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

First & Last Name
Email
Phone Number
Address

Where do you plan to deliver?

Who is your OB/GYN or CNM?

What is your due date?

Which doula do you request? If you are participating in the Group Doula option, please enter 'Group'

Consent

Services to Be Provided by the Doula

During Pregnancy

  • Clients will have individual prenatal visits with a doula to discuss personal questions and concerns and review your birth plan. 
  • Clients choosing the private doula program will have two prenatal visits, and group clients will receive one 30-minute prenatal visit.
  • Clients participating in the private doula program can also reach out to the doula via text, email, or phone with questions, concerns, or updates during pregnancy. Group clients with questions or concerns can call the answering service to request a call-back from a doula.
During Labor
  • If you are participating in the private doula program, your selected doula is on call 24 hours a day beginning 3 weeks prior to your due date. If you are participating in the group doula program, the doulas share a call schedule and are each on-call for 24 hours at a time. You will contact the answering service when your labor begins, and they will have the on-call doula call you back.
  • In the event a doula has been with a mama for over 24 hours, is ill, or has an unexpected emergency, the doula may call a backup doula to be with the client in order 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 provide support in the event of a cesarean birth.

Postpartum Visit
  • Clients will receive a postpartum visit from a doula about 5 days after delivery. You will have the chance to talk to the doula about the birth, sleep, feeding, and any other questions, concerns, or worries.
Services 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 or the answering service by telephone when she thinks she is in labor. The client must telephone the doula again once she has been assessed, admitted, and a determination has been made that she is in active labor.

Fees
  • The fee for the private doula services described in this agreement is 1,200 dollars. The fee for the group doula services described in this agreement is 750 dollars. The fee must be paid to The Birth Center and is non-refundable, other than as described below.
  • The fee is only refundable if the client contacts The Birth Center and cancels this agreement before the first prenatal appointment.
  • Once the initial prenatal visit has taken place, the client may receive a 50% refund if the 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's doula 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.