Midwifery / Home Birth Services Agreement

# Midwifery / Home Birth Services Agreement This Midwifery Services Agreement ("Agreement") is entered into as of ___________ by and between: **Client:** ___________, residing at ___________, telephone ___________, email ___________; and **Midwife / Practice:** ___________, license number ___________, issued by ___________, practicing as ___________, located at ___________. --- ## 1. Scope of Midwifery Care The Midwife agrees to provide out-of-hospital maternity care during the prenatal, intrapartum, and immediate postpartum periods, including but not limited to: prenatal visits, fetal monitoring, labor support, birth attendance, newborn assessment, postpartum home visits, and breastfeeding support, as clinically indicated. Estimated due date: ___________. Planned birth location: ___________. Care is limited to low-risk pregnancies within the Midwife's licensed scope under the laws of ___________. Gynecologic care, genetic testing, and high-risk obstetric management are outside the scope of this Agreement. --- ## 2. Client Eligibility and Risk Assessment The Midwife will perform an initial and ongoing risk assessment. If at any point the client develops conditions outside low-risk criteria (including but not limited to preeclampsia, gestational diabetes requiring insulin, placenta previa, fetal malpresentation unresolved near term, or prior classical uterine incision), the Midwife may require transfer of care to a licensed physician or hospital. The client acknowledges and accepts this condition. --- ## 3. Informed Consent and Known Risks of Out-of-Hospital Birth The client has been informed of and understands the following risks associated with out-of-hospital birth: **Maternal risks:** postpartum hemorrhage, prolonged or obstructed labor, uterine rupture (elevated in clients with prior cesarean), infection, retained placenta, anesthesia unavailability, and maternal death. **Fetal/neonatal risks:** fetal distress, birth asphyxia, shoulder dystocia, umbilical cord prolapse, neonatal resuscitation requirements, and neonatal death. The client understands that these risks are greater in out-of-hospital settings than in a hospital with immediate surgical and anesthesia capability. The client has had opportunity to ask questions and has received satisfactory answers. --- ## 4. Emergency Transfer Protocol **This clause is load-bearing — read carefully.**