What’s in a Fee?

doula_money

 

Every doula has heard it at least once…

“So, if my birth is really fast, you’ll refund part of what I paid you, right? Because then you didn’t really have to work that much.”

“How can you be ok with charging so much?”

Or, my personal favorite, “You know, what you’re doing is an act of service. It’s really special. It’s like doing The Lord’s Work. So, don’t you think it’s wrong to not do it for free?”

The money questions… it’s enough to make any doula want to crawl under a rock, or wish we could go live in a yurt, in a nudist colony, on a self-sustaining  farm, so that our living expenses could be lower.

How a doula sets her fee is an unclear concept to many people who are seeking or offering birth services.  On the surface, it may seem like a doula’s fee is a lot of money for what amounts to one big day of work. I offer this so that new parents and new doulas have greater clarity of what a doula’s fee really includes.

A Typical Work Week:  Booking one “due date” per week is more than just one day a week at work – it’s a full-time workload.  Consider this – for every client I take on, I offer up to three face-to-face prenatal meetings, unlimited phone support throughout pregnancy and the first week postpartum, and an in-home postpartum visit.  This means that an average work week for me will have four to six home visits (about two hours each), six to ten hours of phone time, and eight to twelve hours of travel time. Throw in a couple of hours for recordkeeping, appointment scheduling, text and email support, and the extra hours it takes to call everyone and reschedule when I have a mama in labor. That’s typically a 37 hour work week, before I’ve spent even one minute at a birth. When all is said and done, each client, on average, has had the benefit of 30 to 42 hours of her doula’s time, and most of those hours have been when she hasn’t been in labor.

 Birth Hours: The average number of hours I support an individual labor, from the “this is it” phone call, through birth, and the first hour of recovery is 16 hours. Some labors are short and fast, and some are measured in days.  The shortest and fastest births have still had me returning home eight hours after I left. The longest I’ve spent at one birth is upwards of fifty hours. This unpredictability is why I do not charge an hourly rate. I make myself available to provide support for however long a birth takes, and know that on my end, things will average out in the long run.

Commitment and Availability:  When a due date is added to my schedule, I plan to be on-call at any time from 38 to 42 weeks – two weeks to either side of that due date. This means that if I plan a dentist appointment or dinner with a friend, or schedule myself to attend a training, the commitment I have made to my mamas is taken into consideration. I am responsible for making financial arrangements with my backup in advance when I know of days that I will be unavailable, or if I were to have an emergency.  No matter what I think my plan for the day may be, if I have a mama in labor, she takes priority over anything else I may have going on. Classes that I teach are  either rescheduled or another facilitator is paid to take over for the evening. I rely heavily on my on-call sitters to fill in the gaps when I’m not there to pick someone up at school or get dinner on the table. What this also means is that any fees I am paid for a birth cannot be counted toward my living expenses until after the birth has happened, since parts of this fee may need to go to my sitter, another instructor, or my backup doula. Even a doula who is consistently booked has a monthly income that is highly unpredictable.

The Cost of Self-Employment:   Doulas have typical professional and office expenses, required continuing education expenses every year, high transportation and communication expenses, website fees, professional organization fees, insurance expenses, and parking fees at most hospitals.  For a self employed doula, there’s no sick leave, no medical insurance, no benefits, no paid vacation, and no days off. The living income of any self-employed professional, after taxes and business expenses are factored in, is only about half of what they earn. So, the annual living income that a doula must live off of is half of her fee per birth, multiplied by her number of clients per year. For a doula  to earn the equivalent of the US minimum wage of $7.25 per hour for full-time work, she would need to charge $580 per birth. That is if she was willing to be on-call all year, no days off, no weeks in which she wasn’t booked, while taking on a responsible client load of one birth per week, AND if she did not miss one birth due to illness, emergency, or having two mamas in labor at once. That’s just to earn minimum wage!  Even with her years of training and experience,  your doula might be making a better living by asking if you’d like fries with that.

Though clearly no doula is likely to make a fortune from doing this work, it’s fair to expect that a doula should be able to take on a full-time client schedule and make a livable wage. The options are to charge a fair price to empower a doula to work for a living, or to leave birth work, as most ultimately do, to accept a conventional job with a predictable schedule, a decent wage and benefits.

If one looks for them, there are doulas that can be found who will attend births for free, or who accept significantly reduced fees for their services. These are often student doulas who have attended only a few births, or are women who are in a financial position to offer free services. Regardless of her reasons for asking for less than her services are worth, I strongly encourage any mama to pay her doula a fair price, so that the doula may continue to be available for the mama’s next birth and the births of others. I urge all doulas to consider asking for a fair wage, to treat our services as having value and worth, so that ours may be a profession known for attracting and keeping highly skilled and talented individuals.

Wisdom and Experience:  To every birth she attends, a doula brings her knowledge and the lessons that have come from each birth she has witnessed.  On a personal level, I have learned something new with each birth, over 400 times, in 14 years. I have worked in 15 different hospitals, and keep up-to-date on all of the latest research on birth policies and procedures. Having had the opportunity to work with so many different practitioners, I witness the wide variations from one hospital to another, and one practitioner to another. Studies have shown repeatedly that doula support helps lower the chances of a woman having a cesarean birth,  lowers the use of anesthesia in labor, shortens labor time, and results in mamas who are happier with their birth experience. A doula’s head, heart, and hands are completely committed to supporting each woman in creating the birth that feels exactly right for her. Her wisdom and dedication are valuable resources. Her fee is an investment made  toward creating a positive birth experience.

Burnout and  Balance:  Most people who become doulas stay in this field for less than two years.  Burnout runs rampant among birth workers. The unpredictability and demands on ones’ time and energy are more than most people can bear for very long. Balancing home and family connections with birth work takes mindfulness, flexibility, patience and commitment not only on the part of the doula, but from her spouse, her children, her family and friends.

Being on call requires a level of personal sacrifice that few are willing or able to offer.  I have left my own birthday party to spend the night at the hospital with a laboring mama, while my friends remained to celebrate without me. Each of my children’s birthdays and many holidays have been spent at births. I have rescheduled countless parent-teacher conferences. I have cooked Thanksgiving dinner at 4am because a mama’s water broke and I knew I’d be leaving soon. Vacations are few and far between. I go to bed every night with my phone by my head, not knowing how long I might get to sleep before someone is in labor.

I never know what may happen after the “come now” call. There are long days and nights without rest. I might catch a nap while sitting upright in a chair. I may go hours without nourishment, munching on the occasional granola bar.  My body gets tired and sore from supporting a woman through laboring positions and applying counterpressure. I’m usually the one who ends up holding the vomit basin. I go home with amniotic fluid soaking my pants, or blood on my shoes. When the day is done, I’m messy, and tired, and hungry, and fried… and happy – deeply, completely, truly happy.

I do it because I love it. I do it because I cannot imagine my life without attending births. It’s my calling and my life work. I hold space for women in a scenario more  intimate than others will ever have the opportunity to see. All facades melt away. There’s no pretense – just the genuine, intense, authentic energy of a woman giving birth. It’s raw and sometimes unlovely. I witness the transformation of modern civilized professional women into primal birth goddesses, and see the strong love that their beloveds hold for them. It’s an honor, always, to be a trusted caregiver in a space so sacred. It’s an honor, always, to offer love and affirmation in the face of such vulnerability, and to see it through to the other side – to witness the accomplishment and victory that happens when, after reaching the end of all that she thinks she knows, a woman stands toe-to-toe with her fears and chooses to take just one more step into the mystery, and emerge on the other side victorious, with her wet, squalling newborn naked on her skin, and her newly-born mother-self rising up as never before. This is what this work is all about.

I hope this has helped you in making your decision.  Happy birthing!

 

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19 thoughts on “What’s in a Fee?

  1. Hiring my doula was the best decision I ever made and was money well spent.

    I don’t talk about it enough…but I don’t know many pregnant women…the next time I run across one I will remember to talk about my doula and how she was a blessing.

  2. I just LOVE what you write in your last paragraph in the “Keeping It All In Sycnh” section Jodi!! You brought tears to my eyes. Birth is an amazingly intense and beautiful experience. Thank you for attending mine as Marla’s back-up back in January! I am still a little sad that I didn’t make it through all natural, but I still hold out strong hope and aspirations for my next birth G-d willing! Your intuition about the needs of a birthing/immediately post partum mother are spot on, amazing and a clear manifestation of your years of experience at births. Your love for what you do is clear in the way you do it. Thank you. I continue to spread the word and encourage others to hire doulas. Continued strength and inspiration to you in your calling!

  3. Thank you for addressing fees to the doulas in your readership, as well. Doulas need to charge the fee that their time, work, skill, and experience is worth! Additionally — when the incoming business is somewhat reliable and we don’t need to chase after every inquiry that comes our way — I encourage doulas to take time off – like their birthdays, or Christmas. Make back-up plans, because there is always a doula willing to take the back-up role, if back-up is ever needed. I always take Dec 24-25th off, and I have never had a problem finding back-up. I try to choose my EDD’s carefully (so maybe nothing from Dec 15th through New Year), but I have never lost a contract because I state ahead of time that I will be using back up on those 2 days. While my children are small, I also do everything I can to get back-up for their birthdays. Like I said, there is a right time for many doulas to do this, usually after their business is well-established.

    • I take time off as well Maria. I tend to take August and December off. That’s when I can concentrate on doing lovely things with my family and just chill out. I think that regular time off helps prevent burnout.

      Like you Jodie, this is what I am meant to do. Thanks for articulating my thoughts when talking about fees. Much appreciated.

      Mars xx
      MammyDoula

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  5. In addition to the doula activities you mentioned, even the most established doulas I know in my city spend an awful lot of time interviewing for jobs. Most in my area will do two to four interviews for one actual job, so that commuting and time spent should also be factored into your estimates.

    I’m so glad you wrote this. It came at the perfect time for me.
    🙂

  6. I often laugh when people question how much “alternative” contractors get paid. Now when I say alternative, I don’t mean it in a hippie or grunge culture way, I mean it “as opposed to” licensed contractors like electricians, plumbers or even surgeons and anaesthesiologists.

    Until recently I played in and managed a band. We quote our figure to do a 3 hour set and the people on the other end baulk at the price. It reminds me of this joke that’s been floating around the Internet for some while…

    A guy calls up the musician’s union to get a quote on hiring a five-piece band for his daughter’s wedding. The representative at the musician’s union quotes $2,000. The man on the phone sounds irritated and asks “for musicians, really? I was expecting a couple hundred bucks”. The representative at the union pauses for a moment then replies. “Tell you what, you call up the plumber’s union and ask them what it would cost to have 5 journeyman plumbers out to your house to work for 5 hours on a Saturday night and I’ll get you a band that will work for half that.”

    Now it’s not just the 3 hours we’re on stage that we’re getting paid for. We buy our instruments, we rehearse, and we spend time learning all the latest songs in our own time away from the rehearsal space. We often travel longer than 30 minutes to get to the gig; sometimes it’s an hour away, sometimes (although there’s a premium charged) we are travelling for 2-3 hours. Your party might start between 6pm and 7pm and whilst we’re not hitting the stage until 9pm and playing until midnight, we’ve been there since 4pm setting up.

    Now I relate that back to OUR experience with a doula. We were lucky. Our doula is a midwife by profession but was a doula in training. As a result she charged us $300 which was nothing to blink at.

    But what she did was meet with my wife alone on two occasions and with me there as well at least once, maybe twice before the big day. And she got the call in the middle of the night when we had the first false start which resulted in nothing, but was there in a flash a few days later when it was game on.

    What is a doula really worth? I think maybe more that what they actually charge. But unless you’ve got the money to pay someone for this fantastic service, just like those who say “I can get a DJ for $500 and he doesn’t even take a break,” the cheaper alternative, which is go without a doula would be a very likely option. And that’s sad…

  7. Thank you for writing this article, it is so true and really puts into perspective the practical value that people get from engaging a doula. However there is also the deeper value that only doulas and parents who have engaged doulas can truly understand.

  8. Hi Jodie! This is incredible! Is it ok if I put a link to this from my website? You break it down so succinctly, I would love to be able to refer to it with clients.

    Let me know!

    Thank you!
    Laura

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  11. If our doula had been charging three times the amount she did, she’d still be worth every penny for the invaluable support I received. Completely priceless.

  12. Pingback: How to Set a Doula Fee | Jodi the Doula

  13. I didn’t read the article in its entirety, I primarily skimmed towards the bottom because I just feel like, who in their right mind would ask for a service – free?? I swear, some people can be so selfish, self centered and inappropriate and the worst part is that they may not even realize or understand that about themselves. I’m not swimming in money but I look forward to HIRING my Doula and paying my Doula for her time, education, experience and services…just as we do EVERY OTHER PROFESSIONAL!! Ok. I’m off my soapbox lol

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