How to Create Professional Doula Service Packages and Contracts

By Birth & Baby University · Last updated: October 2026 · 4 min read

A service package tells a family what they will get, and a contract tells both sides what happens when life does not go to plan. Doula organizations and Medicaid programs publish more guidance on this than people expect, mostly as standards of conduct. This article summarizes what those documents say about agreements, backup, confidentiality and billing, how payers structure visits, and what to include when you draft your own packages with legal review.

Key takeaways

• DONA’s standards say backup arrangements, including if a backup is not an option, should be clearly stated in the contract or letter of agreement, and that a doula who must discontinue service should notify the client in writing and refer to replacements if the client wishes.
• The Illinois Medicaid-certified doula guide says doulas describe their scope of practice in writing, describe service agreements clearly and have both parties sign, and bill transparently and accurately.
• Payers package services differently; for example, a 2025 National Health Law Program table lists New Jersey standard care for clients with up to 8 visits and enhanced care for 12 visits.
• Qualitative research suggests flat per-client fees can fail to cover a doula’s unpaid time.

What the research and guidance say

What standards expect

The DONA birth doula standards (revised September 2025) say the doula should make reasonable efforts to provide services as outlined in their contracts, make backup arrangements whenever possible, state all backup arrangements in the contract or letter of agreement, and, if discontinuing service to an established client, notify the client in writing and refer to potential replacements if the client desires. The postpartum standards say the same for rescheduling and backup arrangements. The Illinois Medicaid-Certified Doula Guide lists, under fair dealing, communicating scope of practice in writing, describing service agreements so both parties can sign to acknowledge the terms, complying with health insurance and Medicaid standards and providing transparent and accurate billing. Under continuity of care it lists being forthright about planned absences, identifying backup doulas with clients, giving backups the client information they need and holding it with the same respect for privacy, and providing referrals for needs outside scope. It also requires following the HIPAA Privacy Rule training. These are standards for particular organizations and programs.

How payers package visits

The National Health Law Program’s January 2025 update shows that states pay in different units. Its table lists, for example, New Jersey rates for standard care with up to 8 visits and enhanced care with 12 visits, and California rates that differ for vaginal and cesarean birth. The update also cites reports that doulas spend an average of thirty-six hours with each client, excluding transportation. If you accept Medicaid, your packages must fit the payer’s visit and billing structure, which can differ from private-pay packages.

Flat fees and unpaid time

A San Francisco case study found that leaders and doulas in a community doula network reported that a flat fee per client did not adequately compensate doulas for training and extra support, such as referrals to promote housing and food security. That was one organization’s contractor approach, not necessarily an independent private practice.

What this means for doulas

• A package is a promise of time and a boundary around it. State what is included, what is not and what happens if the client needs more.
• Backup is a contract term, not a favor. Name your backup process or state that you cannot guarantee one.
• Scope belongs in writing. The standards expect it, and it protects both sides.
• Confidentiality and billing should be spelled out. Say who may see client information and how invoices work.
• Get legal review. Contract law, refund rules and consumer protection differ by state.

Putting the evidence into practice

• Describe each package in plain language: number and length of prenatal and postpartum visits, on-call window, labor support rules, how contact works between visits and what happens after birth.
• Include a scope-of-practice paragraph that matches your certifier’s standards, and a statement that you do not give medical advice.
• Write the backup arrangement, and what happens if neither you nor a backup can attend.
• Add how either side may end the agreement, how notice is given and how fees are handled, and have a lawyer check these terms for your state.
• State what personal information you keep, how it is protected and when it is shared with a backup or the care team.
• Track hours per client, then adjust package scope or fees at your next review.

The bottom line

Professional standards ask doulas to be clear about scope, backup, confidentiality and billing in writing. Build your packages around the hours they truly require, write the terms plainly and have an attorney in your state review the final agreement.

Related reading: Understanding the Doula’s Scope of Practice: Ethical Boundaries and Professional Responsibilities; How to Build a Doula Business Plan That Supports Long-Term Growth; Understanding the True Cost of Running a Doula Business.

This article is for professional education. It is not medical, legal, financial or tax advice. Check the standards of your certifying organization and the rules where you work.

Sources and further reading

• DONA International. Birth Doula: Standards of Practice (revised September 2025). Read the source
• DONA International. Postpartum Doula: Standards of Practice (revised September 2025). Read the source
• SIU School of Medicine. Illinois Medicaid-Certified Doula Guide (posted December 2024). Read the source
• Peters R, Robles-Fradet A. 2024 Update: Medicaid Coverage for Doula Care Requires Sustainable and Equitable Reimbursement to be Successful. National Health Law Program, January 2025. Read the source
• Gomez AM, et al. “My 9 to 5 Job Is Birth Work”: A Case Study of Two Compensation Approaches for Community Doula Care. International Journal of Environmental Research and Public Health 2021. Read the source

Clear agreements are part of professional practice. Birth & Baby University’s For Doulas page outlines training and mentorship that can help you prepare your services. Have a licensed attorney in your state review any contract before you use it, since this article is not legal advice.

More for professionals: the Professionals Blog.