Financial Agreement + Consent Form

Please read this agreement in full. You'll sign it electronically when you pay your deposit.

Midtown Birth Center provides a facility for the delivery of your baby. This agreement covers use of the facility for labor and birth only. No prenatal or postpartum care, laboratory testing, ultrasounds, or medical management are included in this agreement. Prenatal care will be provided by your own licensed midwife who will also be responsible for your clinical care during the birth. Your midwife will remain with you at the center at all times.

Consent

I acknowledge and agree that:

  • I am under the care of a qualified, licensed midwife who is affiliated with Midtown Birth Center and responsible for my clinical management during labor, birth, and immediate postpartum.

  • I understand that the Birth Center is not a hospital and does not provide emergency medical services. I have discussed and arranged an emergency transport plan with my midwife should transfer to a hospital become necessary.

  • I agree to comply with all Birth Center policies and procedures regarding facility use, sanitation, and discharge timelines.

  • Most families head home 2–4 hours after birth. If I choose to stay longer than 6 hours after birth, an extended-stay fee of $100/hour applies. If my midwife recommends a longer stay for my or my baby's health, there is no extra charge.

  • I assume full responsibility for my decision to give birth at Midtown Birth Center and hereby release Midtown Birth Center, its owners, and staff from liability arising from the use of the facility.

Financial Agreement

1. Facility Fee: $1,000

  • This fee covers use of the birth suite, basic supplies, use of the birth tub, linens, and cleaning.

  • The fee does not include midwifery services, clinical care, medications, laboratory testing, or emergency transfer costs.

2. Payment Schedule

  • A nonrefundable deposit of $500 is due at the time of booking to secure your date.

  • The remaining $500 balance is due no later than 36 weeks gestation.

3. Refund Policy

  • The deposit is nonrefundable.

  • The remaining balance is refundable only if written cancellation is received before 36 weeks or if the facility becomes unavailable due to circumstances beyond the client's control.

4. Additional Charges

  • Additional cleaning or damage beyond normal use may incur fees.

  • Stays longer than 6 hours after birth, by the family's choice, are billed at $100/hour. There is no extra charge when your midwife recommends a longer stay for your or your baby's health.

Signing

When you pay your deposit, you'll confirm each statement above, add your client information (primary midwife, doula, estimated due date, and emergency contact), and type your full name as your electronic signature. A partner signature is optional. Your order confirmation is your signed copy.