Gentle Beginnings - Doula Contract & Registration Form
Childbirth is a life event that significantly impacts a mother’s physical and emotional well being and an experience she will remember for the rest of her life.
I believe that birth is a normal physiological process and an important journey in a mother and father’s life. It is also an important event for the baby. As your doula it is my aim to help ensure a safe, satisfying and positive birth experience to achieve the type of birth you would like. At no time will I take over or deliberately exclude your partner. I am there to provide support to you and your partner at all times.
I support you during your pregnancy, labor and in the postpartum period in whatever choices you make and will draw on my knowledge and experience to provide emotional support and physical comfort. I will communicate with the medical staff to make sure you have the information you need to make informed decisions as they arise in labor.
I can provide reassurance and perspective to you and your partner, make suggestions to help labor progress, and help with relaxation, massage, positioning, and other techniques for comfort. I am independent and self-employed and will be working for you, not your care-provider or hospital. At the same time, I cannot over-ride their authority in certain aspects that legally bind them as your careprovider, but can encourage you to assert your preferences. 
I guarantee complete confidentiality of all details relating to your pregnancy and birth.
It is very important that you and your partner are comfortable with me and with my role during labour and birth.  If you or your partner decide that our interaction doesn’t “feel quite right” I encourage you to say so.  
Nadine Ghows

Following are the terms of the contract:

Once you have requested me to act as your doula, I will arrange up to TWO antenatal visits.
1.1  Antenatal visits:
-      Sign the contract on first visit (if you haven't done so online)
- Explore and discuss your priorities, fears, concerns and questions you might have
- Meet with your partner and plan how we might best work together and exactly  what you and your partner want from me as your doula  
- Discuss BIRTH PREFERENCE options
- Personal information - e.g. when you will call me in labor, where to meet - home or hospital etc.
- Unlimited phone and e-mail support
- Access to my lending library (RM 50.-- deposit/book/month)
- In case the books/DVDs get damaged or lost, the client is fully responsible to replace the literature.

I will be on call for you 24 hrs a day beginning 14 days before your estimated due date, and 14 days after.  I will not leave town without advising you unless it is an emergency or an event unknown at the time of the signing of this contract. In such a case, I will arrange for a substitute doula to be available.

1.2  During labor:
-      I must be notified early at the onset of labor or if your  waters has broken or if you have a birth show, even if you do not need me yet. This is so that I may make arrangements to attend your birth.
-      You will allow me approximately 1-2 hrs to reach you.
-      Decide whether to meet at your home or at the hospital.
-      Provide early labor support as requested, including in your home.
-      I will remain with you once active labor has begun (except for extraordinary private circumstances).
-      I will strive to maintain a calm and peaceful birth environment
-      I may take short breaks for prayers and light meals if time and circumstance allows. This will be discussed with you at the time and I will not leave you if it is inappropriate.
-      For example,  I may go home and tend to my children if it is the early stage of labor and return later when labor is more established.
-      I will take photographs if desired.
1.3 Postpartum:
-      I will stay with you for about 1 hr after delivery, until you are comfortable and your family is ready for quiet bonding time.
-      During this time I can take photographs of your new family.
-      I will visit you within the first week after the birth of your baby either at the birth place or at your home to see how you are doing, to review the birth and to admire your baby.
-      Additional postpartum visits can be arranged with supplemental charge.
2.0  AS A DOULA:  
I do NOT perform clinical tasks, such as take blood pressure, fetal heart checks, vaginal exams, or other medical procedures. I do not dispense any medical advice. I am not a health care professional.              
I do NOT make decisions for you; however, I will help provide you with information necessary to make informed decisions. I will also remind you if there is a departure from your Birth Preferences.  
 I do NOT over-ride the authority of the medical staff on certain matters. But I will discuss your concerns with you and remind the medical staff of your preferences.
I do NOT take over or deliberately exclude your partner’s role. Instead, I will provide support to both of you at all times at a level that suits your comfort.  

3.0  FEES:
RM 2800.— (total fee)
-   including - up to 2 pre-natal visits
 -  support during entire time of labor and 1 - 2 hrs after the birth
-   1 postpartum visit.
RM  1000. — upon signing the contract - whether via this online form or in-person.
RM  1800.— at post natal visit or latest 7 days after giving birth (whichever  date comes first). This payment is considered as final payment.

Repeat client or HypnoBirthing/ Amani student:    
RM 2600.—  (total fee) including 1 pre-natal visit, otherwise above applies. (Rm1000 deposit)

If you would like additional antenatal or postnatal visits there will be a charge of an additional RM 150 per visit on weekdays or normal office hours (Mon - Fri 9am – 6 pm)
Weekend/Evening fee would be at a cost of RM 200.--
*In case of cancellation of a signed contract before attending labor the following will apply:
-    No prenatal visits done - refund of 50% of first payment 
-    1 or 2 prenatal visit(s) completed - 1st payment Non-refundable
If after signing this contract you plan to have an elective caesarean the above applies.
If after signing this contract, you plan to have an elective caesarean and do not require me to be with you immediately before and after the birth of your baby, an amended service is available. The referred service must be defined based on a mutual agreement.  
Should I fail to attend your birth due to circumstances beyond anyone’s control (extremely rapid labor and birth, your inability to inform me, etc) you will not be charged further and a postpartum visit is optional at a fee of RM 150.--

If your baby arrives unexpectedly at home in my presence, you or your partner will be responsible to receive your baby. After the birth, I can help you arrange transport by ambulance to the hospital. I am not responsible for receiving your baby or performing any clinical skills related to the birth of your baby.

**Please contact me to make sure I am available during your Estimated Due Date BEFORE filling in this form**

If you are agreeable to the above terms, please transfer the deposit to MAYBANK 112353151706 Nadine Ghows, and fill in the details below. Please email to notify me and we will set up an appointment to meet as soon as possible.
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Mother's Name *
Mother's Age *
Mother's Occupation *
Mother's Email *
Mother's Handphone Number *
Address *
Father's Name *
Father's Age *
Father's Occupation *
Father's Email Address *
Father's Handphone Number *
Birth Order *
Estimated Due Date *
Doctor's Name *
Hospital *
Any other information I should know
How did you find out about Gentle Beginnings Doula Services? *
Amount of Deposit Paid *
Method of Payment *
Date Deposit Made *
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