Doula Info

To register for our Doula Program, please complete the following questions:

First & Last Name
Your Email
Where do you plan to deliver?
Who is your OB/GYN or CNM?
What is your due date?
Which doula do you request?

Consent


I have indicated that I would like to participate in The Birth Center’s Doula Program. This Labor Support Doula Agreement sets forth the services that The Birth Center Doula (“Doula”) will provide, as well as your responsibilities as a Client.


Services to Be Provided By the Doula 


During Pregnancy


Clients will have one to two prenatal visits with the doula. This is individual time spent with a doula to discuss personal questions and concerns and discuss or review your birth plan. One is required, the second is optional. Clients also have the ability to reach out to the doula via text, email, or phone with questions, concerns, or updates during pregnancy.


During Labor




  • The doula is on call 24 hours a day beginning 3 weeks prior to your due date.  




  • In the event a doula has been with a mama for over 24 hrs, illness, or an unexpected emergency for the doula, there is potential the doula may call a backup doula to be with the client in an effort to be able to continue to provide the best support possible to the mother.  




  • When you are in active labor, the doula will meet you where you are planning to deliver. The doula will be with you throughout your labor, delivery, and one to two hours postpartum.




  • The doula will also continue to provide support in the event of a cesarean birth.




Postpartum Visit




  • Clients will also receive a postpartum visit from a doula about 5 days after delivery. You will have the chance to talk to the doulas about your birth, sleep, feeding, and any other questions, concerns, or worries.




Services that the Doula Does Not Provide




  • The Doula will not perform any clinical or medical tasks or procedures.




  • The Doula will not make decisions for the Client.




  • The Doula will discuss the Client’s birth preferences with her, but she cannot guarantee that the birth will go as planned.




Obligations of Client




  • The Client must inform her midwife/physician or nurse that a Doula will be present during labor.




  • The Client must contact the Doula by telephone when she thinks she is in labor. The Client must telephone the Doula again once she has been admitted, assessed, and a determination has been made that she is in active labor.




Fees




  • The fee for the services described in this Agreement is $1200. This fee must be paid to The Birth Center and is non-refundable, other than as described below.




  • The $1200 fee is only refundable if the Client contacts The Birth Center and cancels this Agreement before the first prenatal appointment.




  • Once the initial one hour consultation has taken place, the Client may receive a refund of 50% in the following circumstance:




    • Client contacts The Birth Center and cancels this Agreement no later than four weeks prior to her due date and has not yet delivered. Cancellation later than four weeks prior to delivery is non-refundable.






Confidentiality


By joining the program, you agree to give permission to The Birth Center Doulas, to take notes about you, including personal information you choose to disclose, and information regarding your labor, birth and postpartum, as well as any information regarding your child/ren. This information will be charted in a system shared with the doulas providing services through the Birth Center Program.


By stating "yes" I indicate that I have read and understand the above information, I want to hire a Doula to perform the services described herein, and I will comply with the terms and conditions set forth in this Agreement.