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Birth reflections self-referral form

How to self refer to the birth reflections team at South Tees Hospitals.

Childbirth is a unique time in a person’s life, it may be that during this time your birth didn’t go as you had hoped or expected.

It is understandable that you may wish to talk about your experience or that you may have some questions about your labour.

If you had your baby with us, we would like to offer you the opportunity to discuss your birth experience with a midwife.

If you are currently pregnant and delivered your last baby at The James Cook University Hospital in Middlesbrough or the Birth Centre at the Friarage Hospital in Northallerton you are also able to access this service.

You can refer yourself into the service by completing the form below.

You will be offered an appointment with one of our midwives. We can offer a face to face session at the Friarage Hospital or at North Ormesby community hub or a telephone appointment.

If you indicate you would like one of the other services listed, your referral will be redirected to that service. 

Please note you will not be seen before six weeks postnatal but can still make a referral before six weeks.

Please provide as much information as possible on the form in order for us to assess accordingly.

If you have not received a response to your form within 10 days of submitting please email [email protected]

Following this session if we feel you may need more support we can refer you to South Tees Enhanced Psychological Support (STEPs) in maternity, Talking Therapy or facilitate a discussion with an obstetric consultant. 

Please note, wait times can vary, but we will be in touch as soon as we can. Thank you in advance for your patience. 

Birth reflections self referral form

Address(Required)
This is the birth you would like to talk about
Can you give us an idea of the most important thing for you that you would like to address in birth reflection(Required)
Tick as many options as feels relevant
If you are unhappy with the standards of your care, can you please let us know why?
It would be helpful if you can give us some basic information about your delivery. Was your delivery…(Required)
How did you hear about the birth reflection service?(Required)
Privacy statement(Required)