BIRTH DOULA CONTRACT OF SERVICES AND LIABILITY RELEASE
As a birth doula, I (Lindsay Dougal Doula Services) provide emotional, physical, and educational support to a woman and her partner and/or family members during her labor and delivery. I may facilitate communication with your care provider to ensure you have the information necessary to make informed decisions regarding your baby’s birth. I will provide reassurance and perspective to you and your partner and/or other family members, help with relaxation, massage, positioning and other techniques for your comfort, and make other suggestions for labor progress. I will make every reasonable effort to maintain a calm and peaceful birthing environment. I am independent and self-employed, which means I’m working for YOU, not your caregiver or place of birth. P R E  L A B O R I will meet with you and your partner or other support person at least once (preferably twice) to become acquainted and discuss your priorities, fears, concerns, etc. for your birth. We may also discuss evidence-based information on the risks and benefits of common interventions and procedures used during childbirth, your birth plan, and how we might best work together. From the time the contract is signed, I will be available to you 24 hours a day, 7 days a week via phone, text message, and email for any questions or concerns that arise throughout your pregnancy. I will be on call for your birth beginning two weeks (14 days) before your due date until baby’s birth. If you go into labor outside of this timeframe, I will make every reasonable effort to attend your birth. Upon request, I can also consult with you on the creation of your birth plan based on your wants and needs. I will bring a copy of your birth plan with me to your planned place of birth. DURING LABOR When you feel as though you are in labor, please contact me early via phone call, even if you do not need me immediately. This allows me the time to clear my calendar and make the personal arrangements necessary for me to attend your birth. I can answer any questions and make suggestions over the phone and we can decide if I should attend to you then, or wait for further change. Please remember, you/your support person will ultimately make the decision as to when you would like me to attend to you and notify me of that decision. Please keep in mind I will need approximately 2 hours to travel to your place of birth. I will remain with you throughout the duration of your labor. I will make suggestions of comfort measures – positioning, massage, relaxation, breathing, etc. – it is up to you what you do/do not do. Depending on the length of your labor, I may request short restroom and/or meal breaks. These will be taken at appropriate moments as suggested by you and as long as there is another support person in the room (i.e. partner, family member, nurse, care provider, etc.). In the unfortunate and unlikely event I am unable to attend your birth, a back-up doula will attend in my place. You will be able to meet with and talk to this doula beforehand. POST BIRTH I will remain with you for approximately 1-2 hours immediately after the birth, until you are settled and ready for quiet family time. During this time, I may assist with initial breastfeeding (if doing) and answer any questions you may have. During the week or two (7-14 days) following your birth, I will contact you to schedule a follow-up meeting to provide any additional support and review your birth. At that time, I may also ask for any feedback on my role during your birth and answer any additional questions you may still have. Services terminate six weeks after the birth of your baby and any unfulfilled terms of this contract will be deemed complete at that time. LIMITATION OF SERVICES AS A DOULA, I DO NOT: Perform any clinical tasks (i.e. taking blood pressure, fetal heart checks, vaginal exams, etc.) Make decisions for you Speak to medical staff or providers on your behalf Provide medical advice Attend planned unassisted (absence of midwife or other care provider) homebirth AS A DOULA, I DO: Provide physical and emotional support for you and your support person Assist you in getting the information you need to make informed decisions Discuss any concerns you have with you and your support person, and encourage you to voice your opinions, questions, and concerns to the staff on your own behalf Remind you of your birth plan and preferences and support any changes Direct you to resources that might help you answer any medical questions you may have and make informed decisions on your own. Any questions you have about your care or the care of your baby should be directed to your medical care provider EXTENUATING CIRCUMSTANCES 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 the hospital and/or medical provider’s policies), as well as immediately after to help with your comfort and breastfeeding (if doing). My full fee would apply. If you and your doctor decide a planned (scheduled) cesarean is necessary, I will provide support before, during (as allowed by the hospital and/or medical provider’s policies), as well as immediately after the surgery to help with your comfort and breastfeeding (if doing). My full fee would apply. If you are having a home birth and require a transfer to the hospital, I will accompany you and continue to provide doula support there. I cannot, under any circumstances, attend a planned homebirth without a midwife or other care provider present. In the event of a precipitous birth in a location other than your planned birthplace (i.e. home, vehicle) when a care provider is not present, I will provide only emotional and physical support as outlined above. FAILURE TO PROVIDE SERVICES Circumstances outside of my control that result in my inability to attend your birth will be addressed on a case-by-case basis and may/may not, result in a partial or full refund. I will make every effort to attend your birth and fulfill the obligations of this contract; however, in the event of unforeseen events — such as rapid labor, failure to call, or a cesarean section — I may not be able to attend your birth. If failure to attend the birth is due to unforeseen circumstances, payment for my services will not be returned and any outstanding fees for this contract will be owed. If I am unable to attend your birth due to my own error, I will either find a replacement doula, or refund all fees with exception of the retainer fee. CANCELATIONS AND REFUNDS In the event you decide against me attending your birth after signing this contract, you will forfeit the deposit and be responsible for any outstanding fees owed under this contract. FEES The following are fees associated with services described above and the schedule by which they should be paid: _$400_ : (50%) non-refundable retainer fee, due upon signing of contract. This is the only way services are secured and recorded on my calendar. _$400_: (50%) Remaining balance due first day of 36th week of pregnancy (four weeks before due date). I accept cash, Venmo, or PayPal payments. There is also an option to pay via credit card through my website. FSA/HSA Accounts: I can provide proper documentation for you to submit to your carrier for reimbursement. More information available upon request. LIABILITY In entering a contract for doula (labor support) services with Lindsay Dougal Doula Services, 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 Lindsay Dougal Doula Services has a limited role pursuant to the description of tasks outlined in the above-referenced contract wherever services are provided to me/us. Lindsay Dougal Doula Services 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 Lindsay Dougal Doula Services 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 Lindsay Dougal Doula Services 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 Lindsay Dougal Doula Services. 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 resulting from our contract for doula services.
PHOTO RELEASE *
Lindsay Dougal, Doula may use images and/or stories from my birth for marketing purposes (including, but not limited to website, social media, printed materials, etc.).
NAME *
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By typing my name below, I acknowledge I have read and agree to the terms listed in this contract. (At the first prenatal appointment, this document will be signed by each individual)