Labor Doula Agreement

Doula's Name*

Parent(s) Names*

Due Date

Birth Location*

Home address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Phone Number

E-mail

example@example.com

Indicate which doula you wish to hire:

Please click each box, indicating agreement to the following terms of the doula agreement: Services*

The doula provides support prenatally and during birth in the form of education, information, physical and emotional support.During the birth the doula will provide reassurance and perspective to the client and partner, make suggestions for labor progress, and help with comfort techniques.The doula will help the client communicate with staff and gather information to make informed decisions. The doula will not make decisions or speak on the client's behalf.Doulas do not perform medical tasks such as taking blood pressure, listening to fetal heart tones or cervical exams. The doula's role is that of non-intervention and is non-medical.The labor doula package includes one (1), two (2) or three (3) prenatal visits, depending on the client's gestational age at the time of registration. The doula will work to provide thorough information regardless of the number of prenatal visits.The client may contact the doula from the point of hire via phone, text or email. The doula is available to the client 24/7. Non-urgent messages should be sent between 8am-9pm if possible.Doulas go on call at 37 weeks and remain on call until the baby is born. On-call means the doula will be prepared to come when the client is in active labor.The client must alert the doula of active labor. Active labor is defined as a contractions that are 5 minutes apart and 60 seconds in duration, occurring consistently for one hour - or - contractions of any pattern with cervical dilation of 6cm.If labor is being induced, continuous support begins when the client is in active labor. Active labor is defined as contractions that are 5 minutes apart and 60 seconds in duration, consistently for one hour - or - contractions of any pattern with cervical dilation of 6cm. The doula may be present before active labor per the client's request.The doula will join the client in labor once the client confirms they are ready for her to be present. The doula's goal is to be present within an hour (60 minutes) of the client's request to come. Sometimes due to weather or road conditions, that time limit is slightly exceeded. It is the doula's intention to join the client as quickly as possible.The doula will remain with the client for the duration of the labor. If an emergency arises and the doula is not able to be present for the entire birth, a backup doula will be provided to continue labor support.The doula will stay approximately 1-1.5 hours after the birth. Tasks may include assistance with infant feeding, highlighting birth plan items and taking photos. Departure after the birth renders your labor doula services complete.One postnatal visit is included, but is optional.The doula will remain available via phone for four (4) weeks after the birth to answer questions about the birth and provide tips for recovery.If the selected doula is unavailable during the client's active labor, a backup doula will be provided from within the Labor of Love group.

Please agree to the following terms of the doula agreement: Financial Agreement*

The deposit is $500 and is non-refundable. The deposit compensates the doula for reserving the spot on her calendar and covers all prenatal preparation through 37 weeks.The balance payment is due at the beginning of your 37th week and compensates the doula for being on-call for your birth, attending your birth and any postnatal follow-up.The balance payment is the difference of the doula's full fee and the deposit.If services are cancelled before 37 weeks for reasons outside of the doula's control, all money will be refunded except the deposit.If services are cancelled after 37 weeks for reasons outside of the doula's control, no refund is granted.Changes to the birth location visitation policy, birth relocation more than 50 miles from I-285, and client change of heart due to financial constraints, political or social views are considered outside of the doula's control. Refund requests will be reviewed on a case by case basis.The doula will make every effort to provide the services as outlined in "Services". If labor support is not provided due to the doula's and backup’s unavailability, there will be no charge for services and all money paid will be refunded.If services are not provided because the client did not alert the doula of active labor, or if the birth is precipitous (baby is born within one hour of requesting the doula to come), the doula retains the full fee. This is due to having provided prenatal consultations, having been on-call and declining other possible clients.

Payment Methods: We accept several methods of payment. Some methods will incur an additional processing fee. Please indicate your preferred method of payment. An electronic statement will be generated to keep track of all payments.

Venmo - send $500 payment to @LaborofloveatlantaZelle - send $500 payment to 770-241-2078CashApp - send $500 payment to $laborofloveatlElectronic Invoice (below) - $500 deposit + $15 processing fee

*** A note for Venmo, Zelle, and Cash App payments: Sign and submit this agreement, then submit your payment separately through your payment app. Do not select a Product or enter your card information here. If you enter card info below, your card will be charged. ***

Balance Payments are due at the beginning of 37wks. What is that date?*

Photos: All birth photos taken by the doula and apprentice belong to the client and will not be used without permission. Please initial below indicating your preference for photos taken by Labor of Love Doula & Childbirth Services, Inc. and/or your doula, for social media, marketing, and educational purposes.

I consent to the use of my photos for social media, marketing and educational purposes.You may ask me about using photos after the birthNo, I do not wish to share any photos

Apprentice: Labor of Love has apprentice doulas who are eager for opportunities to shadow prenatal visits, client communication, and births. An apprentice can provide an extra set of hands for your doula, record birth notes, and take photos while she is also learning about birth from a more experienced doula. There is no additional cost to have an apprentice present, and she does not replace your primary doula should the need for backup arise. Please initial below indicating whether or not you are open to learning more about including an apprentice.

Signature*

Input your payment information ONLY if you wish to submit your deposit using a credit or debit card. If you prefer to pay via Venmo, Zelle, or Cash App, skip the payment section and click the Submit button:

Labor Doula Services - Deposit

$515.00

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration