Terms of Service

 

Thank you for choosing me to provide your labor doula services!

 

Labor and childbirth are beautiful and challenging, and are unique to each mother. It is a life-changing transition which I feel privileged to witness. I am a DONA trained birth doula and I offer services that are tailored to the needs and wants of each of my clients. My goal is to provide emotional, physical and spiritual support to empower you through your labor and birth. This agreement will help to establish the services that I will provide, your roles in helping me provide these services, the limitations of my services, and the regulations regarding my fees.

 

 

 

I am independent and self-employed. As your doula, I am working for you and your partner, not your caregiver or place of birth. 

 

I will meet with you and your partner at least once before labor so that we may become acquainted with each other, explore and discuss your priorities and any fears or concerns that you have, and to discuss your birth plan. 

 

I will inform you of times when I am unavailable for labor support. To cover those times, I will arrange a qualified back-up doula whom you may also meet ahead of time if you desire.

 

I will provide email/text/phone support after the signing of our contract until 2 weeks postpartum.

 

I will be on call for you 24 hours a day beginning 3 weeks before your estimated due date up until labor begins. 

 

I will provide early labor support in your home at your request.

 

I will remain with you once active labor has begun until 1-2 hours after your baby is born, excepting for extraordinary circumstances. I may take short breaks for meals and rest, if time allows – as you deem appropriate.

 

I can provide reassurance and perspective to you, make suggestions to help labor progress, and help with relaxation, massage, positioning, and other non-medical techniques for comfort.

 

I will strive to maintain a calm and peaceful birth environment.

 

I will draw on my knowledge and experience to provide emotional support, physical comfort, and communicate with medical staff to make sure you have the information you need to make informed decisions during labor.

 

I will help to initiate the breastfeeding process, if that is what you choose to do, and you would like my help.

 

I will maintain confidentiality of all details relating to your pregnancy and birth and will receive consent from you before sharing your story with others.

 

After the birth of your baby I offer one visit at home to answer any questions, check on your and your baby’s well-being, review the birth, and give you referrals to appropriate professionals as desired.

 

 

You will complete a birth plan and discuss it with your caregiver.

 

You will contact me via cell phone or email regarding any questions or concerns throughout your pregnancy.

 

You will call me (not text) as soon as you think you may be in labor, even if you are not sure, so that I may make arrangements to be at your labor and delivery. I can answer questions and make suggestions over the phone. We will decide if I should come right then or wait for further progress. We will also decide at that time where we will meet – at your home, the hospital or the birth center.

 

You will allow me approximately 1-2 hours to reach you.

 

You will contact me following your birth to arrange a postpartum meeting. 

 

 

-perform clinical tasks, such as taking blood pressure, fetal heart checks, vaginal exams, etc. I am there to provide physical comfort and emotional support.

 

-make decisions for you. I will help you get the information necessary to make informed decisions and will remind you if there is a departure from your birth plan.

 

-speak to the staff on your behalf. I will discuss your concerns with you and your partner and offer options and questions that you can ask the clinical staff.

 

-prescribe, diagnose or treat any medical issues that may arise and will not be liable for interpreting diagnostic procedures. These are roles of your medical providers.

 

-force my own beliefs regarding the birth process.

 

-exclude your partner. I am there as a support to both of you.

 

 

$900.00 Doula package. ($950.00 with photography services) Deposit of $450.00 due at signing of the contract. Includes 1-2 prenatal visits, phone and email support, labor and delivery support, and 1 postpartum visit. The remaining balance of $450.00 ($500.00 with photography services) is due by 37 weeks.

 

$25.00 per hour additional services and or visits. Due upon delivery of service. 

 

Total Due ___________

 

Deposit ___________

 

Date ___________

 

Balance Due ___________     On ____________ (37 weeks)

 

Please let me know of financial constraints ahead of time.

 

 

I will make every effort to provide the services described in this agreement. Occasionally this is impossible. If my failure to attend your birth is due to my error, or if I fail to provide a back-up doula, there will be no charge for my services and I will refund the deposit. If it is due to circumstances beyond anyone’s control, or your failure to call me with enough time to arrive to be of service, I will keep the deposit, but there will be no further charges.

 

 

In some cases, labor progresses more quickly than anticipated. If you call me to advise that your labor has progressed quickly and delivery is imminent or your baby has been born unexpectedly at home, I will call an ambulance from the hospital that you were planning to deliver at and arrange for you and your baby to be transferred to that hospital. 

 

If your baby arrives unexpectedly at home with me present, you or your partner will be responsible for the deliver of your baby. I will do what measures I am capable of to try to keep you and the baby safe and comfortable until EMS arrives. This will fall under the Good Samaritan Law.

 

 

 

____________________________ _____________

Client’s Printed Name     Due Date

 

 

____________________________ _____________

Client’s Signature            Date

 

 

____________________________ _____________

Doula’s Signature            Date

 

 

In the event that I am required to drive you to the hospital, I will be acting as Good Samaritan and will not be held liable for any event that should occur in the car, including but not limited to, accidents, precipitous birth, or birth related damage to the vehicle. You will be financially responsible for any damages that occur to the car during transport relating to your birth including reparation of damages or cleaning due to ruptures of membranes, vomiting, blood, urine, feces, physical damage to car, or any birth-related damages not brought on by myself during your transportation.

 

If any emergency occurs during your transportation, I agree to pull over and call 911 and act as Good Samaritan until emergency services arrive.

 

 

 

____________________________ ____________

Client’s Signature            Date

 

 

____________________________ ____________

Doula’s Signature            Date

 

 

____ I give permission for Michelle Sherwin to take photos of me and any support persons present during labor and postpartum.

 

____ I understand that if I have hired Michelle Sherwin as a doula, she will be acting as doula first and photographer second.

 

____ I give permission for Michelle Sherwin to use photographs of me and my labor and delivery and any others involved in my labor and delivery for the use of marketing in a portfolio, publication, or advertising. Photos including nudity will not be included unless granted additional permission. This includes website content, marketing materials such as business cards or brochures, and social media.

 

____ I give permission to use my photos for educational purposes in childbirth education classes, breastfeeding classes, and/or professional presentations.

 

 

____________________________ _____________

Signature                          Date