Financial Responsibility

FINANCIAL AGREEMENT

Natural Attachment Birth Assistance

Michéle James-Parham, TLM, NCBE, Doula
Owner & Director of Services
4 Northeast 10th Street #404
Oklahoma City, OK 73104
Cell: (405) 816.4113
Fax: (405) 720.7874
Website:
www.naturalattachment.com

Natural Attachment Birth Assistance is financed solely on the contributions of its clients. Quality assistance, books and educational services for our clients are important financial expenditures. Traveling expenses to and from client visitations, births and postpartum care combined with automobile upkeep and insurance coverage are expenses involved with transportation. Advertising expenses include paper and printing, publishing and distributing information for community awareness; copy costs for files, education, newsletters, and our website and internet costs. Expenses which occur by obtaining samples and equipment for births (beyond what the clients are supposed to obtain), maintenance and servicing of equipment, testing supplies, well-woman care and supplies; phone expenses for separate lines and cell phone time, computers, printer, fax machine expenses, rent, electricity, and heating expenses and so forth are only some of our major expenses that we must meet each and every month. Natural Attachment does not receive any public or private funds to help defray the costs.

Our birth assistance and maternity care services are available to all healthy, low-risk pregnant women and their babies. Some families may have health insurance coverage which might reimburse a family for our services, however, many of our common HMO’s and other similar policies do not cover “out-of-hospital” (OOH) maternity and birthing care. Due to this serious health care restriction, we have developed means for these families, and families without health insurance, to be able to afford quality homebirth assistance and care. This means that some clients may be able to pay more than other financially stressed clients may be able to afford. Financial arrangements can be made to fit the individual client’s budget by several methods. We have developed a flexible fee scale for low income families which is dependent upon household income, financial hardship and the client’s willingness to help promote our services to other expectant mothers and their partners.

Whatever method is chosen, this agreement must be made and in place prior to the 16th week of pregnancy or fourth visit (which ever comes first) and must be agreed upon by both parties.


Natural Attachment Birth Assistance’s Financial Agreement for Our Services Is:

This Includes:

  • Birth Consultant (Midwife) & Attendants of the Birthing Couple’s Choice
  • Pregnancy Testing
  • Pregnancy Counseling
  • Nutritional Counseling
  • Prenatal Testing
  • Prenatal Visits (as outlined in the Scope of Practice)
  • Private Educational Tutoring & Childbirth Preparation
  • Home Birth & Newborn services & Breastfeeding Instruction & Support
  • Birth Supplies & Equipment supplied by Birth Assistant (Midwife)
  • Repair of Perineal Tissue, if needed up to a 2nd degree tear
  • Postpartum Care for approximately up to 6 to 8 weeks after birth
  • Electronic, Phone, or Post Office Communications

Other Services Provided by Natural Attachment Available for additional financial costs to the client:

  • Breast Exam Education & Kit
  • Parenting Education & Support
  • Baby Wearing Demonstrations & Slings
  • Natural Family Products & Baby Registry
  • Natural Family Planning Supplies

Natural Attachment does NOT provide these services:

  • Circumcision or other forms of genital mutilations
  • Hospital or birth center births, other than birth support
  • Prescribe or give drugs before, during or after the birth.
  • Suturing of perineal tissue with a third or fourth degree tear
  • Cesarean births, other than birth support.
  • Clinical laboratory testing
  • Pap smears and other Medical laboratory or Diagnostic Testing (other than already described)

The Birthing Parents will supply and be responsible for obtaining and paying for the following:

Educational Items: (books, videos, etc. not supplied/loaned by Natural Attachment) and outside childbirth preparation classes.

Medical Laboratory or Diagnostic Tests: (Requested tests may include prenatal blood work, urinalysis, dietary analysis, nutritional supplements, viral blood screening (HCV, HBV, HIV, VDRL, Herpes, Strep B, Chlamydia, etc.), ABO-Rh blood typing and antibody screening, and any other medical tests that may be necessary in providing good prenatal care to the mother and baby and aid in the detection and management of possible birth complications. This may include amniocentesis for chromosomal analysis, or an ultrasound for fetal or placental concerns. All these listed must be attained from other Professional Medical Services such as those provided by a Medical Doctor, if the birthing couple wants or needs these services.

Rh Antibody Testing and Rhogam Treatment: In the case of an Rh negative mother and an Rh positive infant. This may include lab tests done on cord samples to determine the baby’s blood type.

Any hospital, clinical, physician, nursing, doula expenses related to the present pregnancy and any postpartum care not provided by Natural Attachment or that is not included in our Scope of Practice.

Prescriptions & Non-Prescription (OTC) Medications required by the mother and/or infant related to the present pregnancy and postpartum care.

Emergency Care Expenses which may include taxi or ambulance transport, emergency room and physician expenses, surgery and medications.

Mileage for Home Visits, unless agreed upon otherwise, the birthing parents will be responsible for traveling costs of the birth assistant (midwife) for any mileage beyond 30 miles, round trip, of the client’s home. Gas money will be provided at the time of the visit at the rate of $0.25 per mile over 30 miles.

If other foreseen expenses are to occur, the birth assistant (midwife) has the obligation and responsibility to discuss them with the parents ahead of time and come to agreement with the parents.

Since money is tight, Natural Attachment recommends contribution payments should be arranged so that the full amount is paid by the time of the expected due date. It is important to try to meet this payment-due-in-full date since our parents have found that many expenses occur after the birth of their baby.

If a financial hardship occurs or if the pregnancy terminates in a medical setting prior to the 37th week of pregnancy, the remaining amount due on the financial contract needs to be re-negotiated by both parties. After the 37th week, if labor has begun and the birth assistant (midwife) is in attendance whether or not an emergency transfer is necessary and occurs during labor, birth, or postpartum, all remaining payments or fees/contributions are due, regardless of the final location of mother and/or infant.

All fees and contributions are non-refundable. We feel the services we have to offer are well worth the compensation we ask and agree to with the clients. The time, energy and devotion of our birth assistant goes far beyond what she receives in payment. We could not do the work we do without the financial help and support of our clients.

Any photos, stories, and other client materials obtained by Natural Attachment and attendants during the prenatal period, labor, birth, and postpartum are the legal property of Natural Attachment and may be used in the promotion of our services, whether it is electronically or otherwise used. The exception of this clause would be the private client medical records, which would be kept confidential and protected, unless otherwise granted permission by our client or subpoenaed by a legal court of law. Our clients are entitled to one free copy of all medical records; photos and other materials that may be obtained by Natural Attachment while under our service contract.

Our Birth Assistant (midwife) reserves the right to decline further care in the event of non-payment on agreed terms, client medical or psychological reasons, or because of noncompliance / un-cooperation on the part of one parent or both. The client reserves the right to discontinue our services at any time with written notice if they are not completely satisfied with our services.

A retainer fee of ______ dollars is paid at contract signing. Monthly payments can be made in the amount of ______ or more. Any remaining balance is to be paid by 37 weeks gestation, unless otherwise agreed upon.


I / We _________________________________________________________________ have read all sections of this disclosure and have discussed each section with each other and with the Birth Assistant (Midwife) and Natural Attachment regarding the financial obligation of the services rendered. We do hereby understand and acknowledge all information, terms and ramifications. We execute it voluntarily and with full knowledge of its significance.

We agree to pay the amount of: $_______________________________________________ in payments of $___________________ Per Month / Visit. In addition or in lieu of payment, we agree to compensation by other means, such as an exchange of services or talents by:

____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________ ____________________________________________________________________________

______________________________________
Birth Assistant (Midwife)

______________________________________
Parent #1 (Mother)

______________________________________
Parent #2 (Partner)

______________________________________
Legal Guardian (if applicable)

______________________________________
Date


Addendum to this Agreement:

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

 

Print this out from here, sign and contact Michele for your consultation.

 

Other Details of Natural Attachment Birth Assistance Services.

Scope of Practice

Included Services

Financial Responsibility

Informed Choices

Fee Schedules

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