Labor and Birth Support Contract
Client Information
Client’s Info:
Full Name: @Client Name 🏷️
Any Other Legal Names: @Client Details > Last Name 🏷️
Email: @ [___Text_box____] ✍️
Phone Number: @ [___Text_box____] ✍️
Estimated Due Date for your birth: @Baby > Due Date 🏷️
Partner’s Info:
Full Name: @Partner Name 🏷️
Email: @ [___Text_box____] ✍️
Phone Number: @ [___Text_box____] ✍️
Confidentiality Release
I, @Client Details > First Name 🏷️ , Give permission to, Abbey Barnosky of Voices of Eve, LLC, to take notes about me, my family, and my care including; personal information that I give to her regarding my pregnancy, labor, birth, breastfeeding, and or postpartum. I also give her permission to take notes regarding my child(ren). I understand that Abbey takes and keeps these records to help her care for me, my family, and future clients and that she will not disclose any of my information without my permission. I also give her permission to hold records about my care for future reference but will not share it with anyone.
I, @Client Details > First Name 🏷️ , give Abbey permission to share my information with her backup doula and photographer, Hannah Troyer of Mothering Memories Doula Services.
Fee Information
Package we Chose: @ [___Text_box____] ✍️
Discount we Qualified For: @ [___Text_box____] ✍️
Total Fee that Abbey quoted:@Service Fee 🏷️
@Client’s Initials ✍️ I/We understand that If Abbey is unable to deliver services to us because we fail to contact her the entire fee will still be due. Barring specific circumstances at Abbey’s discretion, depending on the circumstances some postpartum services hours may be offered in place of birth services.
@Client’s Initials ✍️ I/We understand that if I/We choose to cancel services at any point that 50% of the total fee is still due.
@Client’s Initials ✍️ I/we understand that in the event that Abbey is unable to deliver services to us because of an error on her part and her backups are unable to serve in her place, she will offer to exchange services to replace or offer a refund depending on the circumstances, and at Abbey’s discretion.
@Client’s Initials ✍️ I/We understand that Abbey reserves the right to go out of town or have dates of unavailability before our on-call period. But I/We also understand that Abbey will cover those dates with us before this contract signing.
@Client’s Initials ✍️ I/We understand that the birth portion of our fee covers 12 hours of labor support and that an additional $100 will be owed for each 12 hour increment after that. This helps Abbey care for basic needs like childcare and food while serving you if the labor ends up being longer than 12 hours-this charge is rarely needed.
Doula Client Agreement:
For a doula to be the best service for you it helps to understand the scope of what a doula does. The following are your doula’s responsibilities Please read and check all the boxes.
@[ ✔ ] ✍️ A doula accompanies a woman in labor to help ensure a satisfying birth experience by providing physical, emotional, and educational support.
@[ ✔ ] ✍️ A doula works for us, not our care provider or the hospital/birthing center.
@[ ✔ ] ✍️ A doula does not perform medical tasks.
@[ ✔ ] ✍️ A doula will help us make decisions by providing information and support.
@[ ✔ ] ✍️ Abbey always carry her cell phone and will not leave the DFW Area during the on call period. The on call period begins at 1 week before estimated due date and continues to 1 week after. She will still likely be able to attend to you if you birth your baby before or after those times.
@[ ✔ ] ✍️ Abbey will provide 1-3 prenatal visits in your home or other meeting place if you choose. (If you are using virtual services prenatal visits will be over phone or internet) At these visits she will: Help form a birth plan, discuss our choices, go over coping measures, and discuss risks/benefits of various choices.
@[ ✔ ] ✍️ Abbey will provide continuous labor support from the time you ask her to come (or the time you choose for video or phone support to begin for virtual doula services) until the after the baby is born. She will not leave unless you ask her to, and even then, will be available by phone (only exception is short periodical breaks). Abbey will take turns with your other support persons taking a naps/breaks when needed.
@[ ✔ ] ✍️ Abbey will provide 1 postpartum visit to discuss the birth, answer questions, and provide breastfeeding support. This meeting is scheduled at your convenience, either at a convenient location, your home, the hospital, or via phone call.
This portion is to assert that you understand that what you put into doula services will strongly effect what you get out of doula services. please read and check all of the boxes. *
@[ ✔ ] ✍️ I/We understand that Abbey has backups and the fees for those back ups is $400 and will be taken out of our fee. (If we received a discount that does not afford offering a backup this amount we may be unable to have a backup)
@[ ✔ ] ✍️ I/We will keep Abbey informed about our pregnancy as it develops.
@[ ✔ ] ✍️ I/We will contact Abbey as soon as we think we might be in labor, and to keep her informed as the labor develops even if we do not need her to come yet.
@[ ✔ ] ✍️ I/We will contact Abbey when we feel we need her, and understand that it may take 1-2 hours for her to reach us
@[ ✔ ] ✍️ I/We will discuss our preferences with Abbey and clearly state our choices to her. She will support us in any decision we make.
@[ ✔ ] ✍️ I/We understand that this is our birth, while everything Abbey does is aimed in helping us have our desired choices and outcomes, that can only happen if we clearly understand our options, ask questions, and state our choices/opinions to her and our health care providers.
@[ ✔ ] ✍️ I/We understand that birth is unpredictable and Abbey or anyone else do not have control over it.
@[ ✔ ] ✍️ If Abbey misses the labor/birth because I/we fail to contact her the entire fee will still be due. (Barring specific circumstances at Abbey’s discretion).
Liability Release
@Client Name 🏷️ and @Partner Name 🏷️ 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, over the phone or online, and/or a hospital/birthing center. I/We understand that Abbey has a limited role pursuant to the description of tasks outlined in the contract wherever services are provided to me/us. Abbey has not represented to me/us that contracting for her services guarantees in any way a risk-free or emergency-free labor and birth experience. I/We understand that Abbey does not make medical or nursing 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.
Now, therefore, in consideration of the above acknowledgements, @Client Name 🏷️ and @Partner Name 🏷️ on behalf of myself, ourselves, my/our heirs, administrators, personal representatives, executors, and assigns to RELEASE AND FOREVER DISCHARGE Abbey and Voices of Eve, 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 or assigns as a result of using the doula services of Voices of Eve, 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 resulting from our contract for doula services.
@Client’s Signature ✍️
Contract Final Steps
Client’s Signature: @Client’s Signature ✍️
Partner’s Signature: @Partner’s Signature ✍️
Date Signed: @Client’s Sign Date ✍️ @Partner’s Sign Date ✍️
