Nia Birth Services
Birth Professionals of the Bay Area
Bay area Birth Keepers
This agreement is between L. Samsarah Morgan and ____________________________________ and ______________________________
for the purposes of providing birth doula services.
Samsarah agrees to provide physical and emotional support as well as nutritional information to you before and during the birth of your baby, expected on or around the ___ day of ________ 200__.
Samsarah will provide a complete course of childbirth preparation or a childbirth prep. Refresher. If desired, a hypnosis for birth session can be included as part of your preparation for birth process. Hypnosis is optional and there is no additional cost for this.
Samsarah will assist and give information which will allow you to prepare a Birth Plan. This birth plan will be presented to the hospital staff and your doctors to inform them of your family’s intention to either have a natural child birth or a birth which excludes certain interventions. (Provided that no emergency condition exists in the pregnancy or labor process.)
Before and during the Labor, Samsarah will explain all interventions and hospital procedures to you fully.
Samsarah expects that your family will carefully consider all of her suggestions, however, your family has final say in your health care choices. You agree to take responsibility for yourselves.
You agree to contact me as soon as you feel that labor has begun. I will them meet you at our greed upon location, either home or hospital. Your hospital’s name and address is:
Have you taken a tour of this hospital? Yes ______ No ______
If no, I suggest that your family make such a visit before your 38 th week.
Our doctor/midwife’s name is: ________________________________
Our doctor/midwife’s practice name is ________________________________________________________________________
Address and phone number of doctor’s office:
Included in this contract is: unlimited prenatal visits, one home visit after the birth of your child (approx. 24 hours after the birth), one visit at 2 weeks postpartum, and one approx. 30 days after your child or children’s birth, this to be sure that all is well and to support those first days of breastfeeding and adjustment to family life.
Postpartum care beyond this can be arranged for an additional fee and a separate contract.
If your intention is to give birth to your baby at home or in a birth center, Samsarah will provide all the above services as well as accompany you to the hospital in the unlikely event of a transport.
In the event of unscheduled c-section, Samsarah can accompany the mom into the operation, should you partner be unavailable. Another option is to have Samsarah accompany the baby to the nursery so that the mom wont be left alone when her baby is take to the nursery for the necessary newborn assessments after the operation. Please check with your doctor to be sure that the hospital you plan to deliver in allows this.
Samsarah does not diagnose medical conditions in the mother or the baby, but will refer you to a health care provider when appropriate. She does not take over the care of your baby, but will assist you and your partner in preparing for this most wonderful even, your child’s birth!
By signing this agreement, you acknowledge that you have received Samsarah’s cell phone number as well as such numbers for her back up and/or assistants, or apprentice!
In the event of illness on my part or unlikely scheduling conflicts, a replacement doula from the practice Birth Professionals of the Bay Area will be sent to be sure that your care will continue uninterrupted. When possible, arrangements will be made so that you can meet this person in advance.
In the event a scheduled C-section becomes necessary – Samsarah will provide a complete preparation for the C-section experience. Samsarah will accompany your family on the day of the operation, to remain with mom in recovery while dad goes to the nursery after the operation to supervise the newborn procedures and over see the baby’s care. Depending upon mom’s rate of recovery, Samsarah many be able to assist with getting breastfeeding as soon as it is medically possible and comfortable for mom.
If, after your 38th week of pregnancy or the birth of the baby, which ever comes first, you decided that you do not want wish to use Samsarah’s services, no refunds will be given. The fee reflects her commitment to you as well as being payment for services rendered.
The fee for birth services is 1000.00 – 2500.00, sliding scale. If your intention is to give birth at California Pacific Medical Center (CPMC) the sliding scale is 1900.00 – 2500.00. Special pricing can be negotiated if your family requires it. Samsarah is committed to providing birth services to any family who desires it regardless of their ability to pay, so please discuss your needs with me!
The amount your family will pay is ________ . Samsarah expects a non-refundable deposit of ½ of this amount when you sign this contract. Final payment is required by your 38th week of pregnancy. This final payment is also non-refundable.
Payment arrangements are allowed as long as the total payment is rendered by the 38th week of pregnancy. If you are expecting twins or multiples, total payment must be rendered by your 30th week.
You are free to make payment using your mastercard/visa card via PayPal. Your email address is ___________________________________ .
Should you decide to pay your fee in full at the time of contract signing, you are entitled to a fee reduction of 5% of the total fee.
Samsarah thanks you for your careful consideration of this contact!
_________________________________ Client – Mom
_________________________________ Client – Dad/Partner
__________________________________ Doula – L. Samsarah Morgan