Client Contract
My role as your doula: I am independently employed and contracted directly by you, my client/s. It is important for you to understand that as your doula I cannot- and do not- guarantee a specific outcome for your birth. If you have any specific requests or circumstances (cultural, religious or otherwise) I kindly ask that you please make me aware of them as soon as possible so that I can help you prepare and act in your best interests. I support women, their partners and families during labor and the birth of their baby. I draw on my knowledge and experience to provide physical, emotional and informational support to women and their partners. I do NOT offer medical advice or preform clinical tasks. Tasks within my scope of practice include, but not limited to: non-medical comfort techniques (counter pressure, position suggestions, hydrotherapy, breathing, imagery, massage, aromatherapy, etc.), providing nourishment and hydration for the mother and birth team, taking pictures or video, and documenting events and milestones during labor and the birth.
Initial Consultation: The first meeting is a time for us to meet and decide if we want to work together. It is very important that you and your partner are comfortable with me and excited about my role in the birth. If you or your partner decide that we do not fit well, I encourage you to say so, and I will be more than happy to refer you to a list of local doulas, with whom you may connect better. If we do decide to work together, the next step would be to sign the contract and send a copy/picture to me via email. At that time, a deposit is necessary to reserve your due date on my calendar. I will give you a form (also found on our website) with some questions to fill out and we will go over and discuss it at our first prenatal visit, usually around 30 weeks.
Prenatal Visits: It is important to meet before labor to become acquainted, to explore and discuss your priorities and any fears or concerns, and to plan how we might best work together. I usually plan for two visits around 30 and 36 weeks. I will first always check in and ask how you have been doing and what has been coming up emotionally, spiritually and physically during this season.
Topics we will/can discuss during prenatal visits:
· Relevant medical history
· Knowledge/expectations, fears/concerns around birth
· Preferred approach to maternity care
· Brief stages of labor education
· Risks and benefits of procedures
· Birth plan preparation
· Comfort measures/doula bag
· Partner coaching
· Any questions
On Call: I am available by phone and email immediately after you choose to sign the contract. I encourage you to contact me with questions, concerns and updates that may come up throughout your pregnancy. I will get back to you as soon as I can, usually immediately, but definitely within 24 hours. Once you are two weeks from your due date, I will consider myself on call for you and I will have my mobile phone with me at all times. If for some reason, I do not answer when you call, please leave a message. During the on call time, I ask that you please keep me updated as to any progress you, or your caregiver, feel you are making towards labor. The more information I have, the more prepared I will be when you actually are in labor. If a couple of days go by and I have not heard from you, expect an email or quick phone call from me just checking in.
In Labor: When you think labor has begun, I ask that you contact me as soon as possible, even if you are not sure you are really in labor. The more notice I have, the better prepared I can be for you! Once you have decided you are in labor, we will then plan to check in with one another every few hours, or as often as you prefer. Active labor typically begins around 5-6cm, which is when I am contractually scheduled to meet you at the birth location to provide hands-on support (unless otherwise discussed). I will remain with you during labor until a few hours after birth. In the event your labor lasts longer than 24 hours, I reserve the right to call a back-up doula and/or take a break to tend to other clients or personal matters.
After Birth: I generally remain with a client for 1-2 hours after birth, until you are comfortable and your newly born family is ready for quiet time together. Again, each situation is different and my duties will vary depending on you needs.
Postpartum Visit/s: My services include one postpartum visit within a few days after birth, but if desired I am happy to schedule more upon request, for an additional fee. During the visits I can provide breastfeeding support (although not certified), baby care tips, referrals to community services as well as help in any way around the house (cooking, cleaning, tending to children or animals etc.). This visit will also give us the opportunity to discuss and debrief your birth experience.
What I Will/Won’t Do:
· I will not make decisions for you
· I will help you get the information you need to make your own informed decisions
· I will remind you if there is a departure from your birth wishes, and will verify this is, in fact, your informed decision
· I will not speak to medical staff directly regarding matters where health care decisions are being made (I can discuss your concerns with you and your partner, suggest options, and act as an advocate, but you or your partner will need to speak on your behalf to medical staff)
COVID: Based on the current local climate surrounding the COVID pandemic and hospital protocols, there may be limitations on my in person support as a doula- but this is changing daily. I am committed to focusing on and prioritizing my individual wellness and staying up to date on hospital policy in order to provide the best birth support possible for you and your partner. Changes to the contract based on COVID will be discussed and altered on an individual basis.
Fees: The total fee for my services is $_________. It is not just for being at your birth. This covers, but may not be exclusive to: prenatal preparation and visits, creation of birth plan, optional visits/facility tours, phone and email availability, on-call beginning 2 weeks before your estimated due date, continuous labor and birth support, immediate postpartum care and a postpartum visit. If you choose not to take advantage of any or all services outlined throughout the contract, by signing this agreement you understand the fee stays the same. If necessary, I am open to payment plans, and I offer a sliding scale based on individual circumstances. As a trained professional, I ask fair compensation for my services. However, I also truly value the positive benefits of doula care and do not want financial need to make those services inaccessible to mothers who desire them. Upon signing of this contract, a non-refundable deposit is paid in the amount agreed upon. After those two things are completed, your due date is officially on my calendar and the remainder of the fee is due 14 days before your due date. I will send an invoice reminder for this payment. Your options for payment include Check made out to Kaley Spears / Cash App: $KaleySpears1 / Venmo: @Kaley-Spears
Total fee due is $________
Less the Deposit of $_________ Paid on_________
Remaining Balance $_________ Due by_________
Refund: If, for any reason, you are unable to keep our prenatal or postpartum appointments, the baby is breech (or other medical concern) and a cesarean becomes necessary, preterm induction occurs, or you fail to call me during labor, the doula fee is non-refundable. Depending on the specific situation, a portion of the fee may be refunded.
Failure of the doula to provide service: When you hire me, it is my utmost priority to be present with you during your birth, and to abide by this contract. However, for unforeseen reasons, it is possible I could miss a birth. If for some reason at any point I am unavailable for any length of time during the time I am on call for you, I will notify you as soon as possible and I can offer a choice of trusted doulas in the area, to fill in until I return. In this situation, this contract will still be binding and I will be responsible for payment arrangements with the backup doula. However, if it is due to negligence (defined as not returning your phone call, not showing up at all without contact and not having a back up doula available) on my behalf, the entire amount will be refunded to you. If I miss the birth because you failed to call me promptly or not at all, at the beginning of your labor there will be no refund. In the case of a precipitous birth, it may be possible for me to provide all the services listed. I will arrive as soon as possible and provide immediate postpartum support, as well as the agreed upon postpartum visits.
Release of Liability: I, ____________________ (client name) understand, Storehouse Birth bears no responsibility or liability for any aspects of my, or my baby’s, medical care or treatment provided by my chosen health care professional(s) or hospital during my pregnancy, birth or postpartum.
Photo and social media release: I, ______________________ (client name) give Storehouse Birth permission to post photos/ comments on social media and website provided they are modest and respectful of our birth. Storehouse Birth will only post with parents' permission and photos given by the parents and/or ones screened by the parents.
__ I give permission for social media release __ I do not give permission for social media release