Birthing Life Doula Collective

Birthing Life® Doula Collective 508-429-MOM3 [email protected] http://birthingforlife.com

Dear Parents,

Congratulations on your pregnancy and thank you for your interest in hiring a doula! Many families are realizing that this "peak" life experience can also be an overwhelming time, especially with all the choices to make regarding the health and well being of mother and baby. The vast majority of families that have used a doula have found that a doula’s presence at the birth or in their home following the birth can mean the difference between a satisfying, empowering experience versus a fearful and sometimes traumatic event. A doula can be particularly helpful in the areas of providing encouragement, reassurance, information on alternatives and practical help.

Enclosed is some general information about doulas and a Doula Services Agreement for you to review and discuss. Additional information about doulas and birth is available on our website. This agreement outlines our responsibilities as doulas, your responsibilities after hiring us, and how we work together cooperatively. The payment structure is also defined. If you have already decided to us, please have these documents read and signed prior to our first prenatal visit together.

If you have any questions about anything in this packet, or if you would like to set up an appointment for an in-home interview, please call 508-429-MOM3. We look forward to helping you realize your birth and parenting dreams!

Sincerely,

Birthing Life® Doula

Doulas Make a Difference The acceptance of doulas in maternity care is growing rapidly with the recognition of their important contribution to the improved physical outcomes and emotional well being of mothers and infants.

The value of providing birthing women with continuous emotional support, physical comfort, and encouragement has been recognized worldwide. Given the clear benefits and no known risks associated with intrapartum support, every effort should be made to ensure that all birthing women receive support, not only from those close to them but also from specially trained caregivers. This support should include continuous presence, the provision of hands-on comfort, and encouragement. Hodnett, E. D. "Support from caregivers during childbirth." (Cochrane Review) in Cochrane Library, Issue 2. Oxford Update Software, 1998. Updated Quarterly. A doula, in conjunction with a woman’s partner, provides support consisting of praise, reassurance, measures to improve the comfort of the mother, physical contact such as rubbing the mother’s back and holding her hands, explanation of what is going on during birthing and a constant friendly presence. Such tasks can also be fulfilled by a nurse or midwife, but they often need to perform technical/medical procedures than can distract their attention from the mother. Care in Normal Birth: a Practical Guide. Report of a Technical Working Group. World Health Organization, 1996. Facing unprecedented pressures to reduce expenses, many hospitals are targeting the largest single budget item--labor costs. (An) unintended consequence of nursing cutbacks may be an increased cesarean rate; the inability of pared down nursing staff to provide continuous coverage to birthing mothers (has been) shown to increase the chance of cesarean. Doulas clearly improve clinical and service quality; they provide an absolutely safe way to reduce cesareans and other invasive birthing interventions. Coming to Term: Innovations in Safely Reducing Cesarean Rates. Medical Leadership Council, Washington DC. 1996. Professionals have paid much attention to innovative technology and the many new options for monitoring and handling birth. While the technology is important, it can become so prominent that clinicians ignore both the natural aspects of birth and the non-technical needs of women during birthing. Changes that support the patient in labor and reinforce the natural, physiologic process includes providing one-to-one psychological support for patients using nursing staff or doulas. Reducing Cesarean Section Rates while Maintaining Maternal and Infant Outcomes. Bruce L. Flamm et al. Institute for Healthcare Improvement, Boston, 1997. The continuous availability of a caregiver to provide psychological support and comfort should be a key component of all intrapartum care programs which should be designed for the effective prevention and treatment of dystocia (non-progressive labor- something you rarely find with a doula). Guidelines on Dystocia. Society Guidelines on Dystocia. Society of Obstetricians and gynecologists of Canada, 1995.

2 of 8 Effects on birth outcomes: Eleven studies showed the following effects of doula support:  Births are shorter – especially when parents avoid interventions.  There are fewer, if any, complications.  Cesarean rates are drastically reduced.  There is rarely a need for oxytocin to speed up birth.  Use of forceps is extremely minimal.  Women request less, and generally no, pain medication.

Effects on the mother:  Greater satisfaction with childbirth.  Positive assessments of their babies and their birthing.  Only very rarely is there postpartum depression.

Effects on the baby:  Babies have shorter hospital stays and fewer admissions to special care nurseries.  Babies breastfeed more easily.  Mothers are more affectionate to their babies postpartum and are better rested (as are partners).

Effects on the health care system:  The cost of obstetrical care is dramatically reduced.  Women are pleased with the personalized care doulas offer.

The benefit of continuous support in birthing is recognized by:  The World Health Organization  The Medical Leadership Council (an organization of over 1200 U.S. hospitals)  The Society of Obstetricians and Gynaecologists of Canada  And more…

How doulas practice:  Privately, hired directly by clients  As hospitals employees  As volunteers in community or hospital programs

3 of 8 Agreement for Birthing Support Services

Your Doula’s Goals

. To support you during your pregnancy, birthing and postpartum period, in whatever choices you make. . To provide information to enable you to make informed choices. . To remain up to date on current research into birth related issues. . To continue believing that birth is a normal physiological process and an important and terrific journey in a mother's life. . To maintain complete confidentiality of all details relating to your pregnancy and birth. . To strive to support you during birthing to ensure a positive birth experience and to help you to achieve the type of birth you desire. . We are independent and self-employed and self-employed doula who work for you. . As doulas we do not perform clinical tasks such as blood pressure, exams, or fetal heart rate monitoring. We do provide physical, emotional and educational support. If you wish for us to perform more clinical care during birthing while you are at home, you may hire us as a Monitrice.

Our Obligations as Your Doulas

. We will draw on our knowledge and experience (and that of our educated peers) to provide emotional support, physical comfort, and communicate with the medical staff to make sure you have the information you need to make informed decisions during birthing. . We will provide reassurance and perspective to you, offering ideas to help birthing progress, and help with relaxation, massage, positioning, and other comfort techniques. . We will be on call for you 24 hours a day beginning three (3) weeks before the estimated due date (EDD) and up until birthing begins. This means that we will carry our cell phones with us at all times, and will not leave the area without advising you, unless it is an emergency or an event not known about at the time of this agreement signing. . The doula named will take responsibility as your primary doula. She is the person that you first contact when you are beginning to feel surges or other signs that birthing is imminent, often following the call to your doctor or midwife. If for any reason you are unable to contact her, or due to an emergency they cannot be with you, please call your designated back-up doula. . During our prenatal visits we will discuss the role of a doula, talk about your expectations, answer your questions, discuss birth plan options, when to call us, etc. We generally take photos of our parents as a present for you. Additional visits may be arranged and are included in some doula packages. It is most helpful for these visits if both you and ideally your partner, if you have one, and older children are present and participating in all prenatal visits. Additional visits to cover childbirth education including physiology of birthing, further breathing & relaxation, breastfeeding and prenatal and postnatal exercises are available. . We are there to provide support to the entire family at all times and ensure that every person the mother has chosen to be present remains as involved as he or she chooses to be during the birthing process. . We will assist in drafting your birth wishes and offer information and consultation. . We will answer questions and make suggestions by phone before birthing begins. . We will provide early birthing support as requested, including in your home. . We will remain with you once active birthing has begun until one to two hours after birth. . We may utilize non-interventive support techniques for birthing. . We will strive to maintain a calm and peaceful birth environment at all times. . We will maintain a birth log as circumstances allow to be given to you after the birth. . We will assist in providing information and supplying emotional support by telephone on postpartum care, breastfeeding, and newborn care after the birth, as requested. Postpartum doulas are also available for in-home support. . We will help to initiate the breastfeeding process, if needed. If you must bottle feed your baby, we will help you with the first feeding or arrange for pumping. . Usually within one week postpartum, we will come and check on you, your partner and baby. We will answer any questions or give you a referral to the proper professional that can meet your needs. Additional follow-up visits can be arranged if desired. . All records are personal and confidential. A copy of all our records will be given to you, upon request. 4 of 8 Your Obligations

. You must arrange for appropriate attendance (midwife or doctor) at your birth. If you plan to have an “unattended/unassisted birth” we can not be hired as a DONA doula. . You will complete birth wishes and discuss these with your care provider, ensuring that your care provider agrees and supports your wishes. . You will tour your birth facility. We can attend with you during a prenatal visit if you choose. . Please provide honest answers and information about your history as well as your intentions for your upcoming birth. . You will call your doula when you think you may be beginning to birth, even if you are not sure, so that she may make arrangements to attend your birth. . You will allow us approximately one to three hours to reach you, depending on your location. . You should maintain your own excellent health and nutrition. . You must make all of the decisions regarding your primary care, your birth, and when to call your primary attendant or go to the hospital. . You must make all final decisions and/or research any suggestion provided by anyone concerning your care. . If you decide not to use a Birthing Life® doula after signing this agreement, but before four weeks prior to your due date, your doula will refund any payment made beyond the retainer. . Unless arranging a payment plan, you will pay the total amount of the retainer due at your first prenatal appointment. This amount is not refundable. The full balance is due at, or prior to, the 36th week of pregnancy or upon signing this agreement, whichever is later. Credit card payments are available- please ask. . If a cesarean section must be scheduled, we will still be present to ensure that you are united with your baby as quickly as possible following the procedure. . If you would like additional prenatal or postnatal visits, these are available upon request. . A $300 retainer is typically required, but may be waived or modified by your doula.

Failure to provide service

. We will make every effort to provide the services described here. However, in the case of a rapid birth or medical emergency, it may be impossible for your doula to provide these services. . If you contact us to advise that you are birthing in good time (3 hours prior to delivery), but neither your doula, nor her back-up is available to attend your birth due to an error on our part or a conflict, we will refund 60% of your total payment responsibility. . If you fail to call any of us to advise us that you are beginning to birth, for whatever reason, you will not be due a refund of amounts paid. If there is a remaining balance outstanding, this will be due. Monthly payment plans are available. Failure to pay may result in collection.

Emergency Delivery

. In some circumstances, birth progresses more quickly than anticipated. If you call to advise that your birthing has progressed very quickly and delivery is imminent or your baby has been born unexpectedly at home, we will call an ambulance if you feel it to be necessary. . If your baby arrives unexpectedly at home with us present, we will request you or your partner to catch your baby. If you sense that additional medical care is necessary, we will arrange transport by ambulance to the hospital. We are not responsible for catching your baby or performing any clinical skills related to the delivery of your baby or his care following birth. Unattended reference guides are available for you.

5 of 8 EXTENT OF CARE

In order to provide quality service this contract stipulates that the care include:

. An initial phone consultation during which you are encouraged to ask questions regarding our standard of care. There should be no charge for this consultation. In home interviews are available for $75. . A varying number of individual visits, depending on the doula package that you select. . Unlimited prenatal telephone contact during the Doulas normal work hours (9 am to 9 pm) is available. Urgent questions are welcomed 24 hours a day, 7 days a week. . Attendance during the birthing according to the parents wishes. . Unlimited postpartum telephone contact during normal work hours in the first six months. . At least one postpartum home visit for the purpose of reviewing the birth and answering your questions. . Birth photography, as desired.

Cost of Services Birth Support Postpartum Care Midwifery Care Classes $750 $25-30/hr

Includes 2 prenatal visits, 1 Cost varies depending on time Cost varies depending See class listing for postpartum visit, 24/7 phone of day, commute, and on stage in pregnancy- cost of classes. support, complete birth responsibilities [may be Many insurance Cost of classes support, and birth photos.* reimbursable]. A four hour companies will varies. Personalized Your first prenatal visit daily minimum applies, except reimburse all or part of sessions available- serves as your "interview" for breastfeeding consultation. the cost. Our midwifery Just ask! with us. A $75 interview fees Overnights are sometimes billing service works to applies only if you choose available. Please click here to get as much coverage not to hire us. Extra visits learn more. possible. Please inquire. are $100/ea.

*Cost of prints extra. We will supply you with the digital proofs (or negatives) and you may order as many or few as you wish. Additional photography is available for the whole family. Childbirth education costs are reduced for doula families and belly casting/photography is provided at no charge. Some insurance carriers may reimburse full or partial costs of doula services [Birthing Classes are also often reimbursed in part by most insurance companies]. Credit Card payments are accepted via Paypal [please add 5% processing fee to your total for credit card payments]. Discounts are offered for referrals, parents birthing at home, and HypnoBirthing families who have attended our classes. Please contact us for pricing on homebirths with a qualified home midwife.

In signing this contract, you agree that we have discussed all the points herein and you understand and agree with them.

______Client's name Date

______Doula's name Date

6 of 8 BIRTH DOULA FINANCIAL AGREEMENT - FAMILY COPY

After considering the information above, as well as asking questions we felt necessary at our initial consultations, we, the Parents, agree, in exchange for the ______Birth Doula package outlined above, to pay the Doula a fee of $______to be paid as follows:

An initial non-refundable retainer of $350 to be paid upon the signing of this contract. The remaining balance of ______is to be paid by the 36th week occurring on ______or at the time of signing this agreement, which ever is later.

If an alternate payment schedule is in effect, payments are due as follows:

In one payment of $______due on . ~OR~ Monthly payments of $ due on the ______of every month, beginning on the following date ______with the final payment due on ______.

Post-dated checks will be accepted at time of signing.

TERMS 1) The initial retainer payment is non-refundable under all circumstances.

2) If we inform the Doula within four weeks of our due date that we no longer require her services, any payment above and beyond the retainer fee will be refunded.

3) If the Doula should be unable to attend our birth due to an emergency or the circumstance of two clients birthing at the same time, we agree to have her back- up partner as a substitute. If her back up is unavailable as well, we may either: a) Have our fees returned less $125.00 for each visit or b) Apply any amount paid beyond the deposit toward postpartum care or other Birthing Life® services

4) We agree that if the Doula should miss our birth due to a precipitous (very fast) labor or failure on our part to inform her and request her presence she will retain her full fee.

5) If we have a scheduled caesarean section due to breech presentment or some other medical reason, anything paid beyond the $350 retainer will be retained. The full fee will be retained if the doula is to be present with us during the birth and the postpartum hours.

6) Failure to pay may result in collection, unless a payment schedule is agreed upon.

6) Any fees that need to be returned according to item number 2, 3, or 5 will be returned within 30 days.

______

______Parents Date Doula Date

7 of 8 BIRTH DOULA FINANCIAL AGREEMENT - DOULA COPY