Contract listed below is for potential client review and/or complete access after signing with me.
Doula – Client Contract and Fee Agreement
LABOR SUPPORT SERVICES, LIMITS AND FEES
As a Birth Doula, I accompany women in labor; to help them in their quest for a safe and satisfying birth experience. I will draw on my knowledge and experience to provide emotional support, physical comfort and as needed, assistance with communicating with the medical staff to make sure you have the information that you need to make informed decisions. I provide reassurance and perspective to you and your spouse/partner, make suggestions for labor progress, give comforting touch, guide relaxation, help with positioning and other techniques for your comfort, and also help protect the memory of your birthing experience. I am independent and self-employed. As your Doula, I work for you, not your caregiver or the hospital.
{I offer a complimentary visit/doula client interview. The complimentary visit is to get acquainted, discuss your priorities, your hopes for this birth, and answer any questions or concerns you might have in hiring a Doula to attend your birth. This meeting does not obligate you to use my services.} I prefer to meet with you and your spouse/partner at least twice before your birth, if possible, usually at your home If you do decide to contract my services, you may expect the following from me:
· 24 hour on-call beginning two (2) weeks before your due date (which means that I will make myself available to you as a first priority, excluding any emergencies on my part.) Excluding previous commitments (such as weddings, vacations, long term commitments):__________________________________________
· early labor support as needed in home or hospital
· assistance in drafting an informed birth plan
· provide information on childbirth education classes in your community, if needed
· complement or supplement information received in those classes
· two pre-natal visits and phone contact
· one post-partum visit and phone contact
· constant care, attention and support once active labor has begun, within my abilities
· maintain a calm birth experience as best that I can
· assistance in unexpected outcomes in providing support, guidance and information
· breastfeeding support and peer counseling or referrals, if needed
· parenting and newborn information and referrals, if needed or requested
I expect the following from you:
· participation in childbirth classes
· a personal desire to educate yourself about birth
· tour of birth facility and meeting with your care provider
· a written birth plan
· open and honest communication on all issues that will have a bearing on your birth experience. I hold whatever you tell me in strict confidence
· timely payment for services rendered; and
· a phone call to me when you think you are in labor. You must allow for at least an hour transit time for me (night or day), as I must secure child care. I can answer questions and give suggestions over the telephone. We can decide if I should come then or wait for further change in your contractions. We will also decide at that time the best place to meet – your home or your birth place.
Just as important as what I will do is what I will not do. As a Doula, I do not perform clinical tasks, vaginal examinations, fetal heart checks, or blood pressure, etc. I am not a Medical Professional. I do not make decisions for you. I will help you get the information you need to make informed choices but the decisions to have or not to have a procedure must be yours alone. I will also remind you if something proposed is a departure from your birth plan.
I do not speak to the medical staff in your place regarding matters where decisions must be made. I will discuss your concerns with you and suggest options, but you and your spouse/partner will speak on your own behalf to the medical staff.
Fee Agreement
I/We,________________________, hereby agree to pay Brandi Monson a fee in the amount of $275.00 for the goods and services listed in the above contract. This fee includes a non-refundable deposit of $125.00 which is payable at the time of signing, and the balance of the fee, $150.00, is due on or before five (5) days after birth.
As your Doula, I will make every effort to provide the services decribed above. However sometimes this is impossible. There may be circumstances beyond anyone’s control, i.e; Act of God, I am unavailable due to a family emergency. In such a case, the remaining fee of $150.00 is cancelled. If my failure to attend your birth is becuase of your failure to call me or your labor is so rapid that I am unable to arrive in time, or in the event of a cesearean delivery and I am not allowed to be present, the remaining fee is still due and payable. (In the event of a precipitous birth I will remain postpartum for 1-2 hours; in the event of a cesarean delivery, I will remain at the hospital during the surgery; I will assist you in my usual postpartum capacity.)
You may cancel my services without penalty up to the 35th week of your pregnancy. After that time period, the balance of the remaining fee is due as stated above.
I/We have read this Contract describing the Doula’s services and fees and agree that I/we understand both the scope and limitations of the services available to me/us.
Signed this _____________ day of _____________________, 20___A.D.
______________________________
Mother
______________________________
Spouse/Partner
______________________________
Brandi Monson, Doula
________________________________________________________________________________________________________________
