Birth Doula Contract
Contract for services with Rachel Becker CD(DONA)
The following agreement is hereby entered into between Rachel Becker,
referred to as “I” and the ABOVE NAMED PERSON OR PERSONS, referred to as “you,” with the following conditions understood and accepted by both parties.
As a birth doula, I provide emotional and physical support to a birth parent and their partner and/or family during their labor and delivery. I am acting solely as an emotional and physical support person, and am not a medical professional. All medical decisions will be left to you and your care providers, but I can provide information, and help facilitate conversations with medical professionals.
I will meet with you and your partner twice before labor to become acquainted with you; discuss your priorities and any fears or concerns; present evidence-based information on the risks and benefits of common interventions and procedures used during childbirth; discuss your birth plans; and plan how we might best work together.
I will also inform you of times when I am unavailable for labor support. To cover those times, I will arrange one or more qualified back-up doulas whom you may also meet.
We may also decide on other meetings, and will remain in touch by telephone and/or e-mail communication.
I will be on call for your birth three weeks (21 days) before your due date and two weeks (14 days) after it. If you happen to go into labor before or after this period, I will make every effort to be there.
If you like, I can also help you write a birth plan based on your needs/wants as communicated to me. I will bring a copy of your birth plan with me to your planned birth place.
Start of Labor
I ask that you call me when you think you are in labor, even if you do not yet need me. This gives me time to clear my calendar for the next 24 hours. I can answer questions and make suggestions over the phone, and we can decide if I should come to you then, or wait for further change. I can meet you at your home or your planned place of birth. I usually need approximately 90 minutes to get to you from the time you ask me to come. Once you call me and let me know you’d like me to begin supporting you, I will make every effort to be there within 90 minutes. Except for extraordinary circumstances, I will remain with you throughout your labor and birth.
I will remain with you after birth until you feel you no longer need me. This is usually approximately 1-3 hours after birth. We will schedule a post-partum visit for 1-2 days after birth.
Limitation Of Services
As a DONA-certified birth doula, I abide by the standards and scope of practice of DONA International. As a doula, I do not:
1. Perform clinical tasks, such as taking blood pressure, fetal heart checks or vaginal exams. I am there to provide only physical comfort and emotional support and facilitate communication between you, medical staff, and care providers.
2. Make decisions for you. I will help you get the information you need to make an informed decision.
3. Speak to medical staff or providers on your behalf. I will discuss your concerns with you and suggest options, as well as encourage you and your partner to voice your opinions, questions and concerns to the staff.
4. Provide medical advice. I can direct you to resources that might help you answer your questions and make informed decisions on your own. If you have questions or want advice about your care or that of your baby, you should contact your care provider.
While it is always smart and helpful to have a plan, births do not always go according to plan.
If you plan a vaginal delivery and a cesarean is performed after labor has already started, I will continue to provide support during the cesarean surgery (as allowed by hospital and/or doctor policies) as well as immediately after to help with your comfort and breastfeeding. I will also follow-up with you after the birth, as I do with all my clients. My full fee would apply.
If you and your doctor decide that a planned cesarean is necessary (that is, a cesarean done before your due date and/or before the onset of labor), I will provide support during the cesarean (as allowed by hospital and/or doctor policies) and immediately after, as well as one additional three (3) hour postpartum visit to assist with breastfeeding, cleaning, laundry, baby care, etc. for my full fee.
If you are having a home birth and need a transfer to the hospital, I will accompany you and continue to provide doula support there, if necessary. I cannot under any circumstances attend a planned home birth without a midwife or other care provider present.
In the event of a precipitous birth in a location other than your planned birth place (such as home or a vehicle) when a care provider is not present, I will provide only emotional and mental support as outlined above.
Release and Confidentiality
I will ask you to also sign a release form giving me leave to take notes about you and your birth, including personal information about yourself and your child(ren). This information may be shared with my certifying organization, DONA.
Signing this contract also gives me permission to discuss your pregnancy and birth with other birth professionals in both formal and informal settings. I will never use your name, your child’s name, the date you gave birth or any other identifying information.
Responsibility of Client
I ask that you inform me of any pregnancy-related or other health complications or conditions you may have, as well as any other special circumstances you might have or require. I also ask that you keep me abreast of what happens at your prenatal appointments from 36 weeks forward (if your cervix is dilated, any tests or procedures you might experience, anything your care provider seems concerned about, etc). Text, email and phone are all fine for contact.
I also request that you inform your care provider that you have hired a doula.
If for any reason you decide not to have me at your birth after you have signed this contract, I ask that you let me know as soon as possible.
The total fee for labor support is $1400, unless a reduced fee has been agreed upon before signing this contract. A deposit of $300 is due upon signing this contract, and the remaining balance of $1100 is due by the 37th week of your pregnancy.
I accept cash, checks made out to “Rachel Becker”, and PayPal (sent to paypal.me/fullbellybirth).
In entering a contract for Doula (Labor Support) Services with Rachel Becker, I/We hereby acknowledge that during the performance period of this contract, services may be provided to me/us in my/our home, traveling to a medical facility, and/or hospital. I/We understand that Rachel Becker has a limited role pursuant to the description of tasks outlined in the above-referenced contract wherever services are provided to me/us.
Rachel Becker has not represented to me/us that contracting for services guarantees in any way a risk-free or emergency-free labor and birth experience. I/We understand that my/our doula(s) does not make medical decisions on my/our behalf, to include the decision when to seek medical care at a hospital when labor support services are provided in my/our home. When services are performed in a medical facility, I/we acknowledge that Rachel Becker is not responsible for the performance of clinical tasks to include medical decisions regarding the inclusion or exclusion of treatments available to me/us and my/our baby.
Now, therefore, in consideration of the above acknowledgements, I/we (both jointly and
separately) on behalf of myself, ourselves, my/our heirs, administrators, personal representatives, executors, and assigns to RELEASE AND FOREVER DISCHARGE Rachel Becker from all damages or causes of actions, either at law or in equity, which I/we may have or acquire or which may accrue to me/us, my/our heirs, administrators, personal representatives, executors or assigns as a result of using the doula services of Rachel Becker. I/We intend this to be a COMPLETE RELEASE AND DISCHARGE them from all liability whatsoever.
I/We have read all statements contained herein and I/we fully realize that I/we are signing a COMPLETE RELEASE AND BAR to any claims which I/we have or believe I/we have resulting from our contract for doula services.