DOULA CLIENT AGREEMENT—LABOR AND BIRTH

THIS AGREEMENT is made and entered into on the                day of                            , 20         , by and between FULLMOONMAMA a CT limited

 

liability company, hereinafter referred to as the “Doula” or “I,” and                                                                                       , hereinafter referred

 

to as the “Client” or “you.”

 

This is an agreement with FULLMOONMAMA, a CT limited liability company. This agreement is not with LAUREN GOMOLA personally.

 

     1. Scope of Services

As your Doula, I accompany you in labor to help ensure a safe and satisfying birth experience. I will assist you emotionally, physically, and mentally.

During pregnancy, I will visit with you during two prenatal visits at your home (or the location of your choice) to discuss your pregnancy, your thoughts and preferences about the birth, your gynecologic history, your knowledge of the birth process and choices in childbirth, your birth plan (if desired), labor positioning, pain-coping techniques, the role of your spouse/partner and others attending the birth, any questions or concerns you are having, and how we can best work together. At your request, I can provide educational information, resources, and referrals; and I am available from point of hire until birth for phone and email consultations.

During labor and birth, I will accompany you in labor to provide physical, emotional, and educational support for a more satisfying birth experience, and can provide early labor support in your home (if desired). I will help you manage labor discomfort with methods such as positioning, massage, rebozo methods, acupressure, relaxation, breathing, and visualizations; and will provide relief for your spouse/partner. I will also remind you about nutrition, hydration and urination, and if a certain decision departs from your birth plan or desires as expressed to me. Upon request, I can provide photography services (if desired), as long as it does not interrupt my performing the doula services under this agreement. Any and all photos taken by me are your property and will be provided to you within a reasonable time after the birth.

After birth (postpartum), I will remain with you for up to two hours after the birth to ensure you are settled and comfortable. I can help you initiate breastfeeding (if desired). I will visit you at your home (or the location of your choice) for one postpartum visit to discuss the birth, answer any questions you have, and provide breastfeeding support.

At all times, I work for you—not your physician, midwife, hospital, or birth center; and I provide information and support to you to help you make informed medical decisions.

 

I do not provide the following services: I am not a medical provider. I do not give you medical advice. I do not perform clinical tasks such as blood pressure checks or vaginal exams. I do not diagnose medical conditions. I do not make medical decisions. I do not speak to providers on your behalf. I do not transport you to or from the hospital or birth center. I do not promise or guarantee a risk-free or emergency-free birth. I am not liable for the outcome of the birth.

 

     2. Duties and Responsibilities of Client

You agree to:

  • Inform your doctor or midwife that I have been hired.

  • Become familiar with the birth center or hospital.

  • Keep me apprised of midwife/doctor visits after 36 weeks.

  • Clearly communicate your preferences and choices to me.

  • Consider attending a childbirth preparation class and a breastfeeding class of your choice prior to birth (for first baby clients only).

  • Notify me if you choose a specific back-up doula.

  • Contact me as soon as you think you might be in labor, even if you do not need doula support yet.

  • Know your provider’s recommendation as to when during labor it is appropriate to go to the birthing facility (example: when your contractions are 3 minutes apart, 1 minute long, for 1 hour).

  • In the case of a surgical birth, request permission from hospital staff for me to accompany you into the operating room (if desired) and to remain with you before, during, and after the birth (if desired).

  • Refrain from sharing my resources/handouts with anyone unless you are given written permission.

  • Return all materials borrowed from my lending library.

  • Inform me if you have any communicable diseases.

You understand the following:

  • You ultimately make the decision as to when to leave home (if laboring at home) to go to the hospital or birth center. While I can answer questions and provide input, you are responsible for deciding when to leave.

  • If your baby arrives unexpectedly while at home with me present, you or your spouse/partner is responsible for delivery of your baby. After the birth, I can help you arrange transport to the hospital (if desired).

     

     3. On-Call

Beginning three weeks before your estimated due date, I will be on call. During this time, you can reach me at 203-209-5135, 24 hours a day, 7 days a week.  If I do not pick up the phone right away, leave me a message, and I will get back with you in a timely manner. During this time, I will not leave CT unless it is an emergency or for an event disclosed at the time this agreement is signed.

When you call at the earliest sign of labor and are ready for doula support, I will meet you within two hours of the call at the location of your choice unless I am assisting another client. In that case, I will notify the back-up doula immediately and will provide you with her contact information.

     4. Back-Up Doula

You understand that a back-up doula may attend your birth in my place, due to either circumstances beyond my control or because I am assisting another client at the time services are to be rendered to you. At the time you first call when you believe you are in labor, I will inform you if I am assisting another client. If my back-up doula must render services in my place, she will be available to you under the same terms as I would be under this agreement.

In the event your labor exceeds 24 hours, I may call in my back-up doula to care for you while I take a break.

You have the option of meeting my back-up doula in advance if you desire. You also have the option of specifying who you prefer the back-up doula to be; if you chose a specific back-up doula, her name and contact information is provided in Section 3 above.

     5. Cesarean Birth

If you have a cesarean birth, either scheduled or emergency, the fee remains the same. I will stay and offer as much support as the medical staff will allow. It is up to you to secure my place in the operating room (if you desire). If the cesarean birth is scheduled, I will meet you at the hospital at a mutually agreed-upon time. I will accompany you in the operating room (if allowed by medical staff) and remain with you during recovery. If for some reason I am not allowed in the operating room, I will join you after the cesarean birth and assist with initiating breastfeeding (if desired).

     6. Fee

My fee for the doula services to be provided is $600 total. You may pay by cash, check, Venmo or PayPal. A non-refundable retainer of $120 is required at the time this agreement is signed by you. The balance is due at 37 weeks (i.e., 3 weeks prior to your estimated due date).

     7. Refund; Terminating the Agreement

You have the right to terminate this agreement at any time. Payment made under this agreement is subject to the following terms regarding refunds:

Retainers are nonrefundable.

Refunds are not provided under the following circumstances: You choose not to have me provide the doula services after signing the agreement; you do not contact me in a timely manner to allow me to provide the doula services; you have a precipitous birth (i.e., two hours or less from the time you request that I join you) that does not allow me sufficient time to attend the birth; and acts beyond either party’s control (such as a snowstorm or flood).

Your fee will be refunded in full if either I or my back-up doula are unable to provide services due to circumstances within our control.  Refunds will be issued within 30 days.

 

     8. Certification

I will maintain appropriate doula certification throughout the life of this agreement.

     9. Grievance Policy; Mediation

I always strive to meet or exceed your expectations. If for any reason you are unsatisfied, I encourage you to communicate with me directly so that I may rectify the situation. You may also file a grievance with Stillbirthday and/or Bebo Mia if for any reason you want to speak privately with another doula regarding your concerns. Stillbirthday and/or Bebo Mia will do their best to assist you with your concerns and, if necessary, will contact me so that I may have the opportunity to offer a solution. If you are ever unsatisfied with how a grievance is handled, you may elect to solve the disagreement through mediation with a third-party mediator.

 

     10. Release from Liability

You understand that I have a limited role pursuant to the description of services outlined above. You acknowledge and agree that I have not represented to you that contracting for my services guarantees in any way a risk-free or emergency-free labor and birth and/or postpartum experience. You acknowledge and understand that neither I nor the back-up doula (if applicable) make medical or nursing decisions on your behalf, including but not limited to the decision when to seek medical care at a hospital when labor and birth and/or postpartum support services are provided in your home. When services are performed in a medical facility, you acknowledge and agree that I am not responsible for the performance of clinical tasks including but not limited to medical or nursing decisions regarding the inclusion or exclusion of treatments available to you and your baby.

Now, therefore, in consideration of the above acknowledgements, you (both jointly and  separately), on behalf of yourself, yourselves, and your heirs, administrators, personal representatives, executors, and assigns RELEASE AND FOREVER DISCHARGE me and the back-up doula from all damages or causes of actions, either at law or in equity, which you may have or acquire or which may accrue to you or your heirs, administrators, personal representatives, executors, or assigns as a result of using the doula services under the agreement. You intend this to be a COMPLETE RELEASE AND DISCHARGE as to me and the back-up doula from any and all liability whatsoever.

You acknowledge and agree you have read all statements contained herein and you fully realize that you are signing a COMPLETE RELEASE AND BAR to any claims which you have or believe you have resulting from our agreement for doula services.

     11. Miscellaneous

This agreement constitutes the entire agreement between the parties relating to this subject matter and supersedes all prior or simultaneous representations, discussions, negotiations, and agreements, whether written or oral.

This agreement may be amended or modified only by written agreement of all parties, which shall include handwritten changes to the document in the presence of all parties as long as the handwritten change is initialed by all parties.

This agreement shall be construed in accordance with the laws of the State of CT and the parties hereto agree that venue shall be in Fairfield County, CT.

If any dispute arises between the parties with respect to the matters covered by this Agreement which leads to a proceeding to resolve such dispute, the prevailing party in such proceeding shall be entitled to receive its reasonable attorney fees, expert witness fees, and out‑of‑pocket costs incurred in connection with such proceeding, in addition to any other relief to which it may be entitled.

IN WITNESS WHEREOF, the parties have executed this agreement on date written above.

     12. COVID-19

 

If you, your partner, or myself become infected with Covid-19 all doula services will be virtual (including labor support) until the infected person is deemed no longer contagious by a healthcare professional and has proof of a negative Covid-19 test.

*Note: Refunds will not be given due to Covid-19 in any circumstance, whether by infection or hospital restrictions. However, there are options and flexibility on how I can best support you. This would be handled on a case-by-case basis.

Your Signature

Partner's signiture (If applicable)

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