Made for This Birth, LLC
Virtual Birth Support Letter of Agreement and Fee Contract

Please read and sign the following form in order to secure virtual birth support services. Downpayment can then be made via Venmo, check, 

By hiring Mary Haseltine as your virtual birth support you will receive:

• One virtual prenatal consultation lasting 1 to 2 hours long. This is for the mother and doula to get to know each other, to learn the mother’s plans and desires for birth, for the doula to discuss how she can best support the mother in her plan, to provide birth plan support and help with information in making decisions, and to discuss a plan of action at the time of labor and birth. 

• Text and email contact throughout pregnancy for concerns or questions 

• On call support availability 24 hours a day, 7 days a week starting at the beginning of the woman’s 37th week of pregnancy for emotional and informational support and the onset of labor. In the case of a premature birth, the doula will still make every effort to be with the client and provide the same availability and support depending on the specific circumstances.

• Continuous labor support via FaceTime or phone beginning from the time of suspected active labor laboring through the first 1 to 2 hours of the early postpartum period

 

• One virtual postpartum meeting during the 6 week postpartum period lasting 1 to 2 hours long. This meeting is for processing the labor and birth experience, breastfeeding support, emotional support, and informational support.

In the unlikely event that I am unable to get to the birth due to emergency, illness, or another client in labor, a refund of 50% will be given.

 

In the event the birth becomes a cesarean section, either planned or unplanned, I will still offer support before surgery, remain virtually available during the surgery , and stay available 2-3 hours after the birth for recovery, baby care, and breastfeeding support. 

 

 

As your birth support, I am working for YOU, not your caregiver or hospital.

Throughout our relationship I will provide the following to the best of my ability:

  • Information for empowered decisions regarding your pregnancy, labor, birth and in the early postpartum period.

  • Education in the physiological process of labor, birth, and postpartum.

  • Emotional, informational, and spiritual support during labor and birth.

  • Facilitation of communication between laboring woman/couple and healthcare providers.

  • Confidence, encouragement, and recommendations for the best birth experience possible.

  • Suggestions and techniques to facilitate an uncomplicated labor thereby reducing risk and improving outcomes for you and your baby.

  • Encouragement, help, and tips for your partner to support at his and your comfort level.

 

A Doula Cannot:

  • Give medical advice, clinical exams, diagnosis, or treatment.

  • Take the place of your partner. A doula should enhance their ability to support you and give them tools to participate in the birth at a level with which you are both comfortable.

  • Make decisions for or on your behalf. I will help you get the information necessary to make decisions and will remind you if there is a departure from your plan. I will not speak to the staff for you but will help you in speaking for yourself.

  • Guarantee specific health or birth outcomes for mother or child.

  • Override your decisions or those of the provider you have chosen.

 

CLIENT EXPECTATIONS

As my client, it is my expectation that you will:

• Do your best to make healthy choices during pregnancy and take empowered responsibility for your birth plan decisions.

• Be honest with me regarding your history and your expectations for the birth and how I can best help you.

• Recognize that you are the primary decision maker for yourself and your baby.

• Keep me informed of important updates regarding the pregnancy, baby, and birth plan decisions.

• Keep appointments and let me know as soon as possible if an appointment needs to be cancelled or rescheduled.

• To communicate with your provider that you have hired birth support to assist at the birth and to communicate your birth plan to your provider.

• Prepare and keep any devices necessary on hand  and charged (phone, iPad, etc.) to facilitate my virtual support.

• To call or text me when having any signs of labor so I can be prepared to be with you.

The rate for complete virtual birth support services is $600.00

 

This fee covers the following care:

  • One prenatal virtual meetings lasting 1-2 hours 

  • On call virtual availability 24/7 starting at 37 weeks through the birth of the baby

  • Text and email contact throughout pregnancy to answer questions or give updates

  • Continuous support through active labor, birth, and early postpartum

  • One virtual postpartum meeting during the 6 week postpartum period

 

A non-refundable down payment of $100 is due upon signing this agreement.

(PayPal: mary@madeforthisbirth.net or Venmo: @maryhaseltine)

The remaining $500 is due by the mother’s 36th week of pregnancy.

(PayPal: mary@madeforthisbirth.net or Venmo: @maryhaseltine)

In the event that a circumstance beyond our control (such as a very fast labor) prevents the support of your labor and birth, a portion of your fee may be refunded to you, depending upon the circumstances. If the client fails to notify me of labor or fails to call or FaceTime at the birth due to their own negligence, choice, equipment failure, or otherwise after they have retained my services and paid, their payment will not be refunded to them. 

In the event that a client chooses to discontinue services prior to 36 weeks of pregnancy but having paid part or all of the balance, a refund of 50% of the payment minus the $100 down payment will be given. After the 36th week of pregnancy no refunds will be given. 

 

I do not work directly with insurance companies but am happy to provide a coded receipt for you to submit to your insurance or health share plan for reimbursement.

I have read and understand the Letter of Agreement for Virtual Birth Support Services and Fee Contract. I agree to take full responsibility for all my health care decisions. Mary Haseltine and Made for This Birth, LLC will not be held liable for any consequence to me, resulting from decisions that I make regarding my pregnancy, labor, or birth. I recognize that Mary Haseltine and Made for This Birth, LLC are not medical professionals and not responsible for any health outcomes resulting from the services retained.

By signing and initialing this form I agree to all of the aforementioned terms and conditions:

Thanks for submitting!