Contract For Services

Contract For Doula Services Content

Services, Supplies and Costs Associated with Doula Services


First Antepartum visit and Consultation: I meet you for the first time; we talk and become familiar with each other. I will also collect some history about you and your pregnancy and past pregnancies. This allows me to: a) have a good understanding of how much you know and what services you might need, b) keep a professional record of services rendered for myself and to release to your insurance company, if they provide reimbursement for doula services. Any information collected is for doula and client only, will not be released to anyone without notice and copies are available for you, your insurance and your doctor/midwife. We will sign a financial and service contract and I will collect payment.

Two subsequent Antepartum visits: We will meet and talk about birth options, labor positions, relaxation techniques and I will help prepare a birth plan for you. If you are birthing at the hospital or a birthing center you will want to file a copy of the birth plan in you chart. If needed, one of these visits can occur at your doctor/midwife’s office, so I can meet and discuss things with her/him.

Labor and Birth support: During the duration of your labor and birth, I will support you both physically and emotionally. I will encourage your partner to help and show him/her techniques to help you. If at the hospital/birthing center, I will remind you of your birth plan so you can express your wishes to the staff. Comfort techniques: I can offer help and advice with comfort measures such as guiding your breathing, enhancing relaxation, encouraging movement, suggesting effective positions for labor, and doing massage. Advocacy: I can assist with gathering information about the progress of labor to make sure you have the information you need to make informed decisions about your birth. I can also serve as an advocate for your needs with the medical staff. Emotional support: My most critical role is providing continuous emotional reassurance and comfort.

Immediate Postpartum: After the birth I will stay with you and help you get settled. I will also help you get breastfeeding off to a good start. If there is anything you need for comfort, I will try to make accommodations for you.

Two subsequent Postpartum visits: I will visit you at home within one week, usually within 48 hours of the birth. I will make sure you are settling in with your new family and that breastfeeding is coming along. I will also discuss your birth with you and your partner and help you remember all the details. During the second visit, usually two weeks after the birth, I will see if you are well on your way to recovery and I will check on you progress at breastfeeding. If you need referrals to a lactation consultant, nutritionist, doctor/midwife or support group, I will help you with this.

Telephone/Email Consultations: I will be available by telephone as well as email, to answer any questions and to refer you to your doctor/midwife if a problem arises.

Birth, Postpartum and Breastfeeding Kit

Moist Heat Labor Pack                                                       Nursing Tea

Labor Massage Oil                                                            Nipple Salve

Labor Tea                                                                          Hemp Nursing Pads

Herbal Lip Balm

Massager                                                                           Baby Bath Herbs

Birth Ball (small, medium or large)                                      Baby Diaper Salve

                                                                                          Baby Diaper Rash Soap

Postpartum Bath Herbs                                                      Baby Massage Oil

Perineum Spray                                                                 Baby Herbal Heat Pack

All items listed are used when available; alternatives will be used if needed due to unavailability

Books and Literature

The Thinking Women’s Guide to a Better Birth

By Henci Goer

Practical Information for a Safe, Satisfying Childbirth

Award winning medical writer and birth activist Henci Goer gives clear, concise information based on the latest medical studies. Goer will help you compare and contrast your various options and show you how to avoid unnecessary procedures, drugs, restrictions, and tests.

The Ultimate Breastfeeding Book of Answers

By Jack Newman, MD

This book is an amazing resource for any nursing mother.  This book is full of excellent information to help with nearly every breastfeeding concern.  You'll turn to Dr. Jack Newman's book time and time again.

Supplemental Literature and Materials

You will also receive literature consisting of up to date information concerning; medications, interventions, nutrition, postpartum recovery, breastfeeding and so much more. Everything will be presented neatly in a binder for easy reference.

All items listed are used when available; alternatives will be used if needed due to unavailability


Breakdown of Costs and Conditions

I have read, understand and agree to all fees and costs concerning services offered by Natural Attachment. (Yes/No) Initials ___. I can read and print this information here. I will be choosing the (Typical Fee Schedule/Reduced Fee Schedule). Initials ___. **Keep in mind the Reduced Fee is for those who qualify for government assistance programs such as Medicaid/Medicare.**

Notifying me that labor has begun: It is very important that you contact me as soon as possible when you suspect labor has begun. I will be considered on call at that point. I will need approximately one hour (maybe less) from the time you request my presence to the time I arrive. It is extremely important that you contact me immediately if you feel labor is progressing rapidly. I will make every attempt to arrive immediately.

Economics of A Doula's Fee

Scheduling - When I contract with you for birth, I limit other parents for that period to avoid conflicts and be reasonably rested when you need me. At times, I may turn away potential parents to be available for you, as there is a large commitment made in time before, during, and after birth. During that time I provide you with a way to contact me 24 hours a day and 7 days a week. I will not usually take trips or weekends away during that time and do not intentionally schedule any activity such as a workshop or seminar that I can't afford to miss, unless I discuss it with you previously. Any good doula respects this commitment. For these reasons a doula that is able to attend 2-3 births each month would be very lucky indeed.

Hours - Couples having a first baby may imagine that a doula will only be spending a few hours with them during the labor and birth. In reality, an eight-hour birth for most Moms would be considered quick. The "average" first time mom's labor is between 12 and 19 hours (though births that I attend tend to be shorter). There are about another 10 hours spent in hosting and traveling to antepartum (prenatal) and postpartum meetings, and at least another hour or two in phone calls. All of this is in addition to being on call for you full time at the end of your pregnancy and for calls following birth. Additional time is spent finalizing your birth plan letter, documentation and other administrative tasks that doulas need to complete to maintain organization.

Expenses - Independent doulas must consider their expenses just as you do. Bookkeeping and tax preparation, advertising, cell phone service, office supplies, travel expenses, membership fees, self-employment taxes, a number of labor support tools, reading, subscriptions and continuing education.

No one becomes wealthy doing labor support work. Most independent doulas, in this area, charge anywhere from $400 up to $1,200. The fee charged usually reflects the economy of the area as well as the doula's experience and certification status. If you feel you cannot afford my fee, please let me know. Although I have been told my fee is quite reasonable for this area, I always do my best to accommodate those in need of special payment arrangements.

Fees. The total fee for these services is $800.00 for typical services or $400.00 for clients who qualify for government assistance programs. I do not offer a sliding scale. I do however let you make payments. I leave it to the client’s discretion to determine what they can afford; it is your responsibility to pay for services received. As a professional, I do ask fair recompense 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. I do not ask to verify your income or any such thing, I simply ask you to be fair in determining if you can truly afford and will pay for my time and services.

I ask for a deposit of $225.00 or $135.00 for clients qualifying for government assistance, which is typically paid during or shortly after the Antepartum Consultation. I will not consider myself obligated to the birth, or “on-call” until I have received this deposit. The remainder of the fee is due by 37 weeks gestation and should be sent to me at Natural Attachment 4 Northeast 10th #404, Oklahoma City, OK 73104.

Failure of a doula to provide service. I will make every effort to provide the services described. Sometimes this is impossible for a variety of reasons. If my failure to attend the birth is due to my error, there will be no charge for my services, and I will refund your deposit. If it is due to circumstances beyond anyone’s control (e.g. an extremely rapid labor and birth), or your failure to call me, I will keep the deposit, but there will be no further charges and I will refund any payments made over the $225/$135 retainer fee. If you decide to end this contract before 37 weeks gestation the same will apply. If you decide to end this contract after 37 weeks gestation, you will not be refunded anything.

I / We have read this letter describing the doula services and agree to the terms of service and financial responsibility.

_________________________________________            ____________________________________

Client Name                                                                             Partner Name


_________________________________________              ___________________________________

Client Signature                                                                       Partner Signature


_________________________________________             ____________________________________

Doula Signature                                                                       Date Signed



Download this form here, print and sign, then contact me to set up a consultation.

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