Traditional Postpartum Care Service Agreement

Traditional Postpartum Care Service Agreement
Traditional Postpartum Care

Definition of a Traditional Postpartum Doula

A traditional postpartum doula (practitioner) is a non-medical, traditionally trained, postpartum wellness advocate who comes into the home to offer support to the postpartum mother for the agreed upon period of time.

Services for Traditional Postpartum Care
- 3-4 hour in home visit(s) per week for 5 weeks. During each visit I will provide:
  - A nourishing meal and beverage (atole aveno or tea)
  - Choice of herbal bath, vaginal steam, or foot soak
- Additional Included Services as Desired:
  - One 90-minute postpartum planning session (prior to weekly visits) including postpartum planning guide, postpartum recovery box, and cotton rebozo.
  - Rebozo closing ceremony - "Closing of the Bones"
    
    Application of warming salve and Mayan abdominal massage
    
    Rebozo alignment
    
    Rebozo binding (Closing of the Bones Ceremony)
    
    Tea preparation and time to process changes you have recently experienced
  - Warming practices available during visits: castor oil packs, moxibustion, instruction for abhyanga massage.
  - Movement, meditation, birth processing, mindful care practices
  - Facilitation of ritual bath or placenta burial
  - Education for self-care including scar-care and various forms of self-massage to facilitate healing, recognizing diastasis recti and pelvic organ prolapse
  - Rebozo belly binding instruction
  - Information and Education on topics including basic baby care, baby sleep, cloth diapering, elimination communication, breastfeeding, safe co-sleeping
  - Light housework (starting laundry, dishwasher, etc.)
  - Infant/childcare as needed (tending to infant while mom bathes, etc.)
  - Assistance and support with breastfeeding
  - Access to lending library of books
  - Herbal knowledge and reference
  - Referrals to local resources as needed
  - Availability by phone or email from time of hire through end of contract
Postpartum Care Investment

$1,200 - The First 40 Days
- 50% of the total amount is due on the date this contract is signed as a retainer fee. The remaining amount is due by 36 weeks pregnancy.
- Payment details are outlined below under "Payment and Billing"
Add ons available:
- Vaginal steaming intake, consultation, and herbs for 30 days $55
- Herbal blend + stool and pot $150
- Mother's Blessing $250 See Service Here
- Herbal Remedies Add-ons:
  - 2 oz After pains tincture $15
  - 2 oz Motherwort tincture $15
Client Information
Client Name*

First NameLast Name
Client Phone Number*
Please enter a valid phone number.
Client Email*
example@example.com
Client Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Partner Name (If applicable)

First NameLast Name
Partner Phone Number
Please enter a valid phone number.
Partner Email
example@example.com
Client Background
What is your Estimated Due Date or When Did you Give Birth?*
36 Weeks Gestation (Final Payment Due)

MonthDayYear
Date
Do You Have any Food Allergies, Intolerances, or Aversions? Any Skin Sensitivity to Oils, Herbs, etc.?*
Do You Have any other Special Needs, Physical Limitations or Injuries that you Feel I Should Know About?*
Do You Have a History of Mental Illness or Any Mental Health Concerns You Feel I Should Know About? *
Place and Type of Birth you are Planning? Any History of Birth Trauma or Other Experiences You Want Me to Be Aware of?
Do You Have Any Special Postpartum Customs or Traditions? Any special requests for postpartum care?
Questions, Concerns, or Comments Prior to Receiving Care:
Do I Have Permission to Share Photos or Anonymous Experiences From our Time Working Together (On Social Media, Website, etc.)?
Practitioner Information

Practitioner Name: Heidi Pyper

Practitioner Phone Number: 385-505-4082

Practitioner Email: heidipyperdoula@gmail.com

Client and Practitioner Obligations
Obligations of the Traditional Postpartum Doula (Practitioner)
Services are to be provided to Client Full Name* (herein after known as the Client) located at the client address (provided above) once a week for 3-4 hours for five weeks total by the traditional postpartum doula Heidi Pyper (herein after known as the Practitioner). I, Heidi Pyper, (the Practitioner) will be on time for the client's care and stay the agreed upon time. If I, the Practitioner, am unable to come or if I am unexpectedly delayed, I will inform the client or the Client's Partner as soon as possible and make every effort to reschedule if needed. I will communicate each step of the traditional process and make adjustments to fit the client's personal beliefs/desires.
Obligations of the Client

The Client(s) agrees to inform the Practitioner of any special needs, food allergies, physical limitations/injuries or customs they may have during the postpartum time. The Client(s) agrees to be present the agreed upon times of service and if they are not available the Client agrees to contact the Practitioner as soon as possible to reschedule care.

Failure to Provide Traditional Postpartum Care

The practitioner will make every effort to be on time and with the Client at the agreed upon times/dates. If the Practitioner is unable to come due to sickness or other emergencies the Client or their representative will be informed as soon as possible, and every effort will be made to reschedule.

Billing & Payment

Postpartum Care Investment

$1,200 - The First Forty Days
- 3-4 hour visits weekly for 5 weeks - Details outlined above under "Services for Traditional Postpartum Care"
Add Ons:

Vaginal Steaming Intake, Consultation, and Herbs for 30 Days $55Herbal blend + stool and pot $150Mother's Blessing $2502 oz After Pains Tincture $152 oz Motherwort Tincture $15
Explain Add Ons (If Not Applicable, type NONE):*
An Invoice with the Total Amount will be Sent to Your Email
Payment

50% of the total amount is due on the date this contract is signed as a retainer fee. The remaining amount is due by 36 weeks pregnancy. Any payment plans or trades must be included and agreed upon in this signed document (inlcuded in Practitioner section).

Payment can be made via:

Venmo (preferred): @heidipyper

Paypal: heidipyperdoula@gmail.com

Pracitioner and Client Signatures
Please sign below indicating that you have read and agree to the above listed services, limits, and fees.
Client Full Legal Name*

First NameLast Name
Client Signature*

Clear
Date*

MonthDayYear
Date
What Type of Record Do You Prefer?

Email PDFPrint CopyBoth
After completing the client portion click SUBMIT, and this document will automatically be emailed to the practitioner for completion. Once both portions are complete, the final document will be emailed to both parties.
End of Client Section

Beginning of Practitioner Section
Are You the Practitioner?

YesNo
Practitioner Full Legal Name

First NameLast Name
Practitioner Signature

Clear
Date

MonthDayYear
Date
Detailed Description of Payment Plans or Approved Trades (If not applicable type NONE)
Should be Empty:

Traditional Postpartum Care Service Agreement

Traditional Postpartum Care

Definition of a Traditional Postpartum Doula

Services for Traditional Postpartum Care

Client Information

Client Background

Practitioner Information

Client and Practitioner Obligations

Obligations of the Traditional Postpartum Doula (Practitioner)

Obligations of the Client

Failure to Provide Traditional Postpartum Care

Billing & Payment

An Invoice with the Total Amount will be Sent to Your Email

Payment

Pracitioner and Client Signatures

End of Client Section

Beginning of Practitioner Section