Contract

Bridging Birth

Nicole Havelka, toLabor trained Doula

www.bridgingbirth.com

910.200.8646

Thank you for your interest in Bridging Birth!

I am a doula trained by toLabor. I trust in a woman’s ability to birth her baby and believe childbirth is a wonderful, natural and beautiful experience. Since women’s memories of birth often last a lifetime and can have powerful effects on one’s feelings of self-esteem and confidence, I am committed to helping women have the most fulfilling, empowering and satisfying experience possible.

A doula, or birth assistant, is a professional care provider who trusts and understands the process of birth.  As your doula I will provide support and information throughout your pregnancy, birth and first weeks of parenthood.  It will be my role to facilitate your birth experience by:

*answering questions and providing information so that you can make informed decisions regarding your care throughout pregnancy and birth

*advocating for you in order to promote collaboration among all members of your birth team

*providing emotional support such as a continuous presence, encouragement and reassurance throughout labor and birth

*providing physical support through brainstorming and encouraging a variety of comfort measures, positions, and relaxation techniques throughout the birth process

It will NOT be my role to:

*provide any medical assessment or medical advice

*make decisions for you

*speak to the medical staff regarding matters where decisions are being made. You or your birth partner will speak on your own behalf to the clinical staff

*guarantee the outcome of your birth

If any complications or emergencies arise, I will be there to help you understand the situation and will work effectively as part of your birth team to foster a positive outcome. It is important that the decisions you make during birth are right for you. I will respectfully help you and your birth partner explore questions and feelings so you can feel confident and comfortable.


Your Doula package:

*2 Prenatal Visits-during these visits we will discuss your plans for birth and I will provide information related to pregnancy, labor and childbirth

*Phone, text and email support and information during your pregnancy

*Labor support- I will be a continuous presence during labor from the time that you feel you would need me until 1 to 2 hours after birth, or until the family feels ready to have alone time

*1-2 Postpartum Visits – during these visits I will assist with initial breastfeeding as needed, provide information about newborn care and comforting, and answer any questions


Fee: $500.00  To be paid in full by our second prenatal visit.

I believe that every woman who would like a doula throughout her pregnancy and birth should be able to have one.  If you feel that you may not be able to meet the regular fee, I would be willing to discuss a trade or barter agreement with you.


I acknowledge I have received, reviewed and agreed on the above terms:
Name (Mother)_______________________________________________________
Signature____________________________________ Date___________________
Name (Partner)_______________________________________________________
Signature____________________________________ Date____________________
Doula: Nicole Havelka
Signature____________________________________
Due Date:__________
Primary Care Provider’s name and office:_________________________________
Name and relationship of others who will be planning to attend your birth:
___________________________________________________________________
___________________________________________________________________