pronouns: *

Phone Number:* *

Date of Birth: *

Email Address *

Street Address *

City *

State/Province *

ZIP / Postal Code *

Client's First Language *

If 'Other' primary language was selected above, please indicate which one. You can also list any additional languages spoken by the client. *

Does the client require an interpreter? *Yes, alwaysYes, for complex discussionNoUnsure

Has the client used this service before? *YesNoUnsure

Estimated due date *

Hospital or homebirth booked: *

If 'Other' hospital was selected above, please write the name here. *

Referrer Information
This will help us match the client with a doula.

Referrer Name* *

Referring Agency

Referrer Role *

Referrer Contact Number *

Has the client consented to this referral? *YesNoIt is important to have gained a client's consent prior to completing a referral and sharing confidential client information. In completing this referral, you are consenting to de-identified client information being collected, held, and used to perform our functions as an organisation. While all information will be kept confidential, information provided may be used for statistical purposes to further our work.

Which support services is your client most interested in receiving from a volunteer doula? *Birth Support (includes antenatal support and education)Extended Postnatal SupportAntenatal Support ONLYChildbirth Education ONLYAbortion SupportPlease note that a Birth Support service includes antenatal support and childbirth education.

Does the client have a partner? *YesNoUnsure

Will the partner be present at the birth? *YesNoUnsureNot applicable

Further information about the client/partner relationship, including safety concerns:

Client Emergency Contact

Emergency contact name: *

Emergency contact relationship: *

Emergency contact phone number: *

Pregnancy and Birth Information

First pregnancy: *YesNo

Reason for referral: *please detail

Details of the events and outcomes of previous pregnancies and births, if any. *

Details of psychosocial and health issues the client is experiencing. *

Other agencies/workers involved *(Please list worker name, agency and contact number/email if known)

Please ensure the client meets our economic disadvantage criteria before making a referral.

Please click here for information on support options for people who do not meet the economic disadvantage requirement.

Support is provided by volunteer doulas, based on their availability.

Anyone can make a referral, including maternity professionals and support workers on someone else’s behalf, or for yourself, a friend or family member.

Client eligibility criteria

Our programs are provided free of charge to people living in Greater Melbourne and surrounds who are experiencing economic disadvantage and also meet at least one of the following criteria:

Aboriginal and/or Torres Strait Islander
Refugee background or seeking asylum
Newly arrived migrant (within 5 years)
Experiencing or at risk of homelessness
Previous or current experience of mental health concerns
Experience of alcohol or drug misuse
Experience of trauma
Experience of abuse
Experience of family violence
Under 25 years of age
LGBTQIA+
Living with a disability
Lacking a birth support person

We try our best to support everyone who is referred to us. However, support is largely provided by volunteers and due to increasing demand, we are not always able to provide support for everyone.

We provide the following support services for eligible clients in greater Melbourne and surrounds.

One-to-one birth support (includes two or three antenatal appointments, support during labour, one to two postnatal appointments)
One-to-one extended postnatal support (includes 12 hours support during the six weeks after birth)

Our doulas provide one-to-one education tailored to suit the needs of the client as a stand-alone service. If your client is in need of additional education support related to pregnancy, birth and the early postnatal period please submit a referral.

Referrals can be made at any stage during the pregnancy, however if the estimated due date is within the next four weeks, please provide as much detail as possible about the client. We will do our best to match them with a doula as soon as possible and will let you know if we have been able to.

Please note: We do not provide any financial assistance for maternity care or costs.

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Client eligibility criteria

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