Services and Liability Agreement
The following agreement is hereby entered into between CHRISTIE DONN, MODERN MOTHER GODDESS LLC, referred to as “I,” and the client named and signed on this form, referred to as “you,” with the following conditions understood and accepted by both parties.
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As a birth doula, I provide emotional and physical support to a birthing person and their partner and/or family during their labor and delivery. I can also facilitate communication with your care provider to ensure that you have the information you need to make informed decisions regarding your baby’s birth. I can provide reassurance and perspective to you and your partner, make suggestions for labor progress, and help with relaxation, massage, positioning and other techniques for your comfort. I am independent and self-employed, and so, I am working for YOU, not your caregiver or place of birth, nor any other agency or organization.
Before Birth:
I will meet with you (and your partner, if applicable) before labor to become acquainted with you; 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 can also help you write a birth plan based on your needs/wants as communicated to me. I will bring a copy of your birth plan with me to your planned birth place. I will also inform you of times when I am unavailable for labor support. We may also decide on other meetings and will remain in touch by telephone, text, and/or e-mail communication. 
During Labor:
I ask that you call me when you think you are in labor, even if you do not yet need me. This gives me time to clear my calendar for the next 24 hours. I can answer questions and make suggestions over the phone, and we can decide together when is the best time for me to come. I can meet you at your home or your planned place of birth. Once you call me and let me know you’d like me to begin supporting you, I will make every effort to be there within two (2) hours. Except for extraordinary circumstances, I will remain with you throughout your labor and birth. 
After Birth:
Circumstances permitting, I will remain with you for one to two hours after the birth, or until you feel comfortable with my departure. I will be available via phone, text, and/or email during the initial postpartum period to answer questions about the birth or your baby. I will schedule a postpartum meeting within a few days of the birth to visit you and the baby at your home. During the postnatal visit we will review the birth, postpartum care for yourself, basic baby care tips (including breastfeeding/chestfeeding if applicable,) referrals for community resources, as well as get feedback from you about my role. 
Communications:
All non-emergent questions can be communicated via text and/or email and will be responded to within 24 hours of my dedicated office hours, Monday-Friday 10am-2pm EST. With all the technology available to us today, I adhere to these guidelines for communications.
  • Text messaging is an acceptable form of communication in non-emergent situations. You may want to tell me you lost your mucus plug, or you tested negative for GBS, etc. I always welcome exciting updates in the form of text messaging! 
  • Once labor has started, I ask that you please give me a phone call so that I can offer support and make assessments via telephone. Together we can decide when the right time for me to physically join you in labor is.
  • Between the hours of 8:00pm-8:00am EST, text messaging is NOT a reliable form of communication. Please be sure to pick up the phone and call me for emergent needs between these hours.
  • Facebook/Instagram messaging and comments are NOT a reliable form of emergent communications. 
On Call:

I am available for text, phone, and/or email consultations immediately from the date that this service contract is signed and returned to me, and payment for services has been confirmed. It is important that we keep in contact with one another and communicate effectively throughout the duration of services, so please try to keep me updated on things discussed by your health professionals during your prenatal appointments regarding your pregnancy. 

I will consider myself “on call” for you starting at 38 weeks of pregnancy. At this time, I will remain within two hours of your home and/or planned birthing location, and will be available for you by phone at all times. You will also be given my direct phone number at this time. If for any reason I do not answer when you call please hang up and repeat the call. If I do not answer the second time please leave a message and I will return your call as soon as is practicable. 

Limitation of Services:

As a certified birth doula, and proud member of DONA International, I abide by the Standards of Practice and Code of Ethics of DONA International. 


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, medical staff, and care providers.
  2. Make decisions for you. I will help you get the information you need to make an informed decision.
  3. Speak to medical staff or providers on your behalf. I will discuss your concerns with you and suggest options, as well as encourage you (and your partner if applicable,) to voice your opinions, questions and concerns to the staff. 
  4. Provide medical advice. I can direct you to resources that might help you answer your questions and make informed decisions on your own. If you have questions or want advice about your care or that of your baby, you should contact your care provider.

Childbirth Education:
It is highly recommended that you participate in a childbirth preparation class. I cannot adequately explain the entire scope of the physiology and process of labor and birth, hospital/birthing center/homebirth procedures, medical interventions, comfort measures, coping techniques, newborn care, etc., in two prenatal appointments. Therefore it is highly recommended that the client seek out this information and be as informed as possible and prepare for their birth. I can provide a list of resources for you upon request. 
Extenuating Labor Circumstances:

Even with the best birth plan, childbirth does not always go according to plan. My full fee still applies. 

In the event of an induction, I can provide early in-person support at the hospital once you are admitted, if requested. Since inductions can sometimes take days, I will leave the hospital once you are settled and comfortable and continue to be on call. I will then return to the hospital as labor progresses within two (2) hours, upon request from you. 

In the event of a cesarean section (C-Section) birth, I will continue to provide support through the entire process if your chosen hospital allows it. If your hospital will not allow me to be in the Operating Room with you, I will help you prepare emotionally and mentally for surgery and remind you and your health care team of your preferences for surgery. I will remain in the hospital and then meet you in recovery after the operation to help initiate breastfeeding/chestfeeding if chosen, bonding, and to make sure you are comfortable. 

I can also make myself available to your partner for support, if requested. This is the same for both scheduled and unexpected cesarean births. 

If you are having a birth center or home birth and need to be transferred to the hospital, I will follow you separately and continue to provide doula support there, as permitted by hospital policy. 

I cannot under any circumstances attend a planned home birth without a licensed midwife or other care provider present. 

In the event of a precipitous birth in a location other than your planned birth place (such as at home or in a vehicle) when a care provider is not present, I will provide only emotional and mental support as outlined above.

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, and a backup doula is not available, I will offer additional postpartum services in lieu of monetary reimbursement. If my failure to attend your birth is due to an error on your part (failing to call me, for example) I will retain the full amount paid and continue my services to completion as outlined in our agreement. If I am not allowed to your birth due to hospital/provider policies, I will offer additional postpartum services in lieu of monetary reimbursement. If my failure to attend your birth is due to a rapid labor (baby is born less than two hours after you call me and ask me to come), I will offer an additional postpartum visit for support at no additional cost once you leave the hospital or birth center. This can include assistance with breastfeeding/chestfeeding, laundry, cleaning, baby care, etc. My full fee applies. I reserve the right to call in a backup doula if labor lasts longer than twelve (12) hours, and/or in extreme circumstances such as personal emergencies, but will make every effort to remain with you through the entire duration. Any other circumstances out of my control (weather, traffic, act of god, hospital policy, etc.,) that result in my absence at your birth or your voluntary termination of this contract will not be refunded, however additional postpartum support may be offered in lieu of monetary value. 
Back-up Doula:
In the event that I cannot attend your birth, or need to leave during labor, I will make every effort to have a backup doula scheduled for our agreed upon fee. Their payment will come from the original payment to the primary doula at no extra charge to you. If the back up doula is unable to make it to your birth, and you are left unsupported, additional postpartum support may be offered in lieu of monetary value. 
Additional Services:
I am happy to create a custom doula package for you that includes any and all combinations of the services I provide. All packages must be agreed upon in writing by all parties. Additional services may be invoiced separately. 
Responsibilities of Client:
I request that you inform your care provider that you have hired a doula. I ask that you inform me of any pregnancy-related or other health complications or conditions you may have, as well as any other special circumstances you might have or require. I also ask that you keep me informed of what happens at your prenatal appointments from at least 36 weeks forward (if your cervix is dilated, any tests or procedures you might experience, anything your care provider seems concerned about, etc). Text, email, and phone are all fine for contact as described above. If for any reason you decide not to have me at your birth after you have signed this contract, I ask that you let me know as soon as possible. Cancellation of this agreement and any potential refunds associated will be handled on a case-by-case basis. 
Child Care:
Birth is a family event! Siblings are welcome and encouraged to attend the birth as permissible. If you choose to have your older children take part there must be a dedicated adult available for each child to help them. My role as your birth doula is to support you and your partner.
Disclosure of Communicable Diseases:
You agree to disclose any communicable diseases that you have so I can take appropriate precautions. In the event that any member of the household of the pregnant person is diagnosed with any communicable disease within 10 days of the onset of labor, I reserve the right to provide virtual labor support instead of in-person support. No alternate hours will be substituted for labor support and no refunds will be provided in such an event.
Fees:
The total amount owed is due at time of contract unless otherwise agreed upon in writing. You will receive an electronic invoice via email, which can be paid electronically. I also accept cash or certified cashier's checks and/or money orders made out to CHRISTIE DONN. I do not accept personal checks. If alternative means of payment, such as barter, sliding scale, or a payment plan are being used, they must be agreed upon in writing by you and I prior to the signing of this contract.  The fee must be paid in full no later that 36 weeks gestation.
Birth Doula Package: $1800

This package includes the following services from me, as outlined within this contract:

  • Two 1-hour prenatal visits, at least one in-home, to discuss your preferences and identify your unique needs to better prepare for your birth.

  • One 1-hour lactation preparation visit, including pump fitting, if requested.

  • One 1-hour virtual appointment to prepare your written birth plan and postpartum plan, if requested.

  • Unlimited phone/text/email support. 

  • 24/7 on-call availability for labor starting at 38 weeks of pregnancy.

  • Support at home and/or hospital throughout labor. 

  • Immediate postpartum support for approximately 2-3 hours after delivery.

  • Assistance initiating breastfeeding/chestfeeding if requested.  

  • One 1-hour in-home follow-up visit one week after delivery. *

  • One virtual appointment approximately 2 weeks postpartum to check in with you and your baby.

  • A follow-up call/text approximately 4 weeks postpartum to check in with you and your baby. 

* Your in-home postnatal appointment must be scheduled within 14 days of your birth or it will be considered void. Any appointments made after 14 days will be subject to a $75 per hour fee.

Release and Confidentiality:
You hereby give me permission to take notes about you and your birth, including personal information about yourself and your child(ren). This information may be shared with my certifying organizations as well as the backup doula. Signing this contract also gives me permission to discuss your pregnancy and birth with other birth professionals in both formal and informal settings. I will never use your name, your child’s name, the date you gave birth, or any other identifying information without your permission. A separate release of information and photographic release is provided.
Liability:

In entering a contract for Birth Doula (Pregnancy, Labor, and Postpartum Support) services with Christie Donn, Modern Mother Goddess LLC, I/we hereby acknowledge that during the performance period of this contract, services may be provided to me/us in my/our home, traveling to a medical facility, and/or hospital. I/We understand that Christie Donn has a limited role pursuant to the description of tasks outlined in the above-referenced contract wherever services are provided to me/us. 


Christie Donn, Modern Mother Goddess LLC, has not represented to me/us that contracting for services guarantees in any way a risk-free or emergency-free labor and birth experience. I/We understand that my/our doula(s) does not make medical decisions on my/our behalf, to include the decision when to seek medical care at a hospital when labor support services are provided in my/our home. 

When services are performed in a medical facility, I/we acknowledge that Christie Donn, Modern Mother Goddess LLC, is not responsible for the performance of clinical tasks to include medical decisions regarding the inclusion or exclusion of treatments available to me/us and my/our baby.


Now, therefore, in consideration of the above acknowledgements, I/we (both jointly and separately) on behalf of myself, ourselves, my/our heirs, administrators, personal representatives, executors, and assigns, to RELEASE AND FOREVER DISCHARGE Christie Donn, Modern Mother Goddess LLC, from all damages or causes of actions, either at law or in equity, which I/we may have or acquire or which may accrue to me/us, my/our heirs, administrators, personal representatives, executors, and/or assigns, as a result of using the doula services of Christie Donn, Modern Mother Goddess LLC. I/We intend this to be a COMPLETE RELEASE AND DISCHARGE them from all liability whatsoever.


I/We have read all statements contained herein and I/we fully realize that I/we are signing a COMPLETE RELEASE AND BAR to any claims which I/we have or believe I/we have resulted from our contract for doula services.

Addendums:
If we have previously agreed upon any changes or addendums to this contract, including but not limited to additional services or changes to the services outlined above, they will be submitted and signed on a separate form. 
I/We have read this contract describing the doula’s services and agree to enter into a client-doula relationship for pregnancy and birth.
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Birthing Person's First and Last Name
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Birthing Person's Email
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Estimated Due Date
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Partner's First and Last Name (if applicable)
Partner's Email (if applicable)
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