Name *

First Name

Last Name

Phone *

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Estimated Due Date *

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My Obligations to You *

As certified doulas, Akasha Hines and Erin Borrett, will provide relational and non-judgemental support to families through pregnancy, birth and early postpartum. Our goal is for you to feel supported and cared for throughout our time together and for you to have a positive birth experience. At all times we will abide by our Code of Ethics and Standards of Practice. As your doula we will: * maintain a network of community resources so we can provide referrals as needed * remain up to date on birth-related research and issues * respect your privacy in all aspects of your pregnancy, birth, and the postpartum period * support and involve your partner * meet with you prenatally to learn how to best support you through your birth * be available to you for support throughout your pregnancy via phone and email * help you form a birth plan to encourage communication between you and your care provider * be on call 24/7 from 38-42 weeks of your pregnancy * provide early labor support via phone * join you during labor at a mutually agreed upon time, or within two hours of your request * provide continuous labor support, with the exception of short breaks to meet personal needs * strive to maintain a calm and peaceful birth environment * remain with you after delivery for up to two hours and help with the initiation of breastfeeding Should either a scheduled cesarean birth, or cesarean birth following labor, be necessary one of your doulas will come to the hospital to provide support before, during and after delivery. We are both prepared and trained to accompany you in the OR, should your birthplace and health care providers permit. The doula who attended your birth will visit you at an agreed-upon time approximately two weeks after the birth of your baby. Further postpartum visits may be scheduled for an additional fee. At the postpartum visit your doula will: * review and help process the joyful and/or difficult moments from your birth * assist with breastfeeding * make referrals and address any postpartum concerns

I understand the above obligations

Your Obligations *

In order to help you have the best birth experience, I ask that you and your partner do the following: * Complete a childbirth education course and discuss your birth plan with me. * Be responsible for your personal health for a healthier pregnancy and better birth experience. * Tour your chosen birthplace. * Call the on call doula when you are in labor and allow your doula approximately two hours to reach you. * Disclose any communicable illnesses you may have so that we may take precautions.

I understand and agree to uphold my personal obligations.

Scope of Practice *

As doulas, we do not: 1. Perform clinical tasks including vaginal exams, or assessment of maternal or fetal wellbeing. 2. Make decisions for you. We will help you gather information necessary to make an informed decision, and will offer ourselves as a sounding board rather than give opinions. 3. Speak to the staff on your behalf. We will discuss your concerns with you and suggest options, but you and your partner will speak directly to the clinical staff about your care. 4. Assist in the delivery of a baby, with or without a health care provider present. If your baby arrives unexpectedly at home with me present, you or your partner will be responsible for the delivery of your baby.

I understand the Scope of Practice of a doula and have sought outside medical care for my pregnancy and birth.

Limitation of Liability *

Client agrees to indemnify, defend and hold Akasha Hines and Erin Borrett harmless from all claims, losses, judgments, damages, expenses and costs (including, without limitation, attorneys’ fees and court costs), whether fixed or contingent, and whether or not adjudicated, arising from or in any way related to: (a) the breach of any of its obligations hereunder; (b) damage to real or tangible personal property of the client or any third party as a result of the fault of the client and not due to the fault of Akasha Hines or Erin Borrett (c) bodily injury to any party caused by client and not caused by Akasha Hines or Erin Borrett; (d) any breach of representations or warranties regarding services of Akasha Hines or Erin Borrett made by clients or any other third party; (e) payment of services owed to the birthing facility (f) any unauthorized act or omission of the doulas; and (g) the negligence, recklessness or willful misconduct of Akasha Hines or Erin Borrett (h) the aforementioned exceptions of services, including but not limited to, medical monitoring, medical decisions, medical opinion, treatment options, physical services, and medical services.

I understand and agree to the limitation of liability.

Fee *

A non-refundable deposit of 50% of the total balance will be due within one week of the signing of this contract. The remaining balance will be due by the 37-week point in your pregnancy. If circumstances are such that Akasha Hines nor Erin Borrett cannot attend your birth, we will provide a qualified backup and will be responsible for the payment of her services. She will provide the services outlined in this contract. In the event of extraordinary circumstances or we have been with you for 24+ hours, we may request a backup doula to relieve me. Our fee reserves your place in our calendar. Fees are non-refundable. In the event you fail to call your doula to advise you are in labor, if you have a rapid birth that your doula is not in attendance for, or if your doula is unable to attend your birth due to the policies of your birth place, Akasha and Erin will provide a postpartum visit per our contract. Fees are not adjusted for length of time in labor or birth. Should fees not be paid in full as directed above, it is solely at our discretion to provide labor and birth support, unless other arrangements have been made.

I understand that the fee is outlined in the package that I chose and a non-refundable deposit of 50% is due upon signing this contract in order to reserve my birth.