Birth Doula Contract/Agreement

[wendoula]

I am in the process of writing a new contract, I can't seem to locate the one I already had and I have to meet a possible client tomorrow.

Would anyone like to share theirs?

[motherwise]

I would be happy to send you mine. If you want to email me

ETA: Well, I copied and pasted...hope that is ok. If you want to look at how it is formatted, I can email it to you.


Letter of Agreement Describing Doula Labour Support
Services, Limits and Fees

What do I do as a Doula?
As a doula, I accompany women in labor to help ensure a safe and satisfying birth experience. I draw on my knowledge and experience as a doula and mother to provide emotional support, physical comfort and, as needed, communication with other caregivers to make sure that you have the information you need to make informed decisions as they arise in labor. I can provide reassurance and perspective to you and your partner (if present), make suggestions for labor progress, and help with relaxation, massage, positioning and other techniques for comfort. I am independent and self-employed. As your doula, I am working for you, not your caregiver or hospital.

Choosing a Doula
I prefer to meet with you (and your partner or other support person, if applicable) at least once before labor to become acquainted, to explore and discuss your priorities and any fears or concerns, and to plan how we might best work together. The first meeting does not obligate you to use my services and we can discuss my fees at that time. Prior to the birth I would like to become familiar with your Birth Plan, including your preferences regarding labor management options and the use of pain medications. I also want to learn about your own best ways of coping with pain and fatigue and how you and your partner (if applicable) foresee working together.

I will also inform you of times when I am not available for labor support. To cover those times, I will arrange one (or more) back-up doula(s) that you may speak with or also meet. Of course, you have as much choice over your back-up doula as your primary doula. We will also decide on other meeting times and will certainly want to remain in touch by telephone.

When you are in labour
Please call me when you think you are in labor, even if you are not sure. I can answer questions and make suggestions over the phone. We will decide if I should come right over then or wait for further changes. I usually need approximately one to two hours to get to you from the time you ask me to come. We will also decide where to meet - at your home or the hospital. Except for extraordinary circumstances, I or my back-up will remain with you throughout labor and birth.

I am available for phone contact to answer questions about the birth and your baby and would like to get together with you within one to two weeks to see how you are doing, to review the birth, to admire your baby, and to get feedback from you about my role.

After birth
I usually remain with you for one or two hours, until you are comfortable, your questions are answered and your family is ready for quiet time together. I would also be happy to help with initial breastfeeding if necessary.

What Doulas do not do
As I Doula, I do not:

• Perform clinical tasks, such as taking blood pressure, fetal heart checks, vaginal exams, and others. I am there to provide only physical comfort, emotional and informational support and advocacy.
• Make decisions for you. I will help you get the information necessary to make an informed decision. I will also remind you if there is a departure from your Birth Plan.
• Speak to the staff instead of you regarding matters where decisions are made. I will discuss your concerns with you and suggest options, and I will help you identify key questions that may help you with your decisions, but you or your partner is the best person to speak to the clinical staff.

As a Doula I will not prescribe, diagnose or treat any medical problems that may arise and will not be liable for interpreting diagnostic procedures. This is the role of your provider.

In the event of a rapid labor or emergency situation, I will call 911. In the event of an emergency delivery I will do what measures I am capable of to try to keep you and the baby safe and comfortable until EMS arrives. This will fall under The Good Samaritan Law.

Failure of a Doula to provide service
I will make every effort to provide the service described here. Sometimes this is impossible (for example, with rapid labor). If I, or my back-up, fail to make it to your birth due to either our error, or your inability to call me in an emergency, you will not be liable for the balance of this fee. If it is due to your failure to call me, payment will be owed in full.

Scheduled Caesarean Clause
Occasionally a woman will have something arise during her pregnancy that necessitates a scheduled Caesarean birth. If this decision is made two weeks or more before your due date, you may choose to cancel my services with no further payment owed beyond the deposit. Alternatively, you may choose to have me come with you to the hospital, accompany you during surgery or wait in the recovery room, and assist you with breastfeeding and adjustment in the first hours after your birth. An extra postpartum visit can also be scheduled at no further charge. In this instance my full fee will be payable.


Fees
My fees for the service described here are $ to be paid as follows:

$ as a retaining fee, due when you select me as your doula

$ postdated to your due date

Please make checks payable to Marilyn Roper.

I/we have read this letter describing the doula’s services and agree that it reflects the discussion we have had.



Date ____________________________________




Client __________________________ Client’s Partner ________________________




_______________________________
Marilyn Roper

[Tiffany]

Here is the one I have available for download on this site.
http://alldoulas.com/forums/downloads.php?do=file&id=3

Hope it helps!

[motherwise]

I love yours, Tiffany. It is so...CUTE! I love your graphics

[wendoula]

Thanks Everyone! I am so happy to find this board and all of you. Thanks Tiffany for such a cool place to come and get support! I now have my first client outside my family and friends! WOO- HOO! EDD Feb 25 I have to get one more client to get my birth evaluations all squared up and write my position paper.

[moncton doula]

That is so great that you have your first "outside" client! That was me not long ago and now I'm waiting to hear about certification, I have a client for May, interviewed last week for another May client, and have 2 interviews tonight for June!! Busy, busy!!

[capandcradle]

I'm curious as to what your contracts usually stipulate. Did you use a template provided by your certification organization? Did you have an attorney draft it?

Have you ever been in a conflict with a client over a birth outcome and the terms of your contract? What was the outcome?

Does your doula association offer any advice or information on this?

I'll go ahead and say upfront that I know I'm unusual. I've never used them. It's always been a verbal agreement, I have never had trouble collecting money, or getting to a birth in time, or a mother reaching a backup in the rare event I'm indisposed. Every other doula in my community uses them, and I have gotten clients who were turned off at being presented (from others) with a contract at the first meeting.

I don't know why I haven't used at least an informal written agreement -- they are useful to clarify expectations and avoid misunderstandings. Just wondered what your experience has been.

[DL]

Quote:

Originally Posted by capandcradle I'm curious as to what your contracts usually stipulate. Did you use a template provided by your certification organization? Did you have an attorney draft it?

No, my organization (CAPPA) didn't supply materials for making up contracts; although in my training, my instructor did highly encourage us to use a contract. No, I did not have an attorney draft mine. I started with a contract that another doula shared with me that came from a pack of doula forms, and then I made modifications to suit my needs; it ended up being quite different from hers.

What my contract stipulates: hmmm...I'm not sure how detailed you're hoping this answer will be. It would be a lot to type out. I'm going to try really hard to be brief and so am paraphrasing quite a bit (my contract is actually in paragraph form):

Doula's Responsibilities: detailed listing of my agreed services, provide phone and cell phone numbers for 24 hour contact while on-call, describes on-call time, states when and under what conditions a backup may be called and how payment is to be made, and doula's scope of practice (including not speaking for and not making decisions for client, not perfoming any clinical assessments)

Client's responsibilities: Informing care-giver that a doula will be present, discussing birth plans with doula, informing doula when client is in labor (before requesting doula's presence if at all possible), give doula at least an hour to arrive after doula's presence is requested (she may arrive sooner, but it cannot be expected).

Fees: describes fee and how/when payment(s) is/are to be made, states that they cannot reserve on-call time without payment of retainer at signing of contract, addresses that there may be payment schedules or special circumstances with signed agreement of all parties for the contract to be valid--and to see addendum if applicable, addresses which situations would warrant a complete or partial refund and amount of said refunds

Signatures & Dates: of Mother, Spouse (if applicable), and Doula

Quote:

Originally Posted by capandcradle Have you ever been in a conflict with a client over a birth outcome and the terms of your contract? What was the outcome?

No, I've not had any conflicts. Although not a guarantee, I do think that going over the contract personally with clients cuts down on the likelihood of possible conflicts. At the end of the Interview, we all know that we are on the same page. I make sure that they fully understand every line.

Quote:

Originally Posted by capandcradle Does your doula association offer any advice or information on this?

Other than saying that we should strongly consider having one, I don't remember any advice on actually coming up with a contract (it's been 3 years since my training).

Quote:

Originally Posted by capandcradle I'll go ahead and say upfront that I know I'm unusual. I've never used them. It's always been a verbal agreement, I have never had trouble collecting money, or getting to a birth in time, or a mother reaching a backup in the rare event I'm indisposed. Every other doula in my community uses them, and I have gotten clients who were turned off at being presented (from others) with a contract at the first meeting. I don't know why I haven't used at least an informal written agreement -- they are useful to clarify expectations and avoid misunderstandings. Just wondered what your experience has been.

I'm not sure about this, but how potential clients view contracts could possibly vary with geographical area. In my local area, I think that most people expect to sign a contract (you can't even get movie rental membership without first signing a contract). The only times that I didn't bother with a contract was when I did volunteer births (since no money is changing hands, I didn't see the point in it). I personally think that my clients better know what is expected of them and their doula after going over the contract with me. If they're investing $400, I believe that the contract makes them feel more secure in their decision and of my commitment. This has never happened to me, but if someone would state that they are uncomfortable signing a contract with me, then that would be reason for me to doubt their commitment to pay me and do good business with me. I'm very flexible and willing to work with people, so in my mind, there's no reason why they should be bothered about signing with me. After saying all of that, I have the attitude of "whatever floats your boat", so if it works just as well for you to not have a contract, that is fine. I just wouldn't be comfortable without one.

[MothertheMother]

I just took my CAPPA training last fall and they do now offer a sample contract in the packet. I was told that even if you do births for free you should still use a contract. It is less about the money and more about the clients understanding what you do and don't do. Some may think the approach is a little paranoid but the concept was put to me to define what you do and DO NOT do in the event someone wants to try to blame you for something. It may sound a little harsh but I am all about protecting myself. And that is why I use a contract. It is very detailed and spells out what they can expect from me, what I expect from them and any possible money issues I could think of. I do not offer a refund/discount if I miss a birth if there was no way I could help it but I probably would still refund them something. I just want them to understand that they can't just decide to not call me. I also do not offer a refund/discount for c-sect. Again, if it was medically indicated to schedule one I would probably offer some money back ( I have them pay in full 3 weeks prior to EDD...I don't want to bug them for money when they are just at home with a brand new baby). It seems everyone does this a little differently. I have not been faced with these situations so I can't say for sure how I would handle them.

Anne, What reasons have you been given by clients who didn't like the contracts? I know you disagree with the image of the "birth professional" but I identify with that and I think the contract helps with that image. I feel like they realize that I put a lot of time and effort into thinking it through and making it look professional and that says something about my commitment to what I do.

[capandcradle]

It is less about the money and more about the clients understanding what you do and don't do. Some may think the approach is a little paranoid but the concept was put to me to define what you do and DO NOT do in the event someone wants to try to blame you for something. It may sound a little harsh but I am all about protecting myself.

Anne: Can't figure out how to use the quote thingy so I'm doing it this way. It is NOT harsh at all, you must protect yourself and make sure all your cards are on the table. I've been at this long enough to see *all sorts* of people and believe that is a wise approach. Naturally I try to send the crazies to the other doulas thereby avoiding these issues.

And that is why I use a contract. It is very detailed and spells out what they can expect from me, what I expect from them and any possible money issues I could think of. I do not offer a refund/discount if I miss a birth if there was no way I could help it but I probably would still refund them something.

Anne: Things happen that are out of anyone's control. I tell people to allow me at least an hour, but once a lady precip'ed and I made it before the midwife.

I just want them to understand that they can't just decide to not call me. I also do not offer a refund/discount for c-sect. Again, if it was medically indicated to schedule one I would probably offer some money back ( I have them pay in full 3 weeks prior to EDD...I don't want to bug them for money when they are just at home with a brand new baby). It seems everyone does this a little differently. I have not been faced with these situations so I can't say for sure how I would handle them.

Anne: I know of no one who offers a refund for a c-section. Your presence, nor mine, is any guarantee of anything. You're right though about someone just deciding just not to call -- I see that much more in my low income clients who use volunteer doulas. Now, I'm seriously considering asking the volunteers to use doula contracts.

Anne, What reasons have you been given by clients who didn't like the contracts? I know you disagree with the image of the "birth professional" but I identify with that and I think the contract helps with that image. I feel like they realize that I put a lot of time and effort into thinking it through and making it look professional and that says something about my commitment to what I do.

Anne: No, ma'am, I believe you're convoluting two different issues. In no way am I suggesting being sloppy. Two ladies said they weren't crazy about being presented with a contract in legalese when first meeting the doula. If I were to use them it wouldn't be in the first meeting, probably. But having all expectations in writing -- especially considering that some hire a doula with the expectation she will run interference with the staff -- is helpful.

The other issue you mentioned is the definition of a professional. Technically a professional is simply someone who just gets paid to do something. However it goes beyond that, professionals usually face proscribed education and usually licensure and state regulation. See professional attorneys, accountants, plumbers, nurses, midwives, nail techs. Can you think of another professional who got trained in 3 days and read some books and did 3 tasks that "qualifies" her? I can't. (Caveat: I think that is plenty of education to massage, suggest position changes, and just love on birthing women.) I provided labor support for years prior to attending a doula workshop, even before the word doula applied to labor support. I'm paid for attending births but as of yet no one has been able to talk me into paying for approval of what I do (even from worthy organizations like CAPPA or DONA). Am I a professional? A doula? (I'm looking in to my crystal ball and predicting that someone will bring up the renegade who makes the hospital staff mad, steps on their toes, and wants a way to differentiate professional doulas from "those" -- right?)

The fallout from choosing this *verbiage* is this -- a local hospital is one of some to ban doulas. Well, they are not banned per se, but they must apply for privileges, pay x amoung to apply, have physician sponsorship, be DONA certified, agree to hospital stipulations (like not discussing medical procedures with hospital patients) and carry liability insurance, like the professional physical therapists, nurses, and music therapists who also have privileges. The rationale is if this is a professional service, the profession is subject to rules and regulations like other professionals.

I wonder sometimes if "professional" is really the most descriptive word, I'm *not* arguing that doula training isn't valuable (it is), there is no place for written agreements (there are) or standards of practice (of course those are good even though hospital staff can't tell "those" from "us". )

I see it as more of a paraprofessional, much like a physical therapy assistant, which has 18 months worth of education and whose scope is similar to a PT but who does a lot of the fun stuff.

I hope this makes sense. Feel free to disagree.

Anne

[MothertheMother]

I didn't mean to imply that no contract was equal to a lack of professionalism...I think I just ran two ideas together. I was curious why some women didn't like the contract (for my own information) and gave some of my reasons for wanting to use a contract. I do present it the first meeting because I think it covers what a client may need to know when deciding between doulas (in addition to the obvious human factor). After I go over it I tell them I want them to take it home and think it over and to interview other doulas and make a decision. I tell them if/when we meet again we will sign it and take care of a deposit. If I were in the position of deciding I would want to know those details up front.

I do want to add, though, that I don't make the meeting about the contract. I just sit and talk and listen etc and when I feel like it is winding down I bring it out and go over it.

I will be more than happy to address my opinion of the "birth professional" when I have had more sleep and less wine ! lol I know you love a good debate!

[capandcradle]

Quote:

Originally Posted by MothertheMother I will be more than happy to address my opinion of the "birth professional" when I have had more sleep and less wine ! lol I know you love a good debate!

I totally see your point on the contracts and agree wholeheartedly. With both the positive and negative press on doulas I see the need to be clear and upfront and get it in writing.

I'm not up for debate for the sake of debating -- must be the lawyer lurking inside rearing her ugly head -- but I believe the verbiage chosen has ramifications that may not be exactly what we had in mind, and we've got to consider it seriously.

I value your thoughts and am eager to hear them. When you reply, though, I'm curious about one thing-- have any clients ever had a bad outcome and filed a lawsuit against their provider? Have you ever been deposed as a witness? I am not at liberty to discuss specifics of a particular situation right now, but will share as I'm able as I believe it is germane to this whole discussion.

Love ya,
Anne

[MindOverLaborDoulas]

You know, I have wondered about lawsuits. Since we don't perform activities that we could really be held liable for, have any Doulas been sued? Maybe this is something for another thread, but I am just curious.

[capandcradle]

Quote:

Originally Posted by MindOverLaborDoulas You know, I have wondered about lawsuits. Since we don't perform activities that we could really be held liable for, have any Doulas been sued? Maybe this is something for another thread, but I am just curious.

Speaking of professionals/lawsuits,

http://www.cmnh.ca/papers/doula.pdf at least the authors of this articles see doulas as paraprofessionals, verbiage that I believe is more descriptive of what doulas do.

Sure you are theoretically liable. In my community one hospital 'banned' -- or made it impossible to work there-- doulas b/c they 'interfere w/patient care.' Meaning -- let's say in a non-emergent situation doc/nurse recommended x, but after a private consult with support partner and doula, mother decided to do y.

Now, moving on to theory -- There is a bad outcome, having little or nothing to do with decision y. In liability suits, it is not uncommon to name as defendants anyone who could possibly be involved. It is certainly reasonable in some states, like recently in IL, some nurse practice acts have been applied to doulas. Doulas discuss medical procedures and help with position changes. Doesn't sound like medicine or nursing to me, but broadly written nurse practice acts are often used to prosecute direct entry midwives.

I wrote a paper on this last year (lawsuits in obstetrics) I'm not aware of a doula who has been sued and at present the risk is probably theoretical. But you use a contract, don't you? You use one for a reason, no?

I am, however, aware of a handful of cases where a woman sued her doctor and her doula was deposed. It happened in my community. Without giving particulars, you probably know that in a deposition the opposing counsel is trying to get information out of your witnesses to bolster their client's case. Some of them are really good about finding a weak spot and getting under the deponent's skin like a boil. The "birth professional," with 3 days training and 3 births for certification and no liability insurance and she gets medical information from her, can and is used against the mother-plaintiff.

Is professional liability insurance available through ALACE, CAPPA or DONA? Some physicians are asking women to sign a form saying they won't file a 'frivolous lawsuit' but the clincher is, who defines frivolous? If a woman files a lawsuit the medical society -- notoriously poor at policing bad doctors -- considers 'frivolous', the woman, her attorney is fair game for a countersuit. (More about this on my blog www.greasyjoan.blogspot.com)

I wish the doula associations would address this. But who, after having been through it, wants to talk about it?

Heavy stuff.

Anne

[MindOverLaborDoulas]

As always, you are right on Anne! My contract really is just laying it out to show what I will do for them/the services that I will provide. (I have a separate statement saying what a Doula does not do that they sign) I am sure that my contract would never hold up in a court cause I just kind through it together but my dh's aunt who is a paralegal said it looked fine off the record. I have the stipultation that in the event of a lawsuit I know that I could be called and the client is to pay for all expenses including the fee if I miss another birth b/c I am in court. Is this ethical? I got the idea from another Doula's website. Someone said that DONA offers it (liability ins) for $70 a year, but I have not checked into it.