Letter of Agreement Describing Doula Labor Support
Services, Limits and Fees
Jill C. Wilkey L.D.
What do I do as a Doula?
As a doula, I accompany women in labor to help ensure a safe and satisfying birth experience. I draw on my knowledge and experience as a doula and mother to provide emotional support, physical comfort and, as needed, communication with other caregivers to make sure that you have the information you need to make informed decisions as they arise in labor. I can provide reassurance and perspective to you and your partner (if present), make suggestions for labor progress, and help with relaxation, massage, positioning and other techniques for comfort. I am independent and self-employed. As your doula, I am working for you, not your caregiver or hospital.
Before Labor: I will meet with you and your partner at least once (preferably twice) before labor to become acquainted with you; explore and 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. To cover those times, I will arrange one or more qualified back-up doulas whom you may also meet. We may also decide on other meetings, and will remain in touch by telephone and/or e-mail communication.
During Labor : Please call me when you think you are in labor, even if you are not sure. I can answer questions and make suggestions over the phone. We will decide if I should come right over then or wait for further changes. I usually need approximately one to two hours to get to you from the time you ask me to come. Except for extraordinary circumstances, I will remain with you throughout your labor and birth.
After the Birth: I usually remain with you for one or two hours after the birth, until you are comfortable and your family is ready for quiet time together. I can also help with initial breastfeeding. I am available to answer questions about the birth or your baby, and I will schedule a follow-up meeting within a few weeks of the birth to visit you and admire your baby, review the birth, and get feedback from you about my role.
Limitation of Services : 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 and the staff. 2. Make decisions for you. I will help you get the information you need to make an informed decision. I will also remind you if there is a departure from your birth plan. 3. Speak to the staff on your behalf. I will discuss your concerns with you and suggest options, as well as encourage you to voice your opinions, questions, and concerns to the staff.
In the event of a rapid labor or emergency situation, I will call 911. In the event of an emergency delivery I will do what measures I am capable of to try to keep you and the baby safe and comfortable until EMS arrives. This will fall under The Good Samaritan Law.
Scheduled Cesarean Clause: Occasionally a woman will have something arise during her pregnancy that necessitates a scheduled Cesarean birth. If this decision is made two weeks or more before your due date, you may choose to cancel my services with no further payment owed beyond the deposit. Alternatively, you may choose to have me come with you to the hospital, accompany you during surgery or wait in the recovery room, and assist you with breastfeeding and adjustment in the first hours after your birth. An extra postpartum visit can also be scheduled at no further charge. In this instance my full fee will be payable.
Back-Up Support
In the event that I am unable to attend your birth due to illness or any other emergency, a back-up Doula will be provided. I will compensate the back-up Doula directly for attending your birth.
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 my error, there will be no charge for my services and I will refund the fee, minus the retainer. If my failure to attend your birth is due to an error on your part (failing to call me, for example) no refund will be given, and I will keep my full fee. 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 provide an additional 3 hours of postpartum support at no cost once you are discharged from the hospital. This can include assistance with breastfeeding, post-partum, baby care, etc. My full fee applies. Any other circumstances out of my control that result in my absence at your birth will be addressed on a case-by-case basis, and may or may not result in a partial or full refund.
Fees For the services described here, to be paid as follows:
$450 as a non-refundable retainer fee, due when you select me as your doula and sign this contract.
$450 due by the end of your 37th week. I hold this payment until after the birth of the baby. I will not discuss money while a new family is bonding after delivery. This way it is handled beforehand.
I/We have read this contract describing the doula’s services and agree to enter a client-doula relationship for the pregnancy and birth with a due date of ______________.
Client Name ________________________ Client Signature__________________________
Client Name ________________________ Client Signature__________________________
Doula Name ________________________ Doula Signature__________________________
Services, Limits and Fees
Jill C. Wilkey L.D.
What do I do as a Doula?
As a doula, I accompany women in labor to help ensure a safe and satisfying birth experience. I draw on my knowledge and experience as a doula and mother to provide emotional support, physical comfort and, as needed, communication with other caregivers to make sure that you have the information you need to make informed decisions as they arise in labor. I can provide reassurance and perspective to you and your partner (if present), make suggestions for labor progress, and help with relaxation, massage, positioning and other techniques for comfort. I am independent and self-employed. As your doula, I am working for you, not your caregiver or hospital.
Before Labor: I will meet with you and your partner at least once (preferably twice) before labor to become acquainted with you; explore and 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. To cover those times, I will arrange one or more qualified back-up doulas whom you may also meet. We may also decide on other meetings, and will remain in touch by telephone and/or e-mail communication.
During Labor : Please call me when you think you are in labor, even if you are not sure. I can answer questions and make suggestions over the phone. We will decide if I should come right over then or wait for further changes. I usually need approximately one to two hours to get to you from the time you ask me to come. Except for extraordinary circumstances, I will remain with you throughout your labor and birth.
After the Birth: I usually remain with you for one or two hours after the birth, until you are comfortable and your family is ready for quiet time together. I can also help with initial breastfeeding. I am available to answer questions about the birth or your baby, and I will schedule a follow-up meeting within a few weeks of the birth to visit you and admire your baby, review the birth, and get feedback from you about my role.
Limitation of Services : 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 and the staff. 2. Make decisions for you. I will help you get the information you need to make an informed decision. I will also remind you if there is a departure from your birth plan. 3. Speak to the staff on your behalf. I will discuss your concerns with you and suggest options, as well as encourage you to voice your opinions, questions, and concerns to the staff.
In the event of a rapid labor or emergency situation, I will call 911. In the event of an emergency delivery I will do what measures I am capable of to try to keep you and the baby safe and comfortable until EMS arrives. This will fall under The Good Samaritan Law.
Scheduled Cesarean Clause: Occasionally a woman will have something arise during her pregnancy that necessitates a scheduled Cesarean birth. If this decision is made two weeks or more before your due date, you may choose to cancel my services with no further payment owed beyond the deposit. Alternatively, you may choose to have me come with you to the hospital, accompany you during surgery or wait in the recovery room, and assist you with breastfeeding and adjustment in the first hours after your birth. An extra postpartum visit can also be scheduled at no further charge. In this instance my full fee will be payable.
Back-Up Support
In the event that I am unable to attend your birth due to illness or any other emergency, a back-up Doula will be provided. I will compensate the back-up Doula directly for attending your birth.
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 my error, there will be no charge for my services and I will refund the fee, minus the retainer. If my failure to attend your birth is due to an error on your part (failing to call me, for example) no refund will be given, and I will keep my full fee. 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 provide an additional 3 hours of postpartum support at no cost once you are discharged from the hospital. This can include assistance with breastfeeding, post-partum, baby care, etc. My full fee applies. Any other circumstances out of my control that result in my absence at your birth will be addressed on a case-by-case basis, and may or may not result in a partial or full refund.
Fees For the services described here, to be paid as follows:
$450 as a non-refundable retainer fee, due when you select me as your doula and sign this contract.
$450 due by the end of your 37th week. I hold this payment until after the birth of the baby. I will not discuss money while a new family is bonding after delivery. This way it is handled beforehand.
I/We have read this contract describing the doula’s services and agree to enter a client-doula relationship for the pregnancy and birth with a due date of ______________.
Client Name ________________________ Client Signature__________________________
Client Name ________________________ Client Signature__________________________
Doula Name ________________________ Doula Signature__________________________
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