Virtual Doula Agreement

You’ve decided to have a Birth Doula. What a wonderful choice!

Helping your doula to get to know you better is always the wisest way to begin (y)our journey together.

Please take a moment and complete the following Agreement Form. It will help us get to know each other better and also clarify what is included in the support your doula will be providing you. It’s in in four simple steps.  

Yours Truly,

Delia
Pregnancy Without Fear

Agreement Form

Step 1 of 5 - 1

Birthing Person's Name(Required)
Partner's Name(Required)
Address

Doula's Obligation

I don’t provide medical diagnosis. Instead I will refer you to the appropriate professional and possibly suggest questions that you may want to ask in order to facilitate a good discussion with your provider.

I provide emotional and educational support. I do not perform clinical tasks such as checking blood pressure, fetal heart tones, vaginal exams or any other medical procedure that falls under the legal definition of practicing medicine.

I don’t make decisions for you. I will point you toward accurate, evidence based information in order to ensure an informed decision, discuss appropriate ways to convey decisions or preferences to your care providers and remind you of previously stated decisions. The responsibility of all decision making lies with you and your care provider.

I don’t speak to medical staff on your behalf. I can discuss concerns and options with you, as well as support you in voicing your concerns, ensuring that you have the opportunity to discuss choices with your care provider. It is your responsibility to convey your thoughts to the medical staff.

Promise any specific birth outcome. I cannot overrule you or a medical professional when a care decision has been made or intervene in your care I will provide a back up doula in the event of a personal emergency or unforeseen circumstance.

Will begin the 'On Call' Period at the beginning of 38 weeks but available as able by phone, text, or email from the start of this contract with responses within 24 hours.

During labour I will be available by phone, text, or Facetime.