Contract of Doula Services
We, the undersigned, state we have discussed and reviewed our wishes with our labor Doula, Raina
Johnson. We understand that planning for this baby’s birth is like designing our dream house: it may not
go exactly as we imagine.
General Definition of a Doula
We understand that:
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A Doula accompanies a woman in labor to help ensure a satisfying birth experience
A Doula works for us, not our care provider or hospital
A doula does not perform clinical tasks such as blood pressure or fetal heart monitoring. She
does provide physical, emotional and informational support.
General information about our Doula
We understand that Raina:
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Is a trained labor support specialist. She is working towards certification through Doulas of
North America (DONA).
Draws on her knowledge and experience to provide emotional support, physical comfort and
communication with the medical staff to make sure we have the information we need to make
informed decisions during labor.
Can provide reassurance and perspective to us; make suggestions to help labor progress and
help with relaxation, position and other techniques for comfort.
Is independent and self-employed.
Obligations of our Doula
We understand that:
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Raina will be on call for us 24 hours a day beginning two weeks before our estimated due date
and ending when our child is born. This means that Raina will carry her cell phone with her at all
times and she will not leave the King/Pierce/Snohomish County area unless it is an emergency or
an event discussed ahead of time.
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As with any situation, there may be unforeseen circumstances that may prevent Raina from
attending our birth. She will have a back-up Doula lined up to attend us (if agreed upon).
Hold harmless agreement
Client(s) will indemnify and hold Raina Johnson harmless from and against any and all liabilities,
including personal injury, death or property damage, which any of them incur as a result of any action or
failure to act by Raina Johnson or arising out of this Agreement or the subject matter thereof. Raina
Johnson shall only be liable to the Client(s) for her gross negligence or intentional misconduct. Client(s)
assume all other liabilities relating to or arising from this Agreement or the subject matter thereof,
including without limitation any investigations or failure to investigate Raina Johnson and qualifications
and limitations of services provided.
Services provided by our Doula
We understand that Raina:
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Will meet with us at least once before the birth to discuss the birth
Will answer questions and make suggestions over the phone or email any time before labor
begins.
Will provide early labor support as requested, including in our home.
Will remain with us once active labor has begun until 1-3 hours after baby is born.
Will utilize non-medical support and comfort techniques for labor and birth
Will provide information for clients to make informed decisions during labor and birth.
Will strive to maintain a calm and peaceful birth environment.
Will photograph/record labor, birth and/or recovery if desired and time and circumstances allow
Will assist in providing information and giving emotional and practical parenting support by
telephone or email on postpartum care, breastfeeding and newborn care after the birth, as
requested
Will meet with us around 1-2 weeks postpartum to admire the baby, give referrals, discuss the
birth and any other concerns we may have at that time, if we so desire
Our obligations as Clients
We understand that:
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We will keep Raina updated after visits with our care provider especially if there are concerns
that our care provider has about our pregnancy and/or birth
We will participate in childbirth preparation classes and/or tour our birth facility (first time
parents only). Other arrangements may be made (and noted)
We will call Raina when we think we may be in labor, even if we are not sure, so that she may
make arrangements to attend our birth
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We will allow Raina approximately 2 hours to reach us
It is our responsibility to ensure that Raina is allowed to attend us at all times at our place of
birth
Raina’s standard fee is $600 . Unless otherwise noted, a cash/check/credit/debit of $150.00 is
due at the signing of this contract. $75 is refundable within thirty days from the signing of this
contract, should you change your mind. The second amount of $450 is non-refundable (except
where noted) and is due within thirty days of your estimate due date as noted in the
“comments” sections.
If other arrangements are made, they will be noted appropriately
In the event of a scheduled (non-emergency) labor induction or cesarean birth, we will take
Raina’s schedule into consideration
Failure of our Doula to provide service
We understand that:
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Raina will make every effort to provide the services described here
In the case of a rapid birth or medical emergency, it may be impossible for Raina to provide
these services
If Raina is with us for 24 hours, she may need to call a back up Doula to relieve her so we are
receiving the best possible service. If no back up doula is available/we choose not to utilize a
back up doula, Raina reserves the ability to leave for up to 10 hours to rest and come back to
better help us, if it comes to that. There is no refund due to Raina not attending due to a
prolonged labor (Raina WILL ensure you have A doula, unless you decline a back-up doula).
If Raina or her back-up do not attend our birth due to unforeseen issues on the part of Raina or
her back-up, there will be no charges beyond the retaining deposit
Raina’s fee is not reduced in the event of a cesarean birth or fast labor, just as she does not
charge extra for long labors or “false alarms”
If there is a weather related or emergency situation (earthquake, family emergency, etc….) that
may make it unsafe or impossible for Raina to travel to us, there will be no charges beyond
retaining deposit
If we fail to call Raina when we are in labor, or for any reason choose not to have her join us at
our labor and birth, Raina will keep the retaining deposit fee and the remaining balance on the
contract will be due or will not be refunded.
Placenta Encapsulation:
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Raina will take my placenta from the place of birth for the sole purpose of preparing it for
encapsulation
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Raina will bring the prepared placenta to me as soon as possible, usually within 48 hours
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I will inform my provider that Raina will be taking my placenta, in addition to signing any release
forms prior to her arrival.
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Raina will provide detailed instructions on storing and ingesting the capsules.
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If Raina is unable to encapsulate our placenta due to unforeseen circumstances (the anatomy of
placenta is compromised, unable to obtain from facility, etc), Raina will refund our placenta
encapsulation fee in full.
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We understand that Raina is certified, but is in the process of being certified through Pbi. She
charges $75 for encapsulation.
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I understand that the act of ingesting placenta in any form has not been tested, nor approved by
the FDA, and I ingest this at my own risk. Furthermore, I release Let it Be Birth and its representatives
from any liability. (initial) ________
Space for payment notes, additions, and deletions:
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Mother
Father/Significant Other
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Raina Johnson, Doula