This is an agreement between Transitions Midwifery Services, LLC, (hereafter “the midwives”), and ____________________ and _________________________________, the undersigned expectant parents.

The parties agree as follows:

  • Philosophy and responsibilities of the midwives

Pregnancy, birth, and breastfeeding are natural, normal functions of a woman’s mind, body, emotions, and spirit, all of which are equally important.  As midwives, we seek to nurture a woman’s sense of personal strength and self confidence so that she may realize birth as an empowering and enlarging life experience.  We do not feel we “deliver” babies; we assist and support women to give birth.  We believe that women are uniquely suited to attend other women during this life passage.  Most of the world’s women give birth with midwives who serve as guides to the total pregnancy experience.   Birth at home among family members, coupled with continuous care by skilled attendants, can provide an optimal environment for the majority of women.  When birth is integrated into life as a family event, the family is strengthened as well. 

As care-givers, our clinical skills, intellects, and intuitions all serve as valuable tools in our work as guides to understanding the process of pregnancy and birth.  We believe the things which matter most in creating a physically healthy pregnancy are those things you have the most control over, including good nutrition, exercise, and the elimination of tobacco, alcohol, and drugs.  On an emotional, psychological, and spiritual level, we recognize that birth is not an event which is isolated from the totality of a woman’s life.  We endeavor to assist women to become as conscious of their personal processes as possible so that they may have a broad base of resources to draw on during their birth experiences.  Our responsibility is to make you aware of any concerns we have based on our past experience and current perception.  We seek to offer informed choice, not merely informed consent.  You are our clients, never our patients.  Any decisions regarding options are yours to make.  At the same time, there are limit to what we are willing to take on as responsible care providers.  When and if our limits are reached, we will let you know immediately.

We offer our services as a team working in partnership with clients before, during, and after the birth of their child.  For us, midwifery is a continually evolving process and we are always learning from our experiences.  Working in partnership with clients means we are supporting you to create your own experience.  You are responsible for the birth and we are assisting you in taking that responsibility.  It also means that we must all be in agreement regarding the care needed and our ability to provide such care.  Complete prenatal care creates the opportunity to develop a relationship before the birth as well as to establish the parameters of well-being unique to each individual client. 

Any environment, whether home, hospital, or birth center, presents a distinct set of risk factors for birth.  Nothing can guarantee a perfect outcome.  We believe each woman has the right to an informed choice of the environment she perceives as safest for her and her baby.  Many women do not appreciate mainstream obstetrics’ approach to pregnancy as a problem waiting to happen.  Our care reflects their own desire to trust birth and themselves.  For such women, homebirth is a logical choice.  We endeavor to create an environment which supports women in opening to their own intuitive process rather than imposing artificial interventions or attempting to make labor conform to a specific pattern.  When allowed to follow its natural course, pregnancy usually results in the birth of a healthy baby and mother.  The range of natural variation is extremely wide.  Occasionally, a critical situation arises during pregnancy or labor which necessitates specialized care that cannot be provided in a home setting.  In such cases, a previously established medical back-up system will be relied on for appropriate care.

  o Prenatal Care

We strongly believe that preventative health and prenatal care are the best ways to avoid complications.  We believe that prenatal care is given to your baby every day by you and monitored regularly by us.  Regular care occurs monthly until the seventh month, twice monthly in the seventh and eighth months, and weekly for the ninth month until birth.  Additional visits may be scheduled as necessary. 

 South Carolina (SC) law requires you to have two additional visits with a physician during this pregnancy, with one occurring in the last six weeks of pregnancy.  At this visit, the OB or CNM must sign some documents (which we will provide) that verify you are an acceptable, low-risk candidate for a home birth.  Again, this is a requirement of the Department of Health and Environmental Control, who regulates the licensed midwives in SC. 

  o Labor and delivery

We feel it is important that parents have the kind of birth they want, as long as their desires do not fall outside a reasonable realm of safety.  We are present to help you meet those needs.  We will help coach you if you wish or leave you to labor alone or as a couple with minimal interruptions.  We will always try to honor your requests regarding the delivery itself.  We will stay after the birth until everyone is stable.

  o Postpartum

Regular home postpartum visits are usually on day one and day three by a midwife, with an additional visit on day five if needed.  Telephone assessments will be done on day two and day four.  We encourage couples to have a friend or relative come to stay with them after the baby is born or to contact a doula service to aid in the chores.  We strongly urge parents to have the baby seen by their pediatrician within the first week of life, or sooner if there is a cause.

  o Legal Status

Direct Entry Midwifery is legal in SC.  We are licensed by the Department of Health and Environmental Control which allows us to practice midwifery by virtue of an approved course of education, clinical experience, and licensing examination.  All clients are encouraged to visit the website and click on the “Regulation 61-24” link to view the regulations under which SC Licensed Midwives practice.  If no internet access is available, a copy is available for clients to borrow.

  o Expectations

We expect honesty from couples we help and they can expect the same in return.  We expect couples to be well informed about home births, and to take seriously the special responsibility they bear for their health, pregnancy, and preparation for their labor and birth.  Please let us know what you expect from us.

The midwives reserve the right to resign at any stage of the pregnancy if we believe it is necessary to do so.  We will discuss with you fully the risks, our concerns, and our reasons if this becomes necessary.  Risk assessment is a tool we use from our initial consultation to six weeks postpartum to ensure you the most appropriate and best care possible.


  • Philosophy and Responsibility of Parents

We have chosen to have a home birth based upon what we believe to be a thorough examination of the alternatives.  We have discussed our prenatal care and birth options between ourselves, and with other knowledgeable people to the extent we think necessary.  After considering these options we have asked Transitions Midwifery Services, LLC,  to assist us in our home birth.

• In addition to the agreements above, we also fully understand and agree as follows:
• It is impossible at a home birth to provide the same type of care that is available at a hospital.  We are fully aware that in the event of a complication or emergency there are fewer alternatives available at a home birth then would be available in a hospital.
• We believe that birth is a natural, generally safe process.  We have, however, discussed some of the problems which can arise in childbirth and feel comfortable with our decision.
• It may become necessary during the birth to transfer the mother and/or child to the hospital.  We may choose to go to the hospital at any time.  If the midwives in attendance believe it is necessary to transport mother or child to the hospital, either before, during, or after the birth, we agree to go to the hospital upon their request. 
• We agree to take the baby to a pediatrician for a newborn exam within one week of the birth.
• We agree to be seen by an OB or CNM for the two required visits prenatally.  We agree to follow our midwives’ recommendations regarding healthy pregnancy, labor, and birth.
• We agree to comply with prenatal testing, including Hepatitis B and HIV for the safety of the mother, child, and midwives.
• We agree to participate as a couple in natural childbirth classes unless our midwives specifically indicate that this is not necessary due to our previous experiences.
  

  • Financial Agreement

A clear understanding of our financial obligation to the midwives helps insure a smooth working relationship.   Toward that end we have expressly entered into this financial agreement:

• By the 37th week of pregnancy, we agree to pay $_____ for the birth.  If filing insurance, $200 will be added to this total to cover billing services fees, making the final total $______.  We understand that if not paid in full the midwives are not obligated to attend the birth.  Should this be the case, the midwives will notify the parents immediately by phone or in person.
• We agree to pay a gratuity of $100 to the birth assistants/apprentices at the time of the birth.
• We agree to pay for all supplies, lab work, medical visits, and childbirth classes requested by the midwives.
• We agree to payment on the following schedule:
•     a. Non-refundable deposit:  ______________, upon this contract agreement.
•     b. Prenatal payments:  ________________, due on day of service.
• Transitions Midwifery Services, LLC, maintains a no refund policy.If during labor it becomes necessary to transport to the hospital because of a complication, we realize that the midwives will have done their job to assess an abnormal situation and we agree that the midwives will be paid in full.
• The midwives will be paid in full if they arrive after the delivery as a result of a delayed notification or a precipitous (very quick) birth.

Transitions Midwifery Services, LLC, and the parents each promise to work to establish an atmosphere of trust and cooperation that will contribute to a healthy, safe, and rewarding birth experience.

LM_________________________________________________  Date__________

Parent_______________________________________________  Date__________

Parent_______________________________________________  Date__________