Caroline:(561)-972-1010

 

doula9months@gmail.com 

www.doula9months.com

  

 

VIP Birth Doula Agreement

The following services are provided in the Birth Doula package:   

 

An initial consultation

UNLIMITED prenatal visits  

Unlimited email, phone or texting support  

Continuous, uninterrupted support during your labor and birth 

Immediate support after the birth of your baby, during the recovery phase

A postpartum home visit

 

 

Limitations on Doula Services:

 

As your doula, I am committed to supporting you and your partner to make informed decisions regarding your care and your baby’s care. I will not make decisions for you, not directly interfere with your health care providers on your behalf. My role is to provide  holistic, nonmedicalised care focused on emotional, educational and physical support, including hands-on comfort measures, during labor and birth. I do not perform clinical exams such as monitoring fetal heart tones or checking dilation while at home in early labor. These tasks are outside of my scope of practice.

 

Back-up Doula Care:

 

I commit to be available to you for

 

2 weeks on either side of your estimated due date (EDD), with the exception of any date that I provide to you up front at our initial interview. Please understand that illness, a family emergency or two births happening at once may also be cause for me to activate my back-up doula. My back-up doulas are doulas who share my values and vision. In the case of using my back-up doula, I will continue to provide support and care as much as possible, including the postpartum visits and follow-up care. I do not anticipate this happening, as I am careful to keep my practice small and commit to being available to every client in labor.

 

Fee and Timeframe for Payment:

 

Birth Doula Services:

 

A 50% deposit is required at time of contract signing. The rest is due by your 37 weeks of pregnancy

 

 

 

You are responsible for: 

 

Keeping me posted on how you are doing and updating me on any significant developments regarding your pregnancy. Please call me, at a minimum, each time you see your care-provider to keep me up to date on your pregnancy.

 

Calling me if you suspect that you are in early labor (if it’s in the middle of the night, and you are still able to sleep between contractions, then you do not need to call, but I would want to be put on notice by 7am the next morning. The more advanced notice I have of your impending need, the better prepared I can be to be there 100% for you).

 

 

Communicating honestly about your needs.

 

I am responsible for:

 

Returning your non-urgent phone calls, emails and texts within 24 hours.

Maintaining availability to respond promptly to all urgent calls.

Notify you when my back-up doula is taking call for me, for any reason, at any time.

Providing all services outlined in this agreement.

 

Mother’s Name_________________________________________

 

 

 

Mother’s Phone (Home)___________________________(Cell)____________________________

 

Address_______________________________________City_____________State___

 

zip_________

 

Email_______

 

__________________________________

 

Husband/Partner’s Name__________________________________

 

 

 

Husband/Partner’s Phone_______________________________

 

 

 

Estimated Due Date______________________

 

 

 

Place of Birth____________________________

 

 

 

Caregiver______________

 

 

 

 


 

 

Signed by Mother