doularegistration

How a doula sets her fees is a mystery to many people.

I offer this information so that you have a better idea of what you are paying for.

(Adapted from www.gentlebirth.org)

Hours - Couples having a first baby may imagine that their doula will only be spending a few hours with them during the labor and birth. In reality, an eight-hour labor would be considered pretty fast; most first labors last at least 24 hours; the longest continuous time I've spent providing labor support is 60 hours. The average number of hours I spend with a woman during her labor, birth and recovery is about 16-18 hours. I spend another 5-8 hours in prenatal and postpartum visits, another hour or two in phone calls or email, 4-8 hours of photo editing and up to six hours of travel time.

Consequently, there is no such thing as going off shift or setting a pre-determined number of working hours.

Clients per Week - When I make a commitment to be available to attend you in labor, I have to limit the number of clients I put on my calendar so as to avoid birth conflicts and to ensure that I am reasonably rested when you go into labor. The rule of thumb for birth professionals providing in-home services (compared to someone working a shift in a hospital or sharing call with another provider) is that one client per week is a full schedule. Because I also do a lot of teaching, I find that two to three clients per month is a full-time workload.

Clients per Year - When I put your due date on my calendar, I commit to being available three weeks beforehand and two weeks after that date. If a complication arises prior to your 37th week, I will do my best to be available to accompany and/or assist you with that situation as well. This means that when I schedule a vacation, or attend a conference, or have a another commitment, I have to add another five weeks during which I cannot accept clients. There is always the possibility I may have to cancel vacation plans or my attendance at a conference in order to be able to accept a new client. My clients hire me with my backup on-call during times that I am definitely unavailable such as when I am scheduled to teach my Birth Preparation Workshop or am experiencing an illness.

Being Self-Employed - The rule of thumb is that a self-employed professional's income is only half of what they earn, after deductions for vacation and sick time, self-employment taxes, insurance, and business expenses. As you may imagine, my communication expenses are high - business phone, cell phone, computer connection and the annual fee to run and maintain my website. I also have typical professional and office expenses, continuing education expenses, and unusually high transportation expenses since I primarily travel to people’s homes and often have to pay parking fees at varoius hospitals.

Putting It All Together - Rarely a day goes by where I don’t have to take my client’s due date and needs into consideration when I am making personal plans. Although I am dedicated to this work, being on-call all the time requires a very high level of personal sacrifice, including a willingness to be awakened after half an hour of sleep to go attend a labor for the next 40 hours. About 25% of my clients have some kind of early labor which starts and stops, resulting in multiple phone calls – often throughout the middle of the night. In past years, I have spent my birthday at a labor, as well as major holidays where I had to leave my family on Christmas, Thanksgiving and New Year’s Eve.. I cannot take weekend trips away from the area, and even day trips from Tacoma to Seattle have to be judiciously chosen during the periods of time when I am on call.

After receiving a labor call, I've had to cancel (and then reschedule) numerous classes and appointments. When it was not possible to reschedule the class, I then had to pay another instructor to teach the class for me so I could attend my client’s labor and birth or, if I could not find a substitute, had to pay my backup doula to attend the birth. What this means is, I cannot factor in the fee from a doula client for my living expenses until after I attend her birth, since the fee may need to go to my backup doula or another instructor. My monthly income is always unpredictable.

I never know what I am going to encounter at a particular labor - I may end up wearing out my body supporting the woman in different birth positions and while applying pain relief techniques, standing beside her for hours on end and coping with a lack of sleep for sometimes, up to 48 or more hours. I may take catnaps sitting in a chair; I may eat nothing but crackers or an energy bar; I may end up holding a vomit bowl for someone vomiting with every contraction during transition; I may end up with blood, meconium or worse on my clothes. Thank goodness I LOVE my work!

But the financial reward for this? The annual income of someone providing labor support services with a responsible client load and a strong commitment to being available for birth is 1/2 the number of clients per year times their fee per client.

Experience Factor – When I step into a birth, I bring not only my knowledge, training, heart and hands, but my 35 years of experience from assisting with over 2000 births, midwifery training, 20 years as an employee of the Franciscan Health System (St. Joseph Medical Center, St. Clare St. Anthony and St. Francis Hospitals), and continual research on subjects relating to birth. As a doula and childbirth educator, I must keep up-to-date on the latest studies, procedures, protocols, and policies surrounding birth and area hospitals and providers. Did you know that doctors, midwives, and nurses are usually only familiar with their way of doing things? As a doula I see the variations from hospital to hospital, between care providers, and over time. Being able to work with many different care providers, I learn all their different approaches and tricks, which I think is unique to the doula profession. And considering that every birth and every family teaches me something new, I have a wealth of knowledge and skills to bring to birth.

Bottom Line - Nobody is getting rich doing doula work. But every doula should be able to make a decent living as a doula without making her life unbearable. I wish I could offer my services at a rate that everyone can afford, but that would require that I make even greater financial sacrifices than I am already making to do this work. I am a self-supporting professional, and my options are to earn a living wage working with birth or to have a more conventional job, which would pay me a consistent, dependable and higher wage, plus would include health insurance, which as a self employed doula, I do not have. My personal medical, vision and dental expenses are all paid out of pocket. I cannot expect nor would I ask my medical care providers to lower their fees for me because I may not be able to afford a necessary procedure or treatment.

There are people offering doula services at significantly reduced prices. They are either still in training, have attended only a few births or are in a financial position to offer free services. If you need free doula services, there are many ways I can help you find a free doula; otherwise, you are doing future birthing women a disservice by making labor support an underpaid profession that cannot attract or keep talented, skilled individuals. If you end up selecting a doula who is undercharging for her services, I strongly encourage you to pay her more than she is asking; otherwise, she may not be around to help you with your next child. The most common cause of doula burnout is feeling overwhelmed by the commitment and uncompensated for one’s time and dedication.

I am willing to discuss the possibility of setting up a payment plan and/or a mutually agreed upon trade, if the fee is not affordable for you.

Advocacy Suggestions – Doula services are rarely covered by medical insurance plans, even though the statistics prove that doulas can save insurance companies lots of money by reducing the use of medications, interventions, time in the hospital, and surgical (Cesarean) births. You can talk with your Human Resources representatives to ask them to lobby to include all doula services as a covered option in your plan. Also lobby your State legislature to include doula services in state-funded healthcare so that low-income women have access to experienced doula support and doulas don’t have to further their financial burden by attending these births for free (that is what we do now). Additionally, you could talk with your midwife or doctor to encourage them to offer universal doula care to their clients. By hiring several doulas to be on-call for their clients, they could substantially reduce the cost per birth (and make their job easier) - although in this model the doula might be someone you've never met before. You could also advocate for the hospital to provide universal doula care, so that it would be covered in the same way as their in-house lactation consultants are covered. By all means, tell everyone you meet about the support you received from a doula – spread the word about doula care so that more doulas are needed and are well-paid and can continue their work for generations to come.