CEA-OC Labor and Birth Observation Verification Form
(Please print this form and fill it out.)
This verifies that _____________________________________ has observed or supported a
(Name)
laboring woman at ___________________________________ in fulfillment of the labor and
(Birth Facility/Home)
birth observation requirement for 3 contact hours for recertification of the CEA-OC certified
childbirth educator.
Signature ___________________________________
Position/Title ________________________________
Date ______________________________________
***************************************************************************************************************************************************
This verifies that _____________________________________ has observed or supported a
(Name)
laboring woman at ___________________________________ in fulfillment of the labor and
(Birth Facility/Home)
birth observation requirement for 3 contact hours for recertification of the CEA-OC certified
childbirth educator.
Signature ___________________________________
Position/Title ________________________________
Date ______________________________________
***************************************************************************************************************************************************
This verifies that _____________________________________ has observed or supported a
(Name)
laboring woman at ___________________________________ in fulfillment of the labor and
(Birth Facility/Home)
birth observation requirement for 3 contact hours for recertification of the CEA-OC certified
childbirth educator.
Signature ___________________________________
Position/Title ________________________________
Date ______________________________________
(Please print this form and fill it out.)
This verifies that _____________________________________ has observed or supported a
(Name)
laboring woman at ___________________________________ in fulfillment of the labor and
(Birth Facility/Home)
birth observation requirement for 3 contact hours for recertification of the CEA-OC certified
childbirth educator.
Signature ___________________________________
Position/Title ________________________________
Date ______________________________________
***************************************************************************************************************************************************
This verifies that _____________________________________ has observed or supported a
(Name)
laboring woman at ___________________________________ in fulfillment of the labor and
(Birth Facility/Home)
birth observation requirement for 3 contact hours for recertification of the CEA-OC certified
childbirth educator.
Signature ___________________________________
Position/Title ________________________________
Date ______________________________________
***************************************************************************************************************************************************
This verifies that _____________________________________ has observed or supported a
(Name)
laboring woman at ___________________________________ in fulfillment of the labor and
(Birth Facility/Home)
birth observation requirement for 3 contact hours for recertification of the CEA-OC certified
childbirth educator.
Signature ___________________________________
Position/Title ________________________________
Date ______________________________________
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