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Flower Blossoms

CONTRACT OF SERVICES:
BIRTH SUPPORT

Service Agreement for Birth Doula Services

As a Birth Doula, my role is to accompany women in labor to help ensure a safe and satisfying birth experience. I will draw upon my knowledge and experience to provide emotional support, physical comfort and the information you need to make informed decisions as they arise in labor. I can provide reassurance and perspective to you and your partner, make suggestions for labor progress, and help with relaxation, massage, positioning and other techniques for comfort. I will support you to my fullest in facilitating the kind of birth you have envisioned for yourself and your family.  As your doula, I am independent and self-employed. I work for you, not your caregiver or hospital/birth center.

1. Scope of Services:

​As your Birth Doula, I agree to offer care with professionalism, compassion and respect.  I further agree to:

  • Provide emotional and physical support during labor and birth, providing comfort measures and continuous presence.
  • Advocate for your birth preferences and facilitate effective communication with the healthcare provider.

  • Assist in creating a birth plan and providing evidence-based information to help you make informed decisions.

  • Offer reassurance, encouragement, and guidance throughout the birthing process. 

  • Provide postpartum support in the first week or two after birth to ensure a smooth transition. 

2.  Your Obligations

​As the client, you agree to conduct your behavior with professionalism, compassion and respect.  You further agree to:

  • Read and be familiar with the information that I provide for you.

  • Discuss your plans for your birth with your caregiver, preferably before labor.

  • Contact me regarding any questions or concerns throughout your pregnancy.

  • Enroll in and attend my HypnoBirthing childbirth education course, or suitable substitute.

  • 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 birth.  

  • Allow me approximately 1-2 hours to reach you.

3. Prenatal Appointments: 

As your Birth Doula, I offer the opportunity for two (2) prenatal appointments.  During these appointments, I agree to:

  • Discuss your birth preferences, concerns and expectations while fostering a strong and trusting relationship.
  • Educate you and your birth partner about labor, comfort measures and the stages of birth
  • Assist in creating a personalized birth plan and explore various coping techniques, labor and birth positions
  • Provide resources and referrals as needed, ensuring you have access to a comprehensive support network.

4. Postpartum Appointment:

As your Birth Doula, I offer the opportunity for one (1) postpartum appointment.  During this appointment, I agree to:

  • ​​​Offer emotional support and assist with any immediate postpartum concerns or challenges.
  • Offer the opportunity to process your birth story, and ask any questions related to your labor and birthing experience
  • Provide guidance on newborn care, including feeding, diapering, and soothing techniques
  • Address any questions or concerns you may have about your recovery or the early postpartum period
  • Provide referrals to community resources and support networks, as needed

5. On-Call Availability:

As your Birth Doula, I agree to be on-call and available to you 24/7, starting at 37 weeks of pregnancy.  I will prioritize your needs and commit to attending the birth, ensuring continuous support during labor and delivery.  I commit to arriving to your birth within 1-2 hours of you requesting me.  I will remain with you for at least 2 hours post birth, or until you are settled and ready for privacy.

6. Fees and Payment:

As the doula client, you agree to pay the agreed upon fee for Birth Doula services.  Payment arrangements are available if agreed upon in advance. You agree to pay in full regardless of the outcome of the birth (cesarean, premature, stillbirth, medicated, precipitous, and so forth) and I agree to support you regardless of the outcome of the birth. Payment terms are as follows:

  • ​​An initial deposit of $350 is due upon enrollment, securing my availability and commitment to your birth.
  • Half of the remaining balance is due at 28 weeks of pregnancy.
  • The final payment for the remaining balance is due by 37 week of pregnancy.
  • Late payments may incur additional charges or affect the availability of services. 
  • I will not attend your birth or provide any labor support until payment has been made in full.

7. Confidentiality Agreement:

Both parties agree to maintain the confidentiality of all personal, medical and sensitive information shared during the course of service.  This includes but is not limited to discussions, records and any other information related to your birth experience.

8. Media Release:

By entering into this agreement, you grant permission for me to use any photographs, videos, or testimonials taken during the birth or postpartum period for promotional purposes. Consent can be withdrawn anytime by specifying in writing.

9. Cancellation Policy:

  • In the event that you wish to cancel Birth Doula services, a written notice should be provided.

  • If you choose to cancel this contract, you may do so at any point before you reach 34 weeks pregnant. Cancelling before 34 weeks means I will keep a $350 retainer as well as $100 for each prenatal visit we've already had. I will return whatever balance remains. If you choose to cancel the contract after you reach 34 weeks gestation, there will be no refunds and I will keep, or you will owe me, the agreed upon full fee for service.

  • If at any point, I choose to terminate services, a full refund will be provided, minus the $350 retainer fee.

10.  Failure to Provide Service:

I will make every effort to provide the service described in this agreement.  If I am unavailable to attend your labor, I will refund your balance minus a $350 retainer fee. If it is due to your failure to call me, I will keep, or you will owe me, the agreed upon full fee for service. If my failure to provide service is due to circumstances beyond anyone's control (for example: natural or catastrophic events or an extremely rapid labor); I will refund $300 and offer 10 hours of postpartum support.

11.  Emergency Delivery:

In some circumstances, labor progresses more quickly than anticipated. If you call me to advise that your labor has progressed very quickly and delivery is imminent or that your baby has been born unexpectedly at home, I will call an ambulance and arrange for you to be transferred to the hospital.  If your baby arrives unexpectedly at home with me present, you or your partner will be responsible for the delivery of your baby. I will take what measures I am capable of to attempt to keep you and the baby safe and comfortable until EMS arrives. This will fall under The Good Samaritan Law.

12.  Liability:

By entering under this contract, you acknowledge and agree that engaging the services of Flagstaff HypnoBirthing for Birth Doula services involves inherent risks and uncertainties. You further understand that Flagstaff HypnoBirthing and its Birth Doulas are not medical professionals and do not provide medical advice or treatment.

 

Therefore, to the fullest extent permitted by law, you release and discharge Flagstaff HypnoBirthing, its owners, employees, agents, and Birth Doulas from any and all liability, claims, demands, actions, or causes of action arising out of or in connection with the Birth Doula services provided.

 

By entering this agreement, you also understand and agree that the I am NOT responsible for:

  • Making medical decisions on your behalf

  • Performing clinical tasks or providing medical interventions.

  • Guarantees regarding the outcome of the birth or your satisfaction with the birth experience.

By signing below, you acknowledge that you have read, understood and agree to the terms and conditions outlined in this Service Agreement for Birth Doula Services.

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