Doula Services Agreement by zwz37221

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									                                             SACRED PASSAGES DOULA CARE
                                                 Doula Services Agreement

         As a doula I:
                            Accompany women in labor to help ensure a safe and satisfying birth experience.
                            Draw on my knowledge and experience to provide emotional support and physical comfort.
                            Make suggestions for labor progress and help with relaxation, massage, positioning, and
                             other techniques for comfort.
                            Communicate with staff to make sure you have the information you need to make informed
                             decisions as they arise in labor.
                            Provide reassurance and perspective to you and your partner (if applicable).
                            Am independent and self-employed. I work for you, not your caregiver or hospital.
         Doula’s Do Not:
                            Perform clinical tasks, such as blood pressure checks, fetal heart checks, vaginal exams,
                             and others.
                            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 instead of you regarding matters where decisions are being made. (I will
                             discuss your concerns with you and suggest options but you or your partner (if applicable)
                             will speak on your behalf to the clinical staff.)

     Doula’s Services and Obligations:
                  I prefer to meet with you and your partner, (if applicable) at least once 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.

         If you do select me I:
                            Will meet with you at least once before labor begins to discuss the birth.
                             (We determine how often to meet depending on your individual needs.)
                            Will want to become familiar with your Birth Plan (if applicable), including your
                             preferences regarding management options and the use of pain medications.
                            Will want to know your best ways of coping with pain and fatigue and how you and your
                             partner foresee working together (if applicable).
                            Will be on call 24 hours a day (for a negotiated time period). This means I will carry my
                             cell phone and have it on at all times that I am away from home. (Unforeseen
                             circumstances may prevent me from attending your labor and birth. I will attempt to have a
                             back-up attend you, but this may not be possible.)
                            Will answer questions and make suggestions over the phone any time before labor begins.
                            Will provide early labor support as requested, including in your home.
                            Will remain with you once active labor has begun until at least one to two hours after your
                             baby is born.
                            Will utilize non-medical support techniques for labor and birth.
                            Will maintain a birth log as circumstances allow.
                            Will assist in providing information and supply emotional support by telephone on
                             postpartum care, breastfeeding, and newborn care after the birth, as requested.
                            Will meet with you once between 1 to 4 weeks postpartum to discuss the birth and any
                             other concerns you may have. (We determine how often to meet depending on your
                             individual needs.)

         Client’s Obligations:
                           You will call me as soon as you think you are in labor, even if you are not sure, so that I
                            may make arrangements to attend your birth.
                           You will allow me one to two hour’s time to reach you, unless notified otherwise by me.
                           It is your responsibility to ensure that I am allowed to attend you at all times while at the
                            hospital (if applicable).
                           If you decide not to use my services after signing this contract you will forfeit the
                            __________ retaining fee and there will be no further charges if you cancel within 1 week
                            of signing this agreement. *
                            You will pay the half of the ___________ sliding scale fee by 37 weeks gestation and the
                            remainder by 2 weeks postpartum.
                                                                                                                             2
                             In the event of a scheduled (non-emergency) labor induction or cesarean birth, you will
                              take my schedule into consideration. (The fee for a cesarean birth is the same as for a
                              vaginal birth. I will still offer physical and emotional support to you and your partner (if
                              applicable) before, during (if I’m allowed into the surgery), and after.)
                             You will allow me to provide limited information about you to my childcare provider.

Failure of Doula to Provide Services:
  It is understood by all parties that I will make every effort to provide the services described in this agreement.
                              In the case of rapid birth or medical emergency, it may be impossible for me to provide
                               these services.
                              If you fail to call me to attend your labor and birth, for whatever reason, I will keep the
                               ___________ retaining fee and half of the ____________ sliding scale fee due by 37 weeks
                               gestation and there will be no further charges.**
                              If I fail to attend your labor and birth due to circumstances beyond anyone’s control I will
                               keep the ____________ retaining fee and half of the ___________ sliding scale fee due by
                               37 weeks gestation and there will be no further charges.**
                              If I am unable to attend your labor and birth I will still meet with you post partum to
                               discuss your experience and provide support.
                              In the event my back-up attends your birth you still pay me the remainder of the sliding
                               scale fee by two weeks postpartum and I negotiate my back-ups payment.


                  Fees:
         The fee for the services described in this agreement is to be paid as follows:

_____________________ as a non-refundable retainer fee, due upon signing this contract.

_____________________ due at 37 weeks gestation ____________ based on Estimated Due Date.
                                                            Date
_____________________ due within 2 weeks after your baby’s birth.


         * (If you reach 37 weeks gestation prior to the 1 week you still must pay half of the sliding scale fee.
         ** ( If you birth your baby prior to 37 weeks gestation and do not call me to attend or I am unable to attend
your birth you still must pay half of the sliding scale fee at the time you would have been 37 weeks gestation)


I/We have read this contract describing the doula’s services and fees and agree that it reflects the discussion we had with
her.

__________________________                    _____________________
Client                                     Date

__________________________                    _____________________
Client’s partner (if applicable)            Date

__________________________                    _____________________
Doula                                       Date




                                         Sacred Passages Doula Care
                                    ahwilkes@sacredpassagesdoulacare.com
                                                 th
                                    19225 SE 136 St.RentonWA98059

								
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