Birth Doula Service Agreement
This contract, by and between DoLove Birth Services and labor doula, Lucretia Jones, herein referred to as the doula, and _________________________________, herein referred to as the client, agree to the following terms:
Services To Be Provided:
Upon signing of this contract, the doula shall meet with the client at least once prior to labor, provide client with phone numbers and email so the doula may be reached in between appointments and 24 hours a day during the on call period, assist the client with making plans for the birth and writing a birth plan, and provide referrals for other services in the community. The doula will be on-call for a period of two weeks before to two weeks after the estimated due date. Once called upon in labor, the doula shall arrive within two hours of that call and will stay with the client until one to two hours after the birth, unless otherwise indicated by the client. The doula will also provide at least one postpartum visit which includes _____________.
It is the responsibility of the doula to inform the client of any dates or times she will be unavailable for service and she shall arrange for a backup doula for those dates or times. The doula shall pay an arranged backup doula for any services rendered per the agreement between them. The doula shall provide physical, emotional, and informational support for pregnancy, labor and birth. The doula shall NOT perform any clinical assessments (including vaginal exams, fetal heart tones, or taking vital signs, blood pressure checks). The doula shall NOT speak on behalf of the client or make any decisions for the client.
The client is responsible for her clinical and medical well being. The client is responsible for informing her caregiver that a doula will be present at her birth and assuring that the doula will be allowed to serve her. The client is responsible for making informed decisions, by educating herself through self-study, completion of homework and questionnaires provided by the doula, and childbirth classes. The client will notify the doula of any pregnancy or non-pregnancy complications when they arise. When the client is in labor, she shall inform the doula as early as possible to afford the doula time to make any personal arrangements.
If you have an extended labor (lasting more than 20 hours), and the doula feels she is unable to support you appropriately due to exhaustion, the doula reserves the right to call in a backup doula to come be with you for the remainder of your labor or for a period of time that will allow her to get adequate rest. You have the right to decline the backup doula, but there will be no reduction in fees.
If client has a cesarean section, planned or emergency, all fees remain the same. The doula will stay and offer as much support as the medical staff will allow. It is up to client to secure the doula’s place in the operating room. If it is a scheduled cesarean, the doula will meet you at the hospital at your scheduled time. The doula will accompany client in the operating room (if allowed by medical staff) and remain with client during recovery, and offer emotional support and breastfeeding support after the birth. If for some reason the doula is not allowed to be present in the operating room (emergency, policy, etc.) she will join you after the birth so that client will not be left alone for the rest of the surgery. If breastfeeding is delayed more than 4 hours due to complications, the doula will return at an appropriate time to assist the client with breastfeeding and newborn care issues.
Failure of Doula to Provide Services:
The doula will make every effort to provide the services described herein. Sometimes this is impossible due to factors beyond our control. If a failure to attend your birth is an error of the doula, nothing else will be owed by client or client will be refunded all fees paid less the non-refundable deposit of $100 paid at contract signing. If failure to attend your birth is not an error of the doula, such as precipitous labor, failure of the client to call or notify the doula, or natural disaster, the contract stands as is. In the case of precipitous labor or failure to notify the doula, the doula can join the client after birth. The doula will remain with the client for the normal period of time to help her get settled in and establish breastfeeding just as the doula would have if present during the actual birth. The doula will also provide the postpartum visit service per this agreement.
Sometimes illnesses and family emergencies happen. These situations are not considered by either party a failure of the doula to provide services. If the doula is unable to attend your birth, she will contact one of her backups. You have the right to decline the backup, but there will be no reduction in fees.
The doula may take photographs at births to document your amazing birth experience as well as to use for marketing purposes. It is up to you if you chose to allow any photography during your labor or birth process. Any and all photographs taken during your labor and birth will be copied to a disc and given to you for your personal use as well. Photographs containing nipples or genitalia will not be published without your separate and specific consent.
____I/We agree to allow photography during our labor.
___I/We do NOT agree to allow photography during our labor.
The fee for labor doula services is $200-400. $100 is due upon contract signing and is non-refundable. The remaining balance ($100- 300) is due prior to the beginning of “on-call” time two weeks before your due date. Payment schedules or special circumstances may be arranged but must be agreed upon by all parties for this contract to be valid. The doula will not attend a birth for which she has not received full payment. The only exception is if baby is born prior to 38 weeks. In this situation, payment is due in full within 5 days of birth.
If you make a payment by check, and it is returned by your bank for any reason, a $25 processing fee will apply and full payment in the form of cash only will be due immediately. Failure to pay the full fee in cash within 3 days of notification of your check being returned will result in cancellation of this contract and any monies already paid will be forfeited.
Since the doula is currently working on her toLabor Labor Doula Certification, she is offering reduced fees in exchange for the clients help in obtaining certification. This will require you, your doctor/midwife, and your labor nurse to fill out paperwork evaluating the doula's services. If you choose to participate in this evaluation process, the doula will refund you $100 upon the acceptance of your birth as counting towards the doula's certification by toLabor. If, for any reason, your birth is not usable towards certification (precipitous birth, missing paperwork, etc.), then no refund will be given.
_____Please check this line if you choose to participate in the toLabor certification evaluation process.
We, the undersigned, agree to the terms and conditions stated above and we fully understand the responsibilities of the doula as well as our own.