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Doula Service Agreement

As a Birth Doula, I accompany women all the way from having that beautiful bump to
holding their sweet newborn baby in their arms for the first time, and beyond. It is my
mission to help ensure an overall safe, evidence-based, and satisfying birth experience for
expecting mothers and their partners. I draw on my skills, knowledge, and experience to
provide physical, emotional, and informational support to women and families. I am
independent and self-employed which means as your doula, I am working for you -- not
for your caregiver or the hospital/birthing center.
As your Doula, I do not :
Perform clinical tasks or exams
Give medical advice regarding treatments
Make decisions for you
Speak to the medical staff on your behalf
Replace the role of your birth partner (unless we have previously agreed this is my role)
Share your personal information with anyone (unless you give me the permission)
Perform alternative/complimentary therapies (unless I am separately serving as your
Prenatal/Postpartum Massage Therapist, Placenta Encapsulator, or Yoga Instructor)

_____ Initials of Expecting Mother

_____ Initials of the Birth Partner, if applicable

I will meet with you and your partner at least once after week 30 of your pregnancy for
our prenatal appointment. Here we will explore and discuss your priorities and any fears
or concerns, discuss evidence-based information on the risks and benefits of common
interventions and procedures used during childbirth, and discuss your birth plans. Also,
we can practice guided imagery and/or breathing techniques if you choose, as well as
positions for labor and birth. I may also be available to offer separate services of placenta
encapsulation and prenatal/postpartum massage. All clients who sign on and receive my
birth services at $850 can also receive one in-home prenatal or postpartum massage
during a prenatal doula appointment, my gift to you! Each additional in-home prenatal/
postpartum massage is discounted to $50 (travel fees may be charged based on your
location), this offer is good until our care is complete at 6 weeks postpartum.
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It is important that you call me when you think you are in labor, even if you do not yet
need me. This gives me time to clear my calendar and arrange for childcare. We will stay
in contact by phone and can decide if I should come to you then, or wait for further
change. I usually need approximately 1-2 hours to get to you from the time you ask for
me (traffic makes a big impact). We will also decide where to meet - home, birth center,
or hospital. Except for extraordinary circumstances or births over 24 hours, I will remain
right with you throughout your entire labor and birth if that is what you would like. I will
step out in quiet moments when you have additional support to quickly pump breastmilk
once every 4 hours or so, then return again to your side. I work with trained/certified
backup doula colleagues and will arrange for birth support for you if a situation arises
where it is needed and I am unavailable, or for births longer than 24 hours so you can
continue to have the best support possible.
I will remain with you for 2 hours after the birth, until you are comfortable and your
family is ready for quiet bonding time together. I can help with initial breastfeeding,
positioning, and help facilitate kangaroo (skin to skin) care. I am available to answer
questions about the birth or your baby, prepare a comfortable bonding space for you,
and make sure you are eating, drinking and preparing to rest. If you are choosing to
encapsulate your placenta, I will immediately place it in my cooler bag and will leave
your birth location with it. That same day, I will begin the process of creating your prints,
capsules, cord keepsake, and tincture in my preparation location. I will schedule a followup meeting within a few days of the birth to visit you and the baby, deliver your finished
placenta services, help with some postpartum needs, offer baby care tips, and review the
birth experience with you.
As a doula, I can help you prepare for your birth, but I cannot guarantee that your birth
will go as planned. If you plan a vaginal delivery and a cesarean is performed after the
onset of labor, I will continue to provide support during the cesarean surgery (as allowed
by hospital and/or doctor policies) as well as immediately after to help with your physical
comfort, emotional support, and breastfeeding. I will also follow-up with you after the
birth, as I do with all my clients.
I will make every effort to provide the services described here. If my failure to attend
your birth is due to my error, you have the option of a refund (all except retainer fee). If
my failure to attend your birth is due to an error on your part, such as failing to call me
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with enough warning, no refund will be given and I will keep my full fee. If my failure to
attend your birth is due to a rapid or precipitous labor (baby is born less than 1.5 hours
after you call me and ask me to come), I will provide an additional 3 hours of postpartum
support at no cost in your home. Any other circumstances out of my control that result in
my absence at your birth will be addressed on a case-by-case basis, and may or may not
result in a refund.
Any time you have questions or concerns, call, text or email me. I am here to support and
assist you! Fear/doubts can negatively impact birth. Please do not hesitate to ask me any
questions so we can move forward in helping you have your best birth possible!
PRENATAL ~ After 36 weeks, contact me after each of your prenatal appointments with
an update on how you are doing physically and emotionally. If you opt for your OB/
midwife to examine you, please inform me of the position (ROA, LOP, etc) and station
(-2, -1, etc) of your babys head. This helps me plan the best way to help baby be
encouraged into the correct position and increase your comfort level during childbirth.
Evidence shows that dilation and effacement of your cervix are not an accurate way to
determine where women are in regards to birth, however you are free to discuss this
information with me as well if you choose.
LABOR ~ When you begin to feel sensations such as contractions, call me and let me
know! If you are in labor, if you lose your mucous plug or have bloody show, or if you
begin true contractions that you're unable to talk through, or if you think your bag of
waters has released (remember: it could be a gush or a leak), call me immediately during
daytime hours (7AM-8PM) so I can prepare to join you when you need me. If a
circumstance has kept me from immediately answering my phone, leave me a voicemail
or send me a text message and I will promptly return your call and discuss how to assist
you. KEEP ME UPDATED! At this point I recommend that you stay in touch with your
OB/midwife to update them with your status. Because I am on call for you from 38
weeks to 42 weeks gestation (meaning I drop what I am doing and go when you are in
serious, active labor), I will fully wake up and be prepared to leave if I receive your call
after hours. Call me when you are ready for me to join you and you need my help. Please
review my 18 Hour Clause on the next page to help you decide when to call me. If you
can easily handle the contractions in the early phase of labor, be sure to stay hydrated
with fluids and try to sleep between contractions! Even small cat naps will help you be
ready for the rest of your labor. Try taking a warm bath to help your body relax. Time
your contractions. Typically, intense waves are about four minutes apart, last one minute,
and are very strong. You may decide to call me to come join you when your labor begins
to feel intense. For many (but not all) women, this is when you start voicing each one.
Above all, my priority is your emotional and psychological state. When you feel you
really need my help, I will support you!
Bump to Baby Birth Services // Dana Cluff, Birth Doula, Placenta Professional, Licensed Massage Therapist //

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As a highly trained and experienced LMT and Birth Doula through BAI, I am proud to be
able to offer the highest level of professional labor and birth support at an affordable price,
with the option of payment plans. 18 Hour Clause: I certainly hope for active labors to not
exceed 18 hours for all involved, but sometimes they do! For births in which I offer inperson labor support for longer than 18 hours, I will bill for $25 each additional hour. This
protects me from moving in with laboring families as soon as Im on call for them, and
ensures that I am giving you my best support! $300 cap. We can always discuss your labor
progress and options on the phone/Facetime in easy early labor. The clock starts when I
arrive at your home or hospital, if you send me home until labor is more established, the
clock is paused until I arrive again.
$850 Bump to Baby Birth Support Package

Includes: initial interview, support throughout pregnancy via phone/email/text, links to latest research for birth, access to lending
library of recommended books and resources for pregnancy birth and baby care, one 60 minute in-home prenatal massage, $20
off additional prenatal/postpartum in-home massages with Dana, $150 pricing for placenta services (tincture, encapsulation,
prints, cord keepsake), list of care providers/chiropractors/birth classes (etc) if requested, one prenatal appointment to practice for
birth and discuss your plan, assistance writing birth plan if requested, on-call readiness for the two weeks before and after your
estimated due date, essential oils and diffuser while you labor, birth moments captured from another point of view through
pictures and videos, full support at your birth including labor massage techniques, two hours of immediate postpartum care, one
postpartum appointment, phone/email/text support until 6 weeks postpartum and our care is complete

Pricing for (Mothers name)__________________________________s birth is as follows:

$300 as a retainer fee at the signing of this contract to hold your place in my birth
calendar, which is nonrefundable. Remaining $550 is due by the end of your 37th week
of pregnancy. I cannot go on-call for you at the 38th week mark (including backup doula)
unless all fees are paid.
Will you be receiving Placenta Encapsulation and Keepsake Services?

Yes. I would like for Dana to provide placenta encapsulation, 2 or more prints, tincture,
and an umbilical cord keepsake and will include $150 in the total amount due.
At this time, I am not interested in taking advantage of Danas placenta services.

Do you live 30 or more miles outside of the 75067 zip code? If yes, there is an additional
one-time travel fee of $50 (for gas, toll fees, driving time, wear on vehicle, etc).
Yes. I have confirmed with Dana and will include $50 in the total amount due.
No. I have confirmed with Dana and will not be charged the additional travel fee.

TOTAL INVESTMENT for birth support package = $__________

Payments can be made by check, credit/debit card in person,
or via PayPal to

Mother ______
Birth Partner, if applicable ______

Bump to Baby Birth Services // Dana Cluff, Birth Doula, Placenta Professional, Licensed Massage Therapist //

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I, ____________________________, have read this entire contract describing Dana

Cluffs birth doula services and agree to enter into a client-doula relationship for the
pregnancy and birth with an Estimated Due Date of ___/____/____.
I understand that Dana is a birth and massage professional and will keep my personal
information private. I understand that modest images of my birth/baby/family may be shared
through this business as advertising or celebratory means, that Dana will ask my permission prior
to sharing, and that I can choose which images I would like shared and when. I am aware that
Dana cannot guarantee that placentaphogy in any form will give me a certain desired result, as
each pregnancy, birth, and hormonal make-up within the placenta is unique unto itself. I promise
to pay the full amount that I owe in a timely manner, and I agree with the services laid out in this

Birth Center


I am planning on birthing at:


Mother ______
Birth Partner, if applicable ______


Name and physical address of birth location:

Home Address (if not above):
Mothers Phone: (_____)______-_______
Birth Partners Phone: (_____)______-_______
Emails: ________________________________, ________________________________
Clients (Mothers) printed name: _________________________________
Signature: ____________________________________________ Date: ___/____/_____
Birth Partners printed name: _____________________________________
Signature: ____________________________________________ Date: ___/____/_____

Doulas signature: ______________________________________ Date: ___/____/_____

Bump to Baby Birth Services // Dana Cluff, Birth Doula, Placenta Professional, Licensed Massage Therapist //