Skylark Birth Services Birth Doula Contract
Letter of Agreement
Describing Birth Doula Services and Limits
What is my role? As a birth doula, I will accompany you during your birth to help ensure a satisfying birth experience. I will help provide you and your partner with emotional, physical, and informational support. I will help communicate your needs and wants to your birth attendants and assist in providing you with education to aide in informed decisions about your birth. I can provide massage, counter pressure, rebozo techniques, relaxation and breathing techniques, and acupressure to assist in relieving any pain, nausea, headaches, and so forth. I will also show you suggestions for optimal positioning including using the birth ball or peanut ball and/or hot and cold packs to help with back labor pain. Other things may include aromatherapy, music, or any other client specific needs. I can also give you access to my pregnancy and birth library, educational forums, additional resources and printouts.
I am independent and self-employed. As your doula, I work for you, not your caregiver, provider, or hospital. Doula services include:
- On-call time from 38 weeks until birth of baby
- 1-2 prenatal support session(s) as determined by birthing person or time of birth
- 1 postpartum support session (additional postpartum hours available upon request/availability at an hourly rate)
- Text/Phone/Virtual availability during early labor
- Support during active labor (or when client requests)
- Support approximately two hours postpartum
1. This agreement is between Ande (Edna) Clark (the “doula”) and (the “client”) whose name is addressed above. Upon signing this contract, a non-refundable retainer of $250 is due to the contractor. This retainer is non-refundable due to the doula’s inability to take on additional clients during client’s birth month. Upon receiving payment, doula will reserve client’s birth on their calendar. The remaining balance is due at 37 weeks gestation. If remaining balance is not paid by 37 weeks, the doula’s obligation to provide support at the birth is nullified until payment is received. In the event client goes into labor before 37 weeks and/or before balance is paid, doula can attend birth if payment plan is agreed upon. Doula cannot guarantee presence at births before 37 weeks due to scheduling. A back-up doula can only be sent if balance has been paid off.
2. Limitation of Services. Doulas are not medical providers and do not provide any medical advice. Doula does not perform clinical tasks, such as listening to fetal heart tones, assessing dilation, or checking blood pressure. Doula does not make any decisions for client or speak to staff on client’s behalf. Rather, doula helps to facilitate discussion with client’s care provider.
3. Scope of Services. Prenatal Support Sessions occur in the client's home, or virtually if preferred. These support sessions last approximately one hour. Prenatal support can involve birth plan formation, childbirth education, and emotional support. Support during labor includes 24/7 availability during on-call window to answer questions via text/phone. Doula will join the client when client requests. Doula support might look like words of encouragement, breathing techniques, position suggestions, information about the labor process, suggestions to communicate with providers, and questions to ask care team.
Postpartum Support Sessions can occur virtually via the phone or a video chat service, such as zoom, or in the client's home. These support sessions last approximately one to two hours. Doula will provide information on postpartum care, breastfeeding, and newborn care after the birth. If doula cannot help, doula will find referrals for additional support (such as IBCLC, dentist for tie revisions,pelvic floor therapy, mental health therapist etc.)
4. Communication. Client is responsible to keep in contact with doula in the weeks leading up to client’s birth. Keep doula updated with appointments and if there are any significant changes in the birth plan. In early labor: notify doula via call or text, so that she can prepare accordingly. If doula doesn’t respond to text, please call. (850-524-7776) Doula will be available to answer questions & help guide birthing family during early labor. In active labor: notify doula once active labor has been established. Doula needs 2 (two) hours from active labor notification, or notification of when doula's presence has been requested, to arrive at client’s birth if supporting client in-person.
5. Back-Up Doulas. Due to the unpredictable nature of birth, doula works with back-up doulas. In the event doula cannot support client’s birth for any reason, or if they need to leave, a back-up doula may step in to support client’s birth. Doula agrees to tell client when they are unavailable and will provide on-call back-up support. In the event a back-up doula is not able to provide support, client will receive a refund of payment made, minus non-refundable retainer. A back-up doula will never be at extra cost to the client.
6. Refunds due to unexpected situations. Client acknowledges that by hiring a doula they are retaining them for their birth window. As a result, doula sets aside time, energy, and resources to support client. Unexpected situations are common in birth, but do not necessarily result in a refund. If client no longer wants birth services before 30 weeks, a refund of all fees except the retainer fee is available. If prenatal session has already occcured, $150 will be deducted from refund amount for each session attended. If client decides to not call or notify doula during labor, a refund is not available. If client chooses to forego services or not utilize services available, a refund is not available. If client does not request doula's presence or notify of active labor, a refund is not available. If client delivers baby precipitously, a refund is not available as long as doula arrived within specified timeframe of 2 (two) hours. Precipitous births are not the fault of client or doula. If client has an unplanned cesarean birth, a refund is not available. Doula will still offer support before, during, and after birth.
*** Cesarean Section: this is not a surgery that I anticipate happening at the time of hire. In the event you have a cesarean section, planned or emergency, all fees will remain the same. I will stay and offer as much support as the medical staff will allow. It is up to you to secure my place in the operating room if desired. If scheduled, I will meet you at the hospital prior to your scheduled time. I will accompany you in the operating room if allowed by medical staff, and offer emotional support and infant feeding support after the birth. If for some reason I am not allowed to be present in the operating room, (emergency, policy, preference, etc.) I will join you after the birth in the recovery area or designated room to provide emotional and infant feeding support after the birth. *** It is the client’s responsibility to ensure place of birth (hospital, birth center or home birth midwife) is aware of doula and doesn’t have guidelines against doula support. The doula is not responsible if medical staff does not allow in-person support. If the client has a c-section or is an emergency situation, it is client’s responsibility to discuss doula’s presence in the operating room (OR) or birth space. If doula is not allowed in the OR (vaginal or cesarean birth) or birth-space virtually or in-person, no refund is available. If doula is unavailable, does not answer text or phone-calls within the specified time, does not provide a back-up doula, a refund is appropriate.
7. Birth Outcome. Doula is not liable for any birth outcome. Doula cannot guarantee a certain birth outcome such as an unmedicated or vaginal birth. Client is responsible for choosing a care provider and birth location that best suits their personal needs. Doula will help facilitate communication between client and provider, and offer emotional and physical support, but ultimately cannot impact the course of birth or decisions made by client and provider. Doula supports client during pregnancy, labor, and in the postpartum period in whatever choices the client makes. At no point will doula take over, exclude partner, or assume decision-making during birth.
8. Privacy. Doula respects and maintains client’s privacy by following HIPPA guidelines. Doula does not post any images or any identifying information on social media without explicit permission by client.
9. Weather. If doula is unable to attend birth due to extreme weather conditions (icy roads, hurricanes, tornadoes, flooding,) or an act of God, the doula and client shall attempt virtual support. If virtual support is not available due to extreme weather, all monies will be applied to additional postpartum sessions due to doula being on-call and available during client’s birth window.
10. Sickness/Emergencies. If doula is unable to perform due to sickness, emergency, or causes beyond doulas control like road closures, hospital restrictions, etc…, the doula and client shall attempt virtual support and/or a back-up may be called. If virtual support and/or back up is not available due to these scenarios, all monies will be applied to additional postpartum sessions due to doula being on-call and available during client’s birth window.
11. Technology. If doula is providing virtual support during birth, neither doula nor client can guarantee fail-proof technology. Doula will provide client with at least two options to contact doula during birth. In the rare event there are multiple technical malfunctions and doula cannot provide support via both options, all monies will be applied to additional postpartum sessions due to doula being on-call and available during client’s birth window. Doula is not responsible if client forgets to bring a device, if device isn’t fully charged, or if client forgets to use device.
12. The client agrees to indemnify, defend and hold harmless the doula against any and all damages, liabilities, and costs (including attorney fees) asserted against or suffered by the doula relating to any breach by the client of any term of this agreement. The doula shall also have the right to seek an injunction to prevent any violation of this agreement.