Postpartum Doula Contract
Description of a Postpartum Doula
A postpartum doula is there to help a new family in those first days and weeks after bringing home a new baby. Services include, but are not limited to, help with self-care recovery, postpartum comfort measures, infant care, parenting information and assistance with learning to feed and take care of your baby, as well as other practical services.
Postpartum doula services for a family last anywhere from a few days, up to a few weeks after bringing home a new baby. Postpartum doulas assist during the day, but also during the night to help the family transition more smoothly into the challenges of night time parenting.
A postpartum doula does not dispense any medications (over the counter or prescribed) to any member of the family or diagnose any medical conditions in mother or baby. She is also not responsible for major house cleaning tasks, nor will she take over complete care of baby, discipline other children or transport any member of the client’s family.
Doulas are not doctors or midwives, and do not practice medicine, nor diagnose and treat postpartum related symptoms. Information presented in our meetings and conversations is not intended as a substitute for the medical advice of a properly licensed health care professional. In addition, doulas do not make specific health claims or promise medical results. We provide education and guidance, and postpartum breastfeeding support.
Once you have requested me to act as your doula, I will provide the following services:
I will provide one (1) prenatal meeting free of charge. At this meeting, we will discuss and explore your priorities and concerns, and plan how to best work together to meet your needs.
I will be available to answer questions about upcoming baby care or services anytime before the birth of your baby.
Once your baby is born I will provide the following services:
Education on postpartum issues
Guidance with newborn care and feeding
Breastfeeding care (ie: preparing sitz baths, foot soaks, etc)
Healthy and nutritious meals/snacks and/or meal planning
Very light housekeeping (ie: light laundry and folding, tidying up, loading and unloading the dishwasher)
I will disclose any potential scheduling difficulties, which may interfere with my ability to provide services beforehand.
You must notify me within 24 hours after the birth of your baby so that I can arrange my schedule and notify you of any scheduling conflicts.
I require 48 hour notice before services begin, unless otherwise agreed upon.
Services are to be provided for __________ hours each day, for a total of __________ hours/days.
Additional scheduling notes:
Fees & Billing
A non-refundable deposit of $120.00 is due upon the signing of this contract. This deposit will be applied to the first week of care. The remainder of services must be paid for, in full, by the last day services are rendered. I will prepare an invoice for the agreed upon hours and it will be provided to you at your first postpartum visit. If, after services are completed, you wish to contract for additional visits, these will be invoiced for separately and paid for during each visit.
For billing purposes, an hour is considered to begin when I arrive at your home.
A minimum of 4 hours per daytime visit and 6 hours per overnight visit.
Daytime hours are 7am to 7pm.
Overnight hours are 7pm to 7am.
• Prenatal Meeting is included with my services
• Daytime Visits: $33.00/hr
• Overnights: $33.00/hr
I will provide the following additional services as listed below:
Honest communication about any relevant medical or emotional health conditions is greatly appreciated.
Your estimated due date is _____________________.
Services are to begin within __________ days of the birth of your baby.
Cancellations & Refunds
I require at least 24 hours notice for cancellations. In the event that less than 24 hours notice is given, a $60.00 fee will apply. (This fee does not apply when severe weather conditions and/or last minute injuries or an illness are the cause of a cancellation)
In the event of illness or injury on the part of the doula or severe weather, services will be rescheduled as soon as possible.*
In signing this contract, you agree that I have discussed all the points herein and you understand and agree with them.
Client's signature (mother) Date
Client's signature (father) Date
Doula’s signature Date
*I am very cautious about bringing any illness into the home of a newborn. I will not hesitate to reschedule if I think I may be getting sick.
Postpartum Client Intake Form
Preferred Email for Communication
Estimated Due Date
Please list classes you have taken or plan on attending like breastfeeding, Infant Care, Infant CPR, etc.
About Your Health
Your Healthcare Provider's Name and Address
Provider's Phone Number
Please state your general health? Any chronic conditions I should be aware of?
Explain any complications you are experiencing, any restrictions or special directions your caregiver has given you, and any medications you are currently taking.
About Your Children
If you choose, please provide the name, sex, and age of your children.
Pediatrician's Name and Address
Pediatrician's Phone Number
Regarding your children, please state their general health? Any chronic conditions I should be aware of?
Regarding your children, explain any complications they are experiencing, any restrictions or special directions their care provider has given, and any medications they are currently taking.
Describe your vision of how I can best support your postpartum period.