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Labor Doula Contract

I, the expectant mother, along with my birth partner (if applicable) have chosen the services of Robin Serwatka and A Better Birth LLC as my doula to support me/us through labor and my early postpartum period. As such, we understand and agree that the services I/we receive will include:
 

  • Three prenatal visits to discuss any birth related question, including pain coping techniques, prior to delivery.

  • Continuous labor support as outlined below.

  • One 1-hour postpartum visit to discuss breastfeeding, newborn care, and general well-being of mother and baby.

I (we) also understand the following  15 stipulations as enumerated below:

1. I (we) understand that my doula will meet me at either my home or place of birth depending on her judgement from talking to me and/or my partner over the telephone.
2. I (we) understand that it is my responsibility to contact my birth doula as soon as I suspect that labor has begun to ensure adequate time for travel to my place of delivery.
3. I (we) understand that my doula will ONLY provide emotional support, and will guide and encourage me to cope with labor, using non-pharmacological methods.
4. I (we) understand that my doula cannot and will not provide medical advice or perform medical procedures. My doula is NOT responsible for medical management of my pregnancy, labor, or postpartum period, the outcome or any complications thereof.
5. I (we) understand that it is NOT my doula’s role to make decisions on my behalf, speak directly to the medical staff, or intercept any medical procedures. She will discuss the situation(s) with me, provide information if necessary and summarize all options being presented by the medical birth team. Ultimately, my partner and I are responsible to direct my medical care

6. I (we) understand that labor is unpredictable, and as such, no guarantee can be made for availability of your doula. Due to another laboring mother, illness, or other unforeseen circumstances, your doula may be unavailable. If this occurs, a back-up doula will be called to attend your birth.
7. I (we) understand that labors can be long. In the event that my labor exceeds 12 hours, a backup doula can be called to provide relief for your doula at no additional cost to you.
8. I (we) understand that I will be provided the contact information for a backup doula during my 37th week of pregnancy. I will ONLY contact the backup doula in the event that proper protocol has been followed to contact Robin Serwatka: 

  • Between the hours of 7am and 10pm, text Robin at 773-699-6300.

  • If you have not received an answer within 10 minutes, call Robin at 773-699-6300.

  • Between the hours of 10pm and 7am, CALL - DO NOT TEXT - Robin at 773-699-6300

  • If there is no answer, you may call her husband, Paul, at 312-388-8000.

  • If you have not heard back from Robin after a 10 minute grace period, please reach out to your backup doula.

 

9. I (we) have agreed to pay my doula the amount of $975 for services described above. I understand that a $300 non-refundable deposit is required upon execution of this contract. Payment can be made via personal check, cash, or paypal (Robin@ABetterBirth.Life). A second payment of $300 is due midway between your initial consultation and your estimated due date. This is March 1, 2019.

10. I understand that the remainder of my balance is due the day of delivery.
11. I understand that labor and delivery is a physically strenuous activity. As such, I can purchase Fit to Deliver classes/consultation to physically prepare my body at a cost of $50 per one hour session, or at a package price as agreed upon.
12. I understand that by signing this contract, I am retaining my doula. To do so, my doula may have declined other clients. I understand that I will not be refunded, in whole or partially, any fees paid if I/we fail to:

  • Keep my prenatal or postpartum appointment(s)

  • A cesarean becomes necessary

  • Preterm induction becomes necessary

  • I fail to contact my doula once labor has begun, or

  • I/we simply change our mind
     

13. I (we) understand if, for any reason, my doula terminates services or my doula and backup doula fail to attend the birth, the deposit shall be returned excluding extra services purchased, such as Fit to Deliver. If my doula or backup doula does not attend my birth due to extenuating circumstances, such as but not limited to natural disaster, my deposit will not be returned.
14. I (we) release Robin Serwatka, A Better Birth LLC, and all backup doulas from any and all liability arising from any aspects of my, or my baby’s medical care, or treatment provided by my chosen health care professionals during my pregnancy, birth, and/or postpartum period.
15. I give A Better Birth LLC permission to post photos/comments on social media and ABetterBirth.life, providing they are modest and respectful of our birth. I will be shown all photos to be posted, and give verbal permission for them to be posted.
OR
15a. I do not wish for photos or comments to be posted to any print or digital sites.

By inputting my electronic signature below, I acknowledge that I have have read, and understand, each of the 15 stipulations as enumerated above. 

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Birth Doula Intake Form
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