preview.jpeg

Birth Doula Letter of Agreement

Printable Version

As a Birth Doula my role is to accompany a woman 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 evidence-based 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 am independent and self-employed. I work for you, not your caregiver or hospital.

Prenatal: I prefer to meet with you and your partner at least twice before labor to become acquainted, to explore and discuss your priorities and any fears or concerns, and to plan how we will work best together. This includes assisting you in making your Birth Plan, your preferences regarding pain management options and the use of pain medications. I will want to know your best ways of coping with pain and fatigue and how you and your partner foresee working together and with me. If possible one of these visits will be at an appointment with your Doctor or Midwife.

During Labor: I prefer that you call me when you think you are in labor, even if you do not yet need me. This gives me time to clear my calendar for the next 24 hours and arrange for childcare. I can answer questions and make suggestions over the phone, and we can decide if I should come to you then, or wait for further change. I usually need approximately 60-90 minutes to get to you from the time you ask me to come. We will also decide where to meet (home or hospital). Except for extraordinary circumstances, I will remain with you throughout your labor and birth.

Backup: I will have a backup Doula chosen that you will have an opportunity to either meet in person or during a phone call to get to know one another. She will be available during the same time frames as myself, 24 hours a day, two weeks before your EDD until birth. You will have her contact information in the case that I am unreachable or have become unavailable when you go into labor. I will make my best attempt to choose a backup that has similar training as myself and is a good “fit” for your special circumstances and desires for your birth process.

Initials __________

Scope of Practice Limitations: As a certified DONA Birth Doula I am not trained or authorized to perform the following:

  • Perform clinical tasks, such as blood pressure, fetal heart checks, vaginal exams, or other medical procedures that fall under the legal definition of practicing medicine.

  • Provide information, dosages or advice concerning prescription or alternative medication, or medical advice pertaining to you or your baby.

  • Make decisions for you. I will help you get the information necessary to make an informed decision. I will also remind you if there is a departure from your Birth Plan.

  • Speak to the staff on your behalf. I will discuss your concerns with you and suggest options, but you or your partner will speak on your behalf to the clinical staff.

After the birth: After your birth I will usually remain with you for about two hours, until you are comfortable and your family is ready for quiet time together. During that time I will take photographs of your new family and help with initial breastfeeding. I am available for phone contact to answer any questions about the birth of your baby. I will also provide one to two hour postpartum visit, at your convenience, to see how you are doing, to review the birth, to admire your baby, and get feedback from you about my role as your Doula.

Extenuating Circumstances: As a doula, I can help you prepare for your birth, but I cannot guarantee that your birth will go as planned. If you plan a vaginal delivery and a cesarean is performed after the onset of labor, I will continue to provide support during the cesarean surgery (as allowed by hospital and/or doctor policies) as well as immediately after to help with your comfort and breastfeeding. I will also follow-up with you after the birth, as I do with all my clients. In this scenario, my full fee applies, and no refund will be given. If you and your doctor decide that a planned cesarean is necessary (that is, a cesarean done before your due date and/or before the onset of labor), I will provide support during the cesarean (as allowed by hospital and/or doctor policies) and immediately after, as well as one additional 3-hour postpartum visit to assist with breastfeeding, light cleaning, laundry, baby care, etc. for my usual fee.

Waiver of Liability: As the express condition of my performance of services under this agreement, you agree, on your own behalf and on behalf of all persons or entities you may bind under Hawaii law to waive and hereby do waive any rights, claims or causes of action that you may have against your doula now and in the future with respect to your pregnancy, birth, postpartum period or the services I may provide and/or fail to provide you. You expressly understand that, as a doula, I am not a medical professional and therefore cannot and will not provide you with medical care or advice.

Initials __________

Dispute Resolution: We agree, in the unlikely event that a dispute should occur between us, that all disputes shall be resolved pursuant to Hawaii law and that, except as otherwise indicated below, the parties to this agreement are not entitled to and shall not receive attorney’s fees and/or expenses arising from any such dispute. We further agree to mediate any dispute arising out of this Agreement before resorting to arbitration or court action mediation fees, if any, shall be divided equally.

Disclosure of Communicable Diseases: You agree to disclose any communicable diseases that you have so that I can take appropriate precautions.
 

Fees: The full fee for doula birth services is $1,200.00.  A non-refundable retainer of $500.00 is due, along with a signed copy of this letter of agreement to reserve my services for two weeks before and two weeks after your expected due date.  The remaining balance is due two weeks prior to your due date. These fees are not refundable unless there is some unforeseeable emergency on my part that prevents me or my backup from attending your birth. If I am not called to attend, or given adequate notice to attend, I will not provide a refund. This includes precipitous labors. If your fee has not been paid in full two weeks before your due date, I am not obligated to be present at the birth.

I/we have read and understood this letter describing Lea Garner’s doula services and agree to its terms.    

I/we consent to the release of this and all other information pertaining to me to the person(s) designated as backup for my birth.

Date:________________

Client:________________________________  

Signature_________________________________________

Date:________________  

Partner:______________________________

Signature_________________________________________

Date:________________  

Doula:________________________________

Signature_________________________________________

                 

Lea Garner

JustTheDoula@gmail.com

808-690-4445

JustTheDoula.com