(This contract is an identical copy of the one you will be asked to sign when you decide to use me as your doula, feel free to print it, but when we meet I will have a copy for each of us.)
Contract for Services:
At your Cherished Birth I strive to support birthing mothers in the way that makes them most capable of cherishing their birth, therefore I offer two packages and you may choose which you prefer. Below you will find a list of services that are intended for all ‘Your Cherished Birth’ clients, and then separate areas that you may decide between for your custom birth package.
All Clients can expect that:
I will meet with you and your partner at least one, preferably three times to get to know you, your hopes, fears, and concerns regarding the birth of your child, and to assist you in the preparation of your birth plan. We will discover together the ways that you hope I can assist in your birthing experience, and what role your partner hopes to play in the birth of your baby. We will also strive to discover the methods you already have in coping with pain and fatigue.
I will inform you of times I am unavailable. Phone or e-mail contact for emotional or informational support will be provided to you as needed or desired. You will be given a reliable way of reaching me and a few back-up phone numbers if for any reason you cannot reach me by my primary number, this is just a precaution and you should been confident in being able to reach me at any time once I am on-call for you.
I consider myself on-call two weeks before your estimated due date and will continue to be on-call until the birth of your baby. Once I am on-call I require a text or email contact once a day just to maintain open communication, this does not have to be birth or pregnancy related and can just be a simple hello.
*exceptions noted below.
It is your responsibility to call me as soon as you believe labor is starting. This will enable me to be sure that when you are in need of my assistance, I can get to you as quickly as possible. By establishing early phone contact, I am also available to answer questions you may have about your labor, and discuss where and when we should meet. You are free to change this destination if needed, but must provide appropriate time for travel, I will need at least one hour from the time that you call to arrive at your labor. **
Once I have arrived at your side, I will remain with you, using my resources, and training to provide you with comfort measures during labor. I will help your partner by offering breaks, reassurances, suggestions and information that we discussed in previous meetings. I will help the communication between your care provider and yourself by reminding both of you of the prepared birth plan and explaining medical procedures when and if needed, and encourage you to ask the ‘right’ questions when more information is needed before making decisions.
I will stay for approximately 1-2 hours after the birth. During this time, I will take pictures or your new family (If requested and available at the time of your birth), answer questions, help you to establish breastfeeding, and quietly pack up my things once everyone is ready for my departure.
I will contact you by phone approximately 1-3 days after the birth to arrange a postpartum visit. I am available to answer questions in regards to how you are feeling, or the care of your baby, by phone. I will meet you at least once possibly twice pos-partum, during which time we will review your birth, clarify any events or areas of your birth that you are unsure of, answer questions, provide resources, and ask for feedback on my performance as your doula.
As a Doula I do NOT:
Perform any clinical tasks (including but not limited to, blood pressure checks, vaginal exams, fetal heart rate; though I do have a fetal heart monitor and parents are welcome to use it for their enjoyment, it is not for medical purposes in Doula practices and any information gained from it will not be used in diagnosis for fetal problems by your doula). I provide elements of physical comfort, and emotional support only.
I will not make decisions for you regarding your care. I can and will help you get the information needed to make informed decisions and will remind you if there is a departure from your birth plan.
I will not speak to staff on your behalf, I will discuss concerns with you, but you or your partner will be the ones to discuss the options offered with your care provider, not me.
* If contact is ceased for any reason then I will assume you have delivered your baby without my assistance and close your case 3 weeks after your estimated due date.
**This is a minimum, if you live or plan to deliver further away this time could be altered.
Below are options for your care with Your Cherished Birth, please select the one that meets your needs.
I will secure a back-up doula for your upcoming birth and inform you of who my back-up will be. You are free to meet with her at your convenience. If for any reason you cannot reach me, you should call my back-up, this is just a precaution and you should feel confident in being able to reach me at anytime.
My back up will be paid a flat rate if she is needed for the birth of your baby only. Any prenatal and post-partum appointments will be attended by me unless otherwise arranged at the time of service. you may request that my back-up attend prenatal and post-partum visits but she has her own clientele and may not have availability to attend, nor will she be paid for that time, so it is unlikely she will attend. I will pass along all pertinent information I collect to her as I receive it, (i.e. I will discuss each prenatal visit and your preferences for birth with her).
Though highly unlikely, if for any reason I am unable to attend your birth I will inform you of this and arrange for my back-up to meet you at our agreed upon location, and pass along any helpful information that she may need, including how the two of you can contact each other. Unless specific changes are arranged before the birth of your baby you should not expect to see my back-up during the birth of your baby unless I am unavailable.
If needed my back-up will attend to your needs for approximately 1-2 hours after the birth of your baby. Any notes taken during the birth of your baby and after delivery will be passed along to me and I will carefully look them over and discuss any deviations from your birth plan that may have occurred with my back-up before contacting you.
I will contact you approximately 2-3 days after the birth of your baby to arrange a time to meet for your first post-part I’m visit. During this time, I encourage you to ask myself or my attending back-up any questions you may have in regards to how your birth played out, how you are feeling, or the care of your baby.
My back-up did not attend the same training as I did, and is not under my business model, and therefore may have different views, methods, and techniques for labor support. By choosing this option I am only promising that a back-up will be available to you for your upcoming birth if I am unavailable. I am NOT promising her methods will align with those discussed in our prenatal appointments. I will strive to communicate your wishes and desires to my back-up the best I am able, but she is not me, and I am not responsible for her actions in any way during her attendance of your birth. That being said I also strive to screen the back-ups that I use, and encourage feedback on the support they give.
The total fee for the services listed above amount to $850.00. From the moment that you sign this contract I will limit my acceptance of other clients near your due date so as to give you my full and undivided attention and assure that there will be minimal chance of my need for a back-up doula to attend your birth. Therefore, the following fee schedule must be followed if not paid in full at the time of signing this contract.
Fee Schedule. $425.00 is non-refundable and due at the signing of this contract.
$425.00 is due by your final prenatal visit, or two weeks before your due date (whichever comes first)
I will make every effort to attend your birth, and provide the services listed above. Unfortunately, sometimes it is impossible (for example with rapid labor). If my failure to attend your birth (or send a back-up in my place) is due to my own error, the second payment of $425.00 will be returned to you, if however it is due to circumstances beyond anyone’s control, or you fail to call me, then I will keep the full amount and no refund will be given.
I will meet with you and your partner as discussed above (see “All Your Cherished Birth clients can expect that” section), no back-up will be secured, and your personal information will not be shared with any other doula or birth professional without your expressed consent.
Though unlikely, if for any reason I am unable to attend your birth I will inform you of this asap, no back-up doula will be called on, and I will arrange to meet with you as soon as I am able. If I am unable to attend due to illness, I will contact you as soon as I am well. If for any other reason I will arrive at the hospital or our agreed upon location as soon as I am able to get there (examples of reasons this may occur include but are not limited to: car trouble, or severe weather).
The total fees for the services listed above amount to $600.00. From the moment you sign this contract I will limit my acceptance of other clients near your due date so as to give you my full and undivided attention and assure you that there will be minimal chance of missing the labor and/or delivery of your baby. Therefore, the following fee schedule must be followed if not paid in full at the signing of this contract.
Fee Schedule. $300.00 is non-refundable and due at the signing of this contract.
$300.00 is due at your final prenatal visit, or two weeks before your due date (whichever comes first)
I will make every effort to attend your birth, and provide the services listed above. Unfortunately, sometimes it is impossible (for example with rapid labor). If my failure to attend your birth is due to my own error the second payment of $300.00 will be returned to you, however if it is dues to circumstances beyond anyone’s control, or your failure to call me, then I will keep the full amount and no refund will be given.
I/we understand that Samantha Mehaffey is a labor support specialist, trained to assist with the physical and emotional demands of labor and childbirth. I/we also recognize that childbirth is a natural unpredictable process and may not go as I/we hope or plan: in this arena I/we understand that a doula will act with reasonable care for the mother and baby’s well being, but will not be able to alter the course of labor or it’s outcomes. I have read and fully understand this form describing the services of Your Cherished Birth and agree that it reflects the discussion I/we have had with out doula. In signing this contract, I/we agree to retain her as our doula and pay the fees required.
Please circle the option you choose for your care
Option 1. Option 2.
______________________________________Partner name. _______________________date