Birth Doula Services Contract

Payment and Confidentiality Agreement

The following agreement is hereby entered into between Rhiannon Browning, referred to as “I” 

and ________________________ referred to as “you,” with the following conditions understood and accepted by both parties.

As a birth doula, I provide emotional and physical support to you and your partner during labor and delivery. I can also facilitate communication with your care provider to ensure that you have the information you need to make informed decisions regarding your baby’s birth. 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 your comfort. I am independent and self-employed, and so, I am working for YOU, not your caregiver or place of birth.

Before Birth:

I will meet with you and your partner twice before labor to become acquainted with you; discuss your priorities and any fears or concerns; present evidence-based information on the risks and benefits of common interventions and procedures used during childbirth; discuss your birth plans; and plan how we might best work together. I will also inform you of times when I am unavailable for labor support. We will remain in touch by telephone and/or e-mail.

I will be on call for your birth two weeks (14 days) before and after your due date (38-42 weeks). If you happen to go into labor before or after this period, I will make every effort to be there. I encourage you to contact me with questions, concerns and any updates. I am available during business hours, via text, phone, or email to discuss any pregnancy-related issues up to 38 weeks. I will get back to you as soon as I can - this will usually be immediately but definitely within 24 hours. After 38 weeks, 24/7 availability is activated for pregnancy and labor-related communication up to 42 weeks, and I will make every effort to respond within a reasonable and timely manner, usually within 5-30 minutes. If communication is in the middle of the night and you need immediate assistance, a phone call is required.

A phone call is required by the Client or Client's partner to activate labor services and have the Doula come to the Client for labor doula support.

If I do not answer my phone when you need to activate labor services, please call my number twice, and then my husband, Austin Ritchie at XXX - XXX - XXXX

During Labor:

I ask 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. 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 can meet you at your home or your planned place of birth. I usually need approximately one-two hours to get to you from the time you ask me to come, barring any unforeseen circumstances (traffic, emergencies, inclement weather conditions, etc.). Long drive times to your location may also affect this one to two (1-2) hour approximation. Once you call me and let me know you’d like me to begin supporting you, I will make every effort to be there within one hour. Except for extraordinary circumstances, I will remain with you throughout your labor and birth.

In the event that I cannot attend your birth, you will have a backup doula scheduled for our agreed upon fee. Their payment will come from the original payment at no extra charge to you. Although I space my clients in order to ensure that I am available to attend every birth, the nature of birth means that there may be the rare occasion in which I am at another birth when you go into labor. In which case, I will provide a backup doula to attend your birth in my place. I reserve the right to jump into the birth to relieve the backup doula, if appropriate and approved by you, also called "bridgework".

I will stay to provide birth support so long as I am physically and mentally able. If labor extends beyond my ability to support you (anywhere from 18-24+ hours), I reserve the right to call in a backup doula. However, I will make every effort to remain with you through the entire duration of activated service until baby is born.

If you desire it, I may take photographs at birth to document your birth experience. Photography is not to replace the purpose of my birth services and those services come first. I will do my best to take as many photos as possible but I cannot guarantee any number of photos or that I will get every moment on camera. For the safety of you and your baby(ies), I will not jeopardize my position in the laboring room to capture the perfect photo.

Siblings are not only welcome but encouraged as birth is a family event. If you choose to have older children take part in the birth, there must be a dedicated adult or Sibling doula to help them. My role is to support you and your partner.

After Birth:

Circumstances permitting, I will remain with you for one to two hours after the birth. I am available to answer questions about the birth or your baby, and I will schedule a postpartum meeting within a few days of the birth to visit you and the baby, review the birth, talk over breastfeeding and baby care and get feedback from you about my role.

For cesarean births, if I am not allowed in the OR with you, we will discuss whether it makes sense for me to go home and return after surgery or to stay for post-op and recovery. Each situation in birth is different and duties will vary depending on your needs.

Limitation of Services:

As a DONA-certified birth doula, I abide by the standards and scope of practice of DONA International. 

As a doula, I do not:

1. Perform clinical tasks, such as taking blood pressure, fetal heart checks or vaginal exams. I am there to provide only physical comfort and emotional support and facilitate communication between you, medical staff, and care providers.

2. Make decisions for you. I will help you get the information you need to make an informed decision.

3. Speak to medical staff or providers on your behalf. I will discuss your concerns with you and suggest options, as well as encourage you and your partner to voice your opinions, questions and concerns to the staff.

4. Provide medical advice. I can direct you to resources that might help you answer your questions and make informed decisions on your own. If you have questions or want advice about your care or that of your baby, you should contact your care provider.

I cannot under any circumstances attend a planned home birth without a midwife or other care provider present. In the event of a precipitous birth in a location other than your planned birth place (such as home or a vehicle) when a care provider is not present, I will provide only emotional and mental support as outlined above.

Extenuating Circumstance:

While it is always smart and helpful to have a plan, births do not always go according to plan. 

If you plan a vaginal delivery and a cesarean is performed after labor has already started, 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. My full fee would apply. 

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 the additional follow up for my full fee. 

If you are having a birth center or home birth and need a transfer to the hospital, I will accompany you and continue to provide doula support there, if necessary.

Failure to Provide Services:

I will make every effort to provide the services described here. 

If my failure to attend your birth is due to an error on your part (failing to call me, for example) I will retain the full amount paid and continue my services to completion. 

If my failure to attend your birth is due to a rapid labor (baby is born less than one hour after you call me and ask me to come), I will offer an additional postpartum visit for support at no additional cost once you leave the hospital or birth center. This can include assistance with breastfeeding, laundry, cleaning, baby care, etc. My full fee applies.

If I am not allowed to your birth due to hospital/provider policies, I will offer additional postpartum services in lieu of monetary reimbursement. 

If you decide against using my services up to and including 36 weeks, you will not be required to pay the Remaining Amount. However, the Retainer Fee applies and will not be refunded. 

If my failure to attend your birth is due to other circumstances such as extreme illness; I am with another birthing person who is in labor, family emergency, and a backup doula is not provided; natural disaster, inclement weather conditions, an act of God, national state of emergency, pandemic shutdown or war, the Fee will be assessed on a services-rendered and fee basis (ie: prenatal visits, administrative duties, communication, on-call timeframe, marketing expenses, etc).

In the event where my physical safety is jeopardized, this contract terminates effective immediately and I reserve the right to make decisions to ensure my safety (ie: calling 9-1-1, fleeing the scene, etc).

Release and Confidentiality:

You hereby give me permission to take notes about you and your birth, including personal information about yourself and your child(ren). This information may be shared with my certifying organization, DONA, as well as the backup doula. Signing this contract also gives me permission to discuss your pregnancy and birth with other birth professionals in both formal and informal settings. I will never use your name, your child’s name, the date you gave birth or any other identifying information.

Responsibility of Client:

I ask that you inform me of any pregnancy-related or other health complications or conditions you may have, as well as any other special circumstances you might have or require. I also ask that you keep me abreast of what happens at your prenatal appointments from 36 weeks forward (if your cervix is dilated, any tests or procedures you might experience, anything your care provider seems concerned about, etc). Text, email and phone are all fine for contact. I also request that you inform your care provider that you have hired a doula. If for any reason you decide not to have me at your birth after you have signed this contract, I ask that you let me know as soon as possible.

Fees:

Fees are agreed to based on the selected package including two prenatal visits, full labour support and one postpartum visit. Total fee for the services described above to be paid as follows:

Retainer fee: 50% of the full fee as a non-refundable deposit, required in order to reserve the Client's due date on the Doula's calendar. This amount is due upon return of this contract signed by the Client. 

Remaining Balance: Due by the 36th week of the Client's pregnancy. If remaining balance is not paid within the 36-week mark (7 days within the 36th and 37th week date), a late fee of $25 per day will be charged to the Client's account.  If remaining balance is not paid within 10 days of the 36-week mark, an invoice will be sent to the Client requesting for payment in full, effective immediately, and is subject to collections admission, if prior arrangements have not been made.

In the event of birth doula support falling on a major Holiday (Easter, Independence Day, Thanksgiving Day, Christmas Eve/Day), I will charge $300 extra for Holiday Pay support.

Liability

In entering a contract for Doula (Labor Support) Services with Rhiannon Browning, I/We hereby acknowledge that during the performance period of this contract, services may be provided to me/us in my/our home, traveling to a medical facility, and/or hospital. I/We understand that Rhiannon Browning has a limited role pursuant to the description of tasks outlined in the above-referenced contract wherever services are provided to me/us. 

Rhiannon Browning has not represented to me/us that contracting for services guarantees in any way a risk-free or emergency-free labor and birth experience. I/We understand that my/our doula(s) does not make medical decisions on my/our behalf, to include the decision when to seek medical care at a hospital when labor support services are provided in my/our home. When services are performed in a medical facility, I/we acknowledge that Rhiannon Browning is not responsible for the performance of clinical tasks to include medical decisions regarding the inclusion or exclusion of treatments available to me/us and my/our baby.

Now, therefore, in consideration of the above acknowledgements, I/we (both jointly and separately) on behalf of myself, ourselves, my/our heirs, administrators, personal representatives, executors, and assigns to RELEASE AND FOREVER DISCHARGE Rhiannon Browning from all damages or causes of actions, either at law or in equity, which I/we may have or acquire or which may accrue to me/us, my/our heirs, administrators, personal representatives, executors or assigns as a result of using the doula services of Rhiannon Browning. I/We intend this to be a COMPLETE RELEASE AND DISCHARGE them from all liability whatsoever.

I/We have read all statements contained herein and I/we fully realize that I/we are signing a COMPLETE RELEASE AND BAR to any claims which I/we have or believe I/we have resulted from our contract for doula services.

We have agreed to a fee in the amount of: $1200

I/We have read this contract describing the doula’s services and agree to enter into a client-doula relationship for pregnancy and birth.

PREGNANT PERSONS SIGNATURE: X X X X X X X X X X X X

DATE: X X / X X / X X X X

PARTNERS SIGNATURE: X X X X X X X X X X X X

DATE: X X / X X / X X X X

DOULA SIGNATURE: X X X X X X X X X X X X

DATE: X X / X X / X X X X