Client Contract to Provide Service and Release of Liability



What a Birth Doula Does

As a birth doula, I accompany women in labor to help ensure a safe and satisfying birth experience.  I am a DONA International trained birth doula and certification candidate.  I received my training from Melissa Cook Harley CD(DONA), certified childbirth educator and certified DONA International doula trainer, along with Vergie Hughes, lactation consultant and course director for

Lactation Education Resources.  I draw on my knowledge and experience to provide emotional support, physical comfort, and, as needed, communication with the staff to make sure that you have the information you need to make informed decisions in labor.  I can provide reassurance and perspective to you and your partner, make suggestions for labor progress, and help with relaxation, massage, positioning, and other techniques for comfort.  I am independent and self-employed.  With your approval I will also educate and guide your partner to participate in your birth experience.  As your doula I am working for you, not your caregiver or hospital.


What a Birth Doula Does NOT Do

•Perform clinical tasks such as blood pressure, fetal heart checks, vaginal exams, etc.  My role is to provide you with physical comfort, emotional 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 medical staff on your behalf.  In some instances I might relay a message to hospital personnel for you (for example, if you request more linens, etc.).  However, for the most part, I will address any concerns that you may have with you, discuss your available options, and/or suggest ways you may be better able to communicate with the medical staff.  It is essential that you and your partner speak on your own behalf.


Choosing a Doula

I prefer to meet with you and your partner at least once before labor begins.  This meeting will allow us to become acquainted, to explore and discuss your priorities, and to talk about any of your concerns or fears.   We will also be able to plan how we might best work together.  At your prenatal meetings I will want to become familiar with your Birth Plan, including your preferences regarding pain management options and the use of pain medications.  I also want to know your own best ways of coping with pain and fatigue and how you and your partner foresee working together.


When You Are In Labor

During the day, I prefer that you call me when you think you are in labor.  Even if you do not yet need me, I can answer questions and make suggestions over the phone.  We will decide if I should come right away or if I should wait for further change.  Please keep in mind that from the time you ask me to come, it could take up to an hour for me to get to you.  We will also decide whether it is best to meet at your home or at the hospital.

At night (11:00pm-6:00am), please call me when you are ready for me to join you.  Except for extraordinary circumstances, I will remain with you throughout the entire labor and delivery.


After the Birth

I usually remain with you for one or two hours after the birth; until you are comfortable and your family is ready for quiet time together.  If you wish, I can help with initial breastfeeding.  I will be available by phone to answer any of your questions about your baby’s birth.  When you get settled at home, I would like to visit you to see how you are doing, review your birth experience, and receive any feedback from you about my role.                                                                                                                  

Failure of a Doula to Provide Service

Although I will make every effort to provide the services described here, at times it may be impossible (for example, if you experience a very rapid labor).  If, for some reason, I am unable to attend your birth due to my scheduling conflicts, (for example, more than one client in labor at the same time, sickness, etc.), I will do my best to provide a suitable backup for you.  If I am unable to provide backup support, I will keep the retaining fee (one half of the contract total), and refund any other money paid to me.  The retaining fee is a dual purpose fee.  It ensures that the client is serious about having a doula present, as well as compensates me for time spent on prenatal visits, phone and email support, and being “on call” for two weeks before and two weeks after your due date.  In most circumstances the retaining fee is non-refundable.  Additionally, failure to call me early enough in labor (or at all), rapid labor, and unplanned cesarean birth are not reasons for a partial refund.  As a doula, I plan family outings, events, vacations, and other functions around your due date.  For this reason, I kindly request that you keep me well informed as things progress in your pregnancy.



The fee for the service described here can vary.  The fee will be agreed upon before signing this contract during the face-to-face meeting.  A minimum of one half of the total contract fee is due upon signing this contract.  This will reserve your due date in my schedule.  The remainder of your fee should be paid in full by your 38th week.



You understand that your doula, Amy Rayhorn, is not a medical professional and will not perform clinical tasks. You understand that she has been trained in comforting a woman before, during, and just after childbirth.


You understand that you may ask her questions pertaining to childbirth and how you are feeling. You accept that she will give you an answer to the best of her ability relying on her training and experience.  You also understand that she will refer you to ask your doctor for a clear, medical response.  You release your doula from any problems that could arise due to these questions/answers.


You understand that she may suggest comfort measures including, but not limited to, position change, massage, breathing patterns, visualization, use of the birth ball, and other techniques like these.  You also understand that you can refuse any suggestions at any time for any reason.


You release your doula, Amy Rayhorn, from liability should anything happen medically to your baby or yourself during the process of labor and delivery.  You realize that you may use her equipment such as, but not limited to, the birth ball and rebozo at your own risk.  You will not hold your doula, Amy Rayhorn, responsible for any injuries that could occur during the use of these comfort supplies.


You agree to keep an open line of communication between your doula and yourself. You understand that this is important so that she may be better able to help you and respond to your needs.  You understand that your doula does not carry insurance as she is not medical personnel and therefore does not perform medical tasks.