Contract Of Services For Doula Support Page 2


If you and your doctor decide that a planned cesarean is necessary (that is, a cesarean done before your due date and/or
before the onset of labor), I will provide support during the cesarean (as allowed by hospital and/or doctor policies)
and immediately after, as well as one additional 3-hour postpartum visit to assist with breastfeeding, cleaning, laundry,
baby care, etc. for my usual fee.
I will make every effort to provide the services described here. If my failure to attend your birth is due to my error,
there will be no charge for my services and I will refund the fee, minus the retainer.
If my failure to attend your birth is due to an error on your part (failing to call me, for example) no refund will be given,
and I will keep my full fee.
If my failure to attend your birth is due to a rapid labor (baby is born less than one hour after you call me and ask me to
come), I will provide an additional 3 hours of postpartum support at no cost once you are discharged from the hospital.
This can include assistance with breastfeeding, laundry, cleaning, baby care, etc. My full fee applies.
Any other circumstances out of my control that result in my absence at your birth will be addressed on a case-by-case
basis, and may or may not result in a partial or full refund.
For the services described here, to be paid as follows:
_________ as a retainer fee, due when you select me as your doula and sign this contract.
_________ due by the end of your 37
week (two weeks before your due date).
I/We have read this contract describing the doula’s services and agree to enter into a client-doula relationship for the
pregnancy and birth with a due date of ______________.
Client Name ________________________
Client Signature__________________________
Client Name ________________________
Client Signature__________________________
Doula Name ________________________
Doula Signature__________________________
Contract of Services (June 2009) // Jackie Mysak, Birth Doula //


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