No Free Births!

“I’m offering service for free until I’m certified, then someday I’ll have paying clients.”

“I don’t charge for more than gas money now, but one day…”

“I’m looking for a student doula, or somebody who is willing to do births for no charge…”

Doulas, Mamas, I’m going to be blunt, here:

KNOCK IT OFF.

Now. I mean right now.  Cut it out.

“One Day” is not a day of the week. “Someday Isle” is a fantasy destination.

This mindset is not doing anyone any good.

If you are a doula, whether you identify as a student doula or an experienced doula, whether this is your first birth or your 401st, it is time to recognize that your work in the world has value, and begin treating it as such. You were given the gifts you have – the same gifts that make you well-suited to this doula thing –  to make it easy for the universe to bless you with abundance. So stop saying, “No thank you, Universe, I’m not good enough for that yet.”

You have been called to this work. You have capabilities and knowledge and skills that affect someone’s most precious memory – that of her child being born. You add value to the lives of others.  It is time to know this about yourself. You deserve an abundant life so that you have more to offer. Your playing small serves no one. It sends the message that you are unworthy, and that what you have to give is of no value. None – as in, less than a Happy Meal toy. This is not the message befitting of the services we provide.

Doulas deserve to be recognized within our culture and our medical system as having worth. We lower the cesarean rate, lower the percentage of interventions necessary, lower the use of pain medications, and leave mothers feeling more satisfied with their birth experiences and their babies.

Even if you have only served a handful of births, when you meet with an expecting mother for the first time, chances are that you already know more about birth than she does. That’s part of why she wants you there! Whether you’ve served one birth or many, you provide families with  information, physical comfort, and emotional support. In the very first studies proving “the doula effect”, the doulas did nothing more than sit in a chair with a clipboard, observing and taking notes. That’s it! If you’re doing at least that much, you are providing a worthwhile service, and it is only fair that you be compensated in exchange.

When you diminish yourself by giving your work away, you affect not only yourself, but every other doula in your community. Those who are charging a fee adequate to make a living wage  – which you someday hope to be – are questioned about the validity of their fee, because it’s something that others are willing to simply give away. (See What’s In a Fee? for a more in-depth breakdown of what a doula’s living wage fee entails.) Sending a message of being worth nothing denigrates the value of doula service as a whole, and begs the question, “If someone else will do this for free, why are you charging me at all?”

Another interesting point to ponder:  If you do hope to someday make a living wage with this work, it will not ever happen as long as you are willing to give yourself away, or charge less than your service is genuinely worth. I hear student doulas frequently saying, “I want to make myself appealing to clients, so I charge a lot less.” This may surprise you to hear:  This actually works against basic human psychology.

Human beings  make financial decisions based on a “set point” for what they believe something to be worth. Let’s think about this a moment. Let’s say that you want to buy your beloved a romantic getaway, and you’ve decided that a night in an oceanfront bed and breakfast would be just right. In your mind, from recommendations you’ve had from friends and a little bit of looking online, you know that the sort of place you’d like is going to be about $150 for the night. That’s your set point. That’s what you believe a nice night in a bed and breakfast to be worth. Now, as you are looking, you come across an ad on Craigslist offering a a night in a bed and breakfast for $40. Is your first response, “Yes! Sign me up for that!” If you’re anything like most folks, no. Your first response is more likely to be, “Eeew! I bet it has bedbugs!” What if curiosity leads you to call to ask a few questions, and upon hearing your hesitation,  they’re willing to give it to you for $30? Is that better?  NO! Oh, well what if they let you stay for free? In fact, what if they’re willing to pay YOU, just so they get the benefit of the experience of having you for a customer?  At that point, you’d be questioning the sanity of anyone who chose to stay there, right?  So, why do this with the value of our own services?

“But, Jodi,” I can hear you saying, “Don’t you believe in ‘a doula for every woman who wants one’?” Without question, yes, I do. Are there people who truly cannot afford a doula’s fee? Yes. Even then, I believe in the equal exchange of something of value for something of value.  I’ve known doulas to barter for meal preparation, for childcare, for piano lessons, for cleaning service, for moving help… there are many possibilities. Brainstorm with your client, and get as creative as you need to, but convey the message clearly that you are offering something of worth, and an equivalent exchange of worth is absolutely necessary. This is not negotiable.  Even the Wall Street Journal has recently published that when businesses offer “pay what you want” policies, customers are more likely to pass up the opportunity altogether than they are to accept something for free. Everybody knows that we can’t get something for nothing. It’s a gamble, like playing the lottery. It’s a nice idea to think about, but it’s not a realistic expectation. That which we have worked for, have earned, or have invested in has far more worth to us. So, if you want more clients, charge what you are worth! Starting today, starting now, no excuses.

This benefits not only your business and your doula colleagues, but our clients, as well. A woman who has spent more on bubble bath at the drugstore than she has on your service has also expressed a belief in her own worth, and in the worth of her birth. An “empowered birth”, like winning the lottery, might be little more than a nice idea. She has invested nothing, and is at no risk of losing anything in the process. In the heat of the moment, very few women are going to put much trust in the opinion of someone who has offered her something-for-nothing. Nobody really wants  the input of someone who has already declared herself worthless. Please, doulas, think carefully about the message you are sending about yourself, the women you serve, and the work we do. Birthing women, know that a doula’s service to your birth is of great worth, and so are you. Birthing with a doula’s support is a beautiful gift to yourself, your partner, and your child.

Together, we can create a culture that supports doula care as a valid and sustainable path for those who are called to it, and a valued service for those who benefit from it.

 

 Like this article?  Come “like” Jodi the Doula on Facebook for more! 

Edit on 7/25/13:  Are you now one of the many asking “But what about the low-income mama who truly can’t afford a doula?” Come take a look at “A Doula for Everyone…But How?” 

88 thoughts on “No Free Births!

    • Great read. Unfortunetly, I was adviced to do may first 3 births free. Not knowing any better I did. Now I know better. I wish I had people around me who would have told me better. Thank you.

  1. Bravo Jodi! Sing it! That’s exactly why Stephanie Dawn and I created the My Birth Business Rocks course for birth pros…so they not only have the skills to be birth-preneurs, but the mindset to stand up and say “No Free Births!” It’s about value, worth, and so much more. Once birth pros do this it WILL change the culture of birth. Thanks for writing this! 🙂

  2. I’m all about what you say here about valuing our work, and what Stephanie Dawn and Karen Brody are teaching.

    And, what do think about the nature of Doula training … that it is a weekend or two, a few births, and unstructured reading. This seems, to me, to inherently create a lot of the issues you raise in your article. Doctors and nurses go through years of training and do unpaid internships with high numbers. Residents get paid pretty low salaries for three to 5 years for 80-100+ hour weeks. I may not agree at all with WHAT they learn, but they DO KNOW it, and have a lot of experience before they are allow to be paid much if at all.

    How would you address the need of new Doulas being able to get the experience they need when they truly aren’t likely qualified to charge a professional rate?

    • Hi, Janel – first, please let me say that I have admired your work with The Other Side of the Glass for a long time. I’m so grateful for your commitment and dedication to that effort, and I thank you.

      It’s true that doula training is significantly different than that of a doctor or nurse or midwife. It’s also true that a doula’s role and set of responsibilities is also significantly different. There is far less liability involved in offering a comforting touch and words of support than there is in needing to make life-and-death medical judgment calls. Ours is not to practice medicine, but to provide a service. In any service profession, (like food service, housecleaning, or childcare) it is a fair expectation to be compensated for ones’ work, even for those who are in training.

      It’s part of the work of doula service to be continually learning and growing. (Heck, even my name is Green!) I don’t think we ever reach a point where we can say “That’s it, I know my stuff, I’m done now.” It’s why continuing education credits are part of any doula certification organization’s requirements. We’re all learning, all the time, with every birth we attend.

      I do think it’s fair for a more experienced doula to be paid commensurate with her expertise. I also think that even a very new doula is providing a service that has value to the laboring mother, and as such, it is fair for her to be compensated for her time and her work. Even she has expenses for her gas, her childcare, her supplies, her training, and so on. Even she is worthy of charging a fair wage, or of exchanging something of value (her time and work) for something of value (what a family is willing to exchange for her services).

      • I wonder if changing the marketing is needed in cases where it’s appropriate to charge less. For example, if a doula is new, she could have her set prices listed and then offer a discount.

        Setting a price and offering a discount is a different method than offering a very low price. These motivate different behaviors in people and also influence your brand differently.

    • When it comes to addressing the training issue, I would simply reply that different jobs have different training needs. When I worked at McDonald’s I had never operated a fry cooker, cash register, or soda machine my first day on the job…and yet I got paid for my first day on the job. So even if we look at minimum wage and no business expenses at all (which of course even a beginning doula has business expenses!), considering that a doula will probably spend about 25 hours total with her client, that would come to nearly $200.

      But I think a doula–even a beginning doula–is worth much more than minimum wage (and for that matter, you are wrong in saying that doctor interns are unpaid, they make about $40K per year, which at 80 hours per week–the maximum they are allowed to work–that comes out to about $10/hr–and they likely have medical insurance and some other perks that doulas don’t get as business owners. Residents get paid slightly more.). My husband–as a painter who did NO training at all before starting his business (though he has done a smattering of training since he started, but in the same time period I’ve spent more money on doula related training than he has on painter training), charges MUCH more than minimum wage…and he doesn’t get woken up at 2 a.m. by a customer who has a paint job that just MUST be done right then.

      • All of the above ignores supply and demand issues. Furthermore there are many professions, like law, where people A) offer free (Pro bono) legal advice and people are grateful not dismissive and B) work in judicial clerkship sand other positions for free, with no benefits, for experience after going to school for years and most likely owing tons of money in student loans. This article is not realistic, doesn’t operate on economic principles of supply and demand, and takes for granted that certain “facts” are true when there are many contrary examples.

        • Can you document that there is somehow a supply and demand issue that requires new doulas to do births for free?

          Offering pro bono services for people in financial need is a good thing, and no one is saying that should never happen in the doula world.

          In regard to internships, first…they aren’t all free, and specifically I know someone who got a summer internship at a law firm that paid $20,000…just for the summer break from school. Second, there is research that shows that individuals who work unpaid internships end up having lower salaries once they start working for pay than those who did not do internships at all. Third, there are very strict rules for when those can be unpaid vs fall under minimum wage laws (which many companies do violate, but there are starting to be lawsuits about this, and several interns have won retroactive wages). You might check out https://www.facebook.com/groups/internlaborrights/ for more information about this. Part of the requirement for an internship to be legally unpaid is that the employer providing the internship has to expend more effort in training the intern than the intern returns value for the company. Certainly a new doula working a birth is providing more value to the expectant family than the family is providing to her–she is working, not training. That there is some educational component to her experience does not make it training, I learn something new with every client I work with, and outside of the birth field, my favorite jobs have been those where I was encouraged to learn and grow. Now of course business owners such as doulas are not “required” to pay themselves minimum wage, but it is advisable to seek to turn a profit with your company lest the IRS deem it an “expensive hobby” and stop allowing you to take business deductions for it on your taxes.

          Could you give specific examples of “facts” that Jodi presents that you feel are not accurate?

  3. Thanks so much Jodi. I really needed that pep talk!!! 🙂 In the recent past… I had trouble with setting a fee for any services that I offer and being in training really didn’t help that mindset. I was offering free at first, and then started negotiating per family… Whether it be barter (very comfortable with that) or money. It’s feeling better now that I took the leap. I was just telling my husband about u about 10 minutes ago (an amazing doula who is really an integral avatar… paving the path for for us and just so happens to be a red tent co-facilitator as well! 😉 Lots of love to you and deepest gratitude for all you do and influence. Hope to meet you in Glassboro soon!! Peace mama! 🙂

  4. Janel makes some good points worth pondering and I am interested to see your response.

    Jodi, you referred to Klaus and Kennel’s original study on the benefits of having a doula at births. You are correct that this was an untrained woman, unknown to the laboring mother. She was not expected to give care, just companionship, and the mother was told only that this person would not leave her, but stay with her until the baby was born.

    Since those days we have effectively created a new “profession”. We are encouraged to bill for our time. There are significant financial benefits for the organizations and individuals who train, credential and validate us to sit with other women while they labor. Often the laboring mother will be a woman who has attended and paid for childbirth classes, including perhaps one where her husband or partner went with her and was also
    trained and validated as her support person.

    Here is my concern, and it has been since I first began sitting with women in labor over 30 years ago: if we continue to push to be recognized as skilled professionals providing a healthcare-related service, not simply valuing each other and ourselves as women willing to come alongside other women, we will eventually be regulated, licensed and, in the end, limited to a “scope” of doula practice. What we are allowed to do (or not) will be defined by those who will have the power and the right to say we may only do what we do with their authorization.

    If you do not think this is the end point of the path we are already on, ask a midwife.

    • You are correct, Quietly, that the title of Doula as an actual “thing” has only come into existence in recent years. Times have changed, and the face of birth has changed. When my Great Aunt was a midwife in Indiana in the 1940’s, having a baby in a hospital was unheard of. Now, hospital birth is the norm for over 95% of families in the US. There are those who are working to again shift birth as we know it, and doulas are a significant part of this effort.

      A doula, as a trained labor support person, is more than simply a friend, or sister, or a woman willing to be present with other women. A doula, by commonly accepted definition, is a skilled professional. Since the mid-1990’s, there are certifying organizations with training requirements, codes of ethics and standards of practice already in place for those who choose to identify as certified doulas, and one who is practicing outside of those boundaries is not practicing doula care, but something else.

      This existence of doula-as-profession, with value and worth for the services we provide, is not mutually exclusive with women choosing to show up in support of other women in whatever capacity they may choose. As women, we are biologically hard-wired to connect and create community with one another. That can take many forms, and is the driving force behind grass roots movements such as the Red Tent Temple movement, another initiative I wholeheartedly support.

  5. Jodi,
    Thank you for your reply. I am aware that Alace and Dona etc have been been actively advancing and promoting doula care and have developed standards for certifying women they have trained and who consent to remain within the boundaries they have established. There is much overlap between the two organizations but also areas in which they respectfully disagree on where the boundary lines of practice should be drawn. However I don’t think that either organization would say an experienced woman providing skilled labor support who was not certified with them was therefore not practicing doula care. CPMs would not say that midwives without certification were not providing midwifery care; even CNMs don’t say women who are apprentice trained aren’t ‘midwives’.
    Do you really mean to say that without certification one can give care, but it will not be ‘doula’ care??
    Since my beginning to attend births as a doula predated certification by some years I am not certified, so I am not aware of all the inter-Nicene debates about who can use the word ‘doula’. Is it a widely held consensus that the term doula only applies to people who are formally trained and certified?

  6. I do not at all say that one cannot be a doula without certification. I do maintain that not everyone providing labor support is acting as a doula, and I do maintain that even uncertified doulas (those who are skilled and experienced at providing labor support, and who have been invited into a birth team to do so) are held responsible for operating within the commonly-accepted scope of practice for doula care that now exists, though it may not have 30 years ago, for those identifying as doulas.

    CNMs and CPMs, while both midwives, are responsible for knowing their professional boundaries, as well. Should either of them attempt to perform surgery, they are overstepping their professional scope of practice, and what they are doing is then not practicing midwifery, but practicing medicine without a license.

    Likewise, those who call themselves doulas, but who overstep the doula’s scope of practice by taking on responsibilities usually delegated to midwives, are not providing doula care, but something else.

    It matters not to me if someone chooses to identify herself as doula, as monitrice, as midwife, as childbirth educator, or whatever-else. What does matter is that they uphold the professional boundaries and codes of conduct of their chosen profession.

    • I see that I misunderstood your practicing outside the boundaries comment, thank you for clarifying 🙂
      I took the time to look at various resources describing the scope of practice for doulas and was surprised at how deep the differences run. I think your point is well-taken that it is important to stay within ones boundaries, and I think Penny Simpkin at DONA is particularly articulate on that issue.

  7. Rocking post! I was going to reference the exact same thing Karen said – as I attended one of her webinars talking about this exact topic! Going to repost and forward to my local doula network. 🙂

  8. Pingback: No Free Births! | Jodi the Doula | Not Another Mom

  9. This is exactly what I have been struggling with and there is nothing more discouraging than being desperate to work. As a doula what I do is far from worthless it is truly amazing. Mothers and fathers love having doulas, doctors and midwives love having doulas present. We have an amazing value and I am so glad you wrote this.

  10. What do you think about certifying organizations that require you to attend births for free in order to get certified? I have to attend 5 free births for mine.

    • Sara, I think it might actually be against anti-racketeering/price fixing laws for the certifying org to mandate what you charge as an independent business person. I know that seems very extreme, and truthfully, I doubt it would ever make it on the radar of a prosecutor…but I read in the past year about a small non-profit group that supported independent music teachers–like stay at home moms who teach piano lessons out of their homes–that found themselves in the cross hairs of a federal investigation because they encouraged their members to find out what other music instructors in their area were charging so that they charged fees that were in-line with local norms. They ended up having to pay all sorts of legal fees and signing and agreement that they would FORBID their members from talking to each other about pricing at all!

  11. I agree with everything you said wholeheartedly! I don’t think the problem is with individual doulas, though. I believe that the problem lies in our community. Many new doulas are incredibly uncomfortable expecting payment for their services because they have no idea what they’re doing! Although women take different paths to doula work, the vast majority of new doulas that I know have never step foot in a labor room until they attend their first birth. One can only learn so much from a book. Doulaing is an art form. It requires so much more than can be taught without experience.

    I believe that if we want to see our work have value, we have to assign it value in our own community. We have to offer new doulas the opportunity to learn their trade by apprenticing. I’m not suggesting a lengthy apprenticeship, but I think we’re fooling ourselves to think that reading a couple of books and attending a training that reads more like an informed choices childbirth education is good enough for new doulas to feel confident that their services are worth something (or for them to be actually be worth much for that matter).

    If each new doula silently shadowed an experienced doula through one prenatal appointment, one postnatal appointment, and two births, then they could get their free births for experience out of the way without devaluing our field. Even better, the experienced doula could then silently supervise the new doula through the same, adding further skills, confidence, and value. Even with the second scenario, I think many clients would be happy to pay the experienced doula’s fee since she’ll be there to guide and assist. Although it should be an individual pair’s business, since so many doulas offer their services for free anyway I believe many of them would be happy for the experience and wouldn’t expect any part of the fee.

    By throwing these new doulas in at the deep end, we’re setting them up to offer free births and subpar service, both of which devalue our field.

  12. I think you make an excellent point, Mandi. I’m always willing to support a newer doula in gaining experience, and think it’s really important to encourage newer doulas to reach out for their learning this way.

  13. Mandi, you are spot on! This is an issue for female entrepreneurs, valuing themselves, their training and the services that they offer enough to charge accordingly. Over the years, I have been a childbirth educator, doula, reflexologist. I have done energy work, and run a business doing medical transcription. Now, I am a health and wellness coach offering a combination of healing modalities for women in all walks of life. There is a common thread in all these business ventures that I have seen again again. Working with other women, having female colleagues, I see that we don’t value ourselves, don’t see ourselves as worthy and don’t want to rock the boat, make waves, trouble anybody, etc etc etc We so badly want to be liked that we actually undermine our credibility by devaluing our selves, devaluing our investment in our training, our experience, devaluing our services. How exactly do we empower women when we ourselves are not congruent with that message and we are not empowered to ask for what we are truly worth?

  14. I am a low income mom and doula. I couldn’t afford a doula with my first baby. I was able to scrape up the $300/month for my home birth midwife (with help from family I might add). I cannot find it in my heart to charge outrageous fees that that lower middle class and low income moms can’t afford. I make sure that the family knows my desired fee. It is written on every contract so they can see what I think I am worth. But then we go from there. We can make a payment plan. Or I will accept the price that they can pay. Or I will even give my services for free. If we as doulas are not willing to budge from our $700 price tag, we are selling our services to privileged upper middle class women. We are leaving out an entire spectrum of women who need us: women who may not have access to a computer even to research their birth options. I think it is essential to work on a case by case basis so we are not advertising our services to only those lucky enough to afford us. Also, the whole swapping services thing seems insensitive. A client calls on us to help her through a very important time in her life. Here she is, pregnant, maybe scared, maybe emotionally unstable, maybe ill from the pregnancy. This is HER time and her journey. This is about her and her child. And to ask her to do something for us seems very unprofessional and cold.

    • I agree, i am a placenta encapsulator. I charge 75 as a base fee and each add on is 10 extra. never over 100 ever. I also offer my services for trade if they are up to it. I know far too many people in the “natural” crunchy world that have too many kids they cannot afford that simply cant afford the standard 250 price tag. I would hate to think that one of these mamas got ppd because she couldn’t afford my services and didn’t have the energy/means/what have you to do it herself.

      • Your theory operates under the mindset that doula services are a need, or a right. When in fact, they are not. They are a luxury. Air, water, food and shelter are needs. Doulas services are not. It is from my experience that anyone who wants something and who values it, will find a way to obtain it (even low income families, flatscreen tvs much?!). Being a doula is a profession, not a philosophy. We do not sustain ourselves off the experiences of others, but from the compensation from others…from all classes.

    • I find it puzzling that you describe expecting some sort of a fee for services to be “unprofessional.” Isn’t part of the stamp of a professional charging for services rendered?

      I can see someone describing it as lacking in compassion…but I’d also say it is lacking in compassion to think that I shouldn’t expect some sort of payment that will help to feed my children. Yes, birth is an important time in a woman’s life. So is marriage, and death. Yet you don’t see florists, dressmakers, caterers, and morticians being guilted into offering their services for free lest they be described as “unprofessional and cold.”

  15. I agree! I had a doula for my first birth, and she was fantastic. She did offer flexible payment plans, and gave me a discount BUT it was still a significant cost (AUD $1200), and one thing that I remember consciously thinking was that I could let go, I didn’t have to be concerned with being polite in the heat of labour or whether I poo’d, I was paying her for her assistance, and as she told me “My job is basically to be your pooper scooper.” Lol. It was harder second time around with just my husband. He rebuked me when I was rude in transition, and constantly wanted to scratch his nose mid contraction. Lol. I remember her many times stating in our meetings that the price she was paid was not worth the amount of work that she did, but that women who do this do it for the love and passion of it. 🙂

    • Unprofessional to ask for something in exchange for service? That’s an interesting point of view. The way I see it, if a woman calls me – not a friend or a sister, but a professional – to provide the work by which I keep a roof over my head, she is getting something of value. Prenatally, she’s getting up to three facetime appointments. Including my driving time, that’s nine to 12 hours of my time, right there. She gets phone time with me after each doctor appointments – that’s easily another 4 to 12 hours of my time, there, depending on how much she chooses to use this. She gets unlimited email and text contact with me. I spend a couple of hours in recordkeeping for each client. So, before the time spent at her birth is even included, she has benefitted from a good twenty-something hours of my time, during which I have had expenses for my childcare (a good $75, easily, just for the time that I have spent with her), my transportation (another $50), my on-call phone ($40 a month), my internet service to be available for email ($70 a month). That’s not even touching on expenses for my birth supplies, my lending library and office supplies, or the taxes I pay on every penny I’ve earned (which accounts for about 50% of my income). After 38 weeks, she has my commitment, willingness, and availability 24 hours a day until her baby is born. This means that my life is structured around being on call for her. Whether I’m there one hour or forty, there are expenses involved, and I am, in essence, giving her a day of my life in which she takes priority over my sleep, my self care, my children, my partner, my social life, my holidays and family time.

      I’ve said, clearly, that no family should be in hardship simply to have labor support, but that this is a relationship in which it is appropriate to have an exchange of something of value for something of value. That’s all money is, really – a means of exchange. People work in whatever way they do, and exchange their time, energy, and effort for money, so that they may then exchange that money for what they need – food, shelter, clothing. If someone does not have adequate means for this sort of exchange, an exchange of another sort – time, energy, effort – is completely appropriate and fair. It doesn’t need to be a dollar-for dollar value sort of exchange, but something proportionate for that individual family in a way that doesn’t cause hardship. As long as the doula and client are in agreement about what seems fair to one another, that’s fine.

      There is value in my time, for being available for her time. This is a service. It is a profession, and expecting an exchange for services is, in my view, entirely professional. Doulas are providing a warm, caring, and friendly service, but we are not their friends. We are strangers upon whom they are calling to provide a service. There’s more to it than being nice because she’s pregnant.

  16. Pingback: Salt Lake City Doula | Internet Resources | Andrea Lythgoe Doula Salt Lake City Utah

  17. Jodi,
    THANK YOU! I have been a doula/monitrice for 14 years. And before I was a doula, I worked in a field predominately populated by female workers. In both places, I see women devaluing themselves and the services we provide, all in the name of “serving others” and/or developing their skills. We are worth more. Our work is worth more. And we only raise our own worth and the worth of every other doula and woman when we claim our worth. You said it well and in so much nicer terms than I normally manage. Thank you,
    Debbie

  18. Other professionals volunteer their time and expertise as charity work. I don’t see how doulas are any different. Obviously our work has value and we deserve to be paid for it, but if a doctor can volunteer at a local clinic a few hours a week or a teacher can give up her Sunday afternoons teaching literacy, why shouldn’t take on a client in need a few times a year, and not expect payment?

    • Megan, I can appreciate where you’re coming from. I think that “occasional volunteering” is a different scenario than one who hopes to build a thriving practice simply by working for free. To use your example, that would be like a doctor wishing to build a private practice by working in the community clinic as a volunteer, or the teacher hoping to eventually earn a living by way of volunteering on Sunday afternoons. It just doesn’t work that way. To build a solid business, and to promote doula work as a valid and credible field of skilled professionals, we must be willing to charge what we’re worth.

  19. Pingback: No Free Births! By Jodi The Doula - Birth Balance

  20. Hi,

    On the subject of student doulas and fees for lower-income pregnant women – I like the model of lawyers. There are pro-bono law students and there are also full-fledged high-end lawyers who give pro-bono time for certain types of cases. However, the latter is still usually earning well from their paying clients. We are charged with this balance in our own practices. I like how Jodi spelled out the time involved prenatally – I also tell clients the breakdown that the payment includes personal, phone, and email consultations prenatally. I also watch closely as people in other professions answer questions initially, especially for friends and family, but they have their boundaries of how much they can answer before giving an estimate for a full charge. We are no different in this sense. I wish all of you doulas well with this end of matters. It is also an issue of respect for women – if men were doulas, I’m not sure this would be such a question.

  21. Your blog was right on target. I am retired now but when I was practicing I did a couple of feebies, one as a favor to another doula. I found that they often failed to call me when they went into labor. This is after I spent many hours traveling, teaching, lending them books etc. One couple couldn’t pay but then I saw their nursery set up and duh you couldn’t even give me money for gas!! I loved being a doula and if I had to do it over again I would respect my worth!

  22. Mandi Wagnild……well said, I am a doula of 5 years..certified for over 3 and have thought your thoughts exactly : ) Thanks for sharing.

  23. Great post Jodi, thanks! I will be referring all our student doulas to this post which is completely aligned to our belief that doulas – whether training, certified or choosing not to be certified, provide a valuable service and that to offer that service for free (with no cash or barter taking place) devalue the service for themselves and others. Loved reading this post!

  24. Megan, there’s a difference between a doctor volunteering at a clinic a few hours a week or a teacher teaching literacy on Sunday afternoons vs a Doula giving her services throughout an entire pregnancy. That doctor or teacher can, and does, schedule that time into her or his schedule. The equivalent for a Doula would be to volunteer their time for an hour or so with groups of lower income women (either pregnant or not) for a few hours to educate them on birthing. I would venture to say there are some Doulas already doing that and that others would be open to doing that if it could be arranged.

    I completely agree that it shouldn’t be *expected* of all Doulas to volunteer their valuable services to a pregnant women. Jodi has lined out all that she does, on an on-call basis, and that shouldn’t be expected for free. There are monetary costs involved for her, she is not just spending a little bit of time (which has value also, but I did want to mention the monetary costs). Why should be expected to actually spend money, out of her pocket, to help multiple people throughout the year. When would she have a chance to earn money? I can picture the job interview, “Yes, I’m perfect for your office job, but about 15-20 times a year there will be a 2-week period where I may not be able to work for like 2 days. And while I’ll be able to tell you those 2 week periods in advance, the 2 days off will be last minute.” Yeah, she’ll get hired in a second.

    Maybe there could be a Doula donation fund. Higher income women who have enjoyed the expertise and experience of a Doula could give donations that would help lower income women have a Doula. Sort of like a scholarship fund.

  25. Well. I’m going to go out on my own doula branch- as we all should and express personal reflective thought here. I do not agree with this post and find words like diminish just as un tastefully sound and the entire article. Entitlement is excellent for sound however when you base your opinions on a collective group is more mongering then anything else. We have some tools we use to help mothers along, and pay little to acquire these. The passion stems from the want. We are the old wise women of the villages who did this because it was in essence the way. I would absolutely do this job free of charge. Period. It isn’t about payment its about the deed and the future of our children. The best part about owning your own business is being in charge of said business. It’s not cut-throat to charge less or nothing while certifying? What a ridiculous thought process. Tell me you wouldn’t go to a 3rd world country and assist in as many births as possible? Or perhaps we have different values. We are not doctor’s and although I spent over a decade in the health care field I wouldn’t return- for one reason. It’s nice to make a little extra money along this journey however if you’re not willing to offer a sliding scale or won’t assist needy women for free- then perhaps you are in the wrong realm. This path stems from the heart not the bank account. I digress. I disagree with this article and your drive behind it.

    • Hi Sarah,
      I am curious..How much did you pay for your doula training? How many births do you offer to volunteer for a month? How long have you been doing this? Do you do continuing education to learn about the best evidence-based care? Do you have other sources of income?

  26. This is something I have struggled with since starring my path. I believe our work should be valued and compensated but also accessible to all women. I look forward to the day when I can offer my services free but for now I do what I can for the families that contact me. Using the barter system for exchange of services sometimes works out for both myself and my client. I think it comes down to a personal choice of how you see your business. For me to offer it as a free service I would have to cancel my website or change to a free one and cut down on other business expenses as I do not have another source of income.

  27. I agree with what is being said here. I am not of the means to be able to offer my services for free or a discount, without first taking paying clients that can afford to pay. Each relationship/payment agreement can be different. But ultimately, I love what I do and I deserve to be paid for it. We are very lucky in our community because our local doula non-profit does fundraising to offer scholarships to families that can’t afford the full fee of doula services. I’m proud to be a part of that effort.

  28. It’s been great to read all of the thoughts and suggestions here. I am currently offering volunteer doula services as a mitzvah for women who can’t afford to have a doula because I do believe all women deserve one. Since I’m still working on my certification, I’ve put a sliding scale on my website, with the intention of going to “regular” NYC prices when I have a birth under my belt.

    I will, however, continue to volunteer my time because I think it’s a gift to be able to give a woman who needs it.

  29. Pingback: A Doula for Everyone…But How? | Jodi the Doula

  30. Thank you Jodi!
    I’m a student doula, but because of an upcoming hip replacement surgery, I haven’t yet taken on any clients. However, the issue of what I should charge has really been weighing on me. It just didnt feel right to give away my services as I’ve seen some other students do and some mothers looking for. In fact, I saw a request for a free student doula that really didn’t sit well with me last week; it was from an upper middle class couple that had paid for their doula with their first child’s birth, but was looking for a cheaper option this time. Overall, the underlying message seemed to be that they didn’t feel that the first doula’s services had been worth it and they thought that a student would do an equal job for free. I was offended on behalf of the first doula and all doulas and I was really glad that I didn’t have to speak to these people in person.

    I’ve been reading your blog for a while (my cousin Tara Earnest introduced me to your Facebook page) and I respect what you have to say as an experienced member of our profession, so I was really pleased to read this and the follow up on what options are available for those of us who may not want to charge full price for our services. Personally, I’m hoping to hook up with a volunteer service, like the one out of UPenn, or with an experienced doula or group of doulas to maybe tag along with them to a few births and then transition out on my own before I try to do it all by myself.

    Thanks Again!

  31. Pingback: Utah Doula | Weekly Roundup of Web Links | Andrea Lythgoe Doula Salt Lake City Utah

  32. I just have to say that I soooo dislike your title!! It’s disgusting and I’m so disappointed that every single thing is revolved around money. Not saying you shouldn’t be paid for the job you perform, but putting so much accent on the money while talking about the miracle of life is making me sick to the core!

    • Well…as a doula, I’ve got 6 little miracles–my kids–who need to be fed and clothed. So yes, money MUST be a consideration. It’s the way the world works. If I’m not paid, I can’t continue to be a doula (and other doulas likewise), so experienced doulas will not be available, only young doulas who have no one to mentor them to help them grow. This is not a “hypothetical.” It’s real. The only reason I’ve been able to hang on for 12+ years is that I’ve had other paying jobs while working as a doula. Most doulas in my community last for 2-3 years before they have to quit because they can’t afford it.

      • Every profession needs to be ‘awarded’ and I completely agree that one should get paid, so please don’t get me wrong. But I’m so disgusted by the title and introduction of this article which obviously favors money over profession. All I can read is money, money … tough luck if you cannot afford it?!? I dislike the intention of the writer of this article in this business, writing article like this and then go witness one of the most intimate encounters in a woman’s life! If I ever needed a doula, after reading this article I would never chose The Jodi!

        And congratulation on your six little miracles 🙂

        • I don’t think that Jodi is intending for women who can not afford doulas to be completely without the ability to get one. I think she would completely be on board with programs to encourage Medicaid to pay for doulas, or private programs that are funded by grants to pay for doulas for low income women. I think she’d even be in favor of individual doulas occassionally doing “pro bono” births for women in need.

          But the current system where women start out in the doula field doing many births for free or steeply discounted rates has resulted in a situation where experienced doulas can not charge a “living wage,” and thus find themselves leaving birth work.

          I’m curious, are you a doula, and if so, how many births have you done? If you are not a doula, how many hours of your time do you estimate that you gave your work product away prior to getting paid in your field? For me, though I did invest many years of education before getting a job, I was paid from the moment I clocked into work for all of my non-doula jobs–even when the initial days on the job were entirely “training.”

    • Yes, the title is about money. The article is about money. More specifically, about an exchange of value acknowledging that doulas are offering something of worth to others, and as such deserve compensation in a mutually acceptable form. Money isn’t all that I write about – of the forty-something posts I’ve written, only two are about fees. Another one is about how services should be provided to women who cannot afford them. But, when writing specifically about fee, as I did here, I did stick to the topic of money. Thank you for allowing me to explain that.

  33. Pingback: Values, Passion and your Doula Practice

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

  35. Thanks for your post. I really do see the point of why it isn’t helpful for the profession when newbies like myself do free births, but I also see a real problem with the training and beginning stages for new doulas. I am charging a very modest fee basically to cover my childcare costs. I would like to charge more to cover all the start up costs, and I do think what I do is of value, even though it is not of the same caliber as an experienced doula. I don’t really know how to find clients who would be willing to pay, say $500 for someone with two births when they could pay the same for someone with much more experience. As one other person mentioned, I think the solution that we should have is an apprenticeship as part of the certification process. It would take the burden off marketing/finding clients before one really has any experience and put their energy toward honing skills. By the time one finished an apprenticeship, they would be much more experienced and marketable. As it is I feel like DONA (and really all of the major organizations) really sends us out into the cold with very little support, expecting us to figure this out on own. The only doulas I know are the ones I met in my training, so they are in the same boat. I feel uncomfortable just emailing doulas at random from the DONA list or other sites and asking them to mentor me. That doesn’t seem like the best way to find a mentor, to say the least! I think the profession as a whole must do something to help the new doulas get their experience and training without just saying “go out there and start charging a full fee, and good luck getting clients!”

    • You are SO right about the mentoring situation Jamie! This is why Informed Beginnings, a co-op for childbirth educators, made the decision that we would require/provide mentorship for all of our new educators. Some day we plan to also certify doulas, and we will include mentorship in that too.

      As for you feeling like you can’t charge $500 when there are experienced doulas who charge $500…sigh. That is what I charged when I was starting up in 2001. The experienced doulas should NOT be charging $500. You just can’t make doing births for $500 each work out long term, so what happens is that doulas don’t last long. 🙁 But what can you do? Well I’d encourage you to at least charge $300, if not $400. Be part of the change you want to see in your local community! I wish you the best in your journey!

  36. Pingback: Doula on a Shoestring | THE TAPROOT DOULA PROJECT

  37. For the lack of money is the root to all evil. I must say the concept of our “labor” being free of charge is a root planted from the days of training. Depending on which organization and doula you’re trained by you are taught to offer a “community service” to at least 1-2 mom’s a year. This may be OK for some Doulas but it’s not for every. We are a valuable asset to the women, babies, families, birth community and society, by providing them with such a high- quality of service. If Doulas repect the position, then the profession will respect the doula!

  38. You are so interesting! I don’t think I have read through a
    single thing like this before. So wonderful to discover another person with some unique thoughts on this subject.

    Really.. thanks for starting this up. This website is something that is required on the web, someone with a little originality!

  39. Too bad doula fees are outrageous.
    I wish I had $800-$1000 to drop on a doula, but since we have to live off of one salary there’s just no way.

    • Rebekah, most doulas will work with women who have financial need. We really do want to serve women.

      I know it can seem that the fees are outrageous. But when you consider that a doula will spend, on average, about 25-40 hours of her time on a client depending on the services provided; and the average house cleaning service charges $30-40 per hour or $750-$1000 for just 25 hours; its really a bargain. Doulas don’t “net” a lot of money after business expenses are paid. As Jodi explained in a comment on March 20, 2013:

      Prenatally, she’s getting up to three facetime appointments. Including my driving time, that’s nine to 12 hours of my time, right there. She gets phone time with me after each doctor appointments – that’s easily another 4 to 12 hours of my time, there, depending on how much she chooses to use this. She gets unlimited email and text contact with me. I spend a couple of hours in recordkeeping for each client. So, before the time spent at her birth is even included, she has benefitted from a good twenty-something hours of my time, during which I have had expenses for my childcare (a good $75, easily, just for the time that I have spent with her), my transportation (another $50), my on-call phone ($40 a month), my internet service to be available for email ($70 a month). That’s not even touching on expenses for my birth supplies, my lending library and office supplies, or the taxes I pay on every penny I’ve earned (which accounts for about 50% of my income). After 38 weeks, she has my commitment, willingness, and availability 24 hours a day until her baby is born. This means that my life is structured around being on call for her. Whether I’m there one hour or forty, there are expenses involved, and I am, in essence, giving her a day of my life in which she takes priority over my sleep, my self care, my children, my partner, my social life, my holidays and family time.

      • It is illegal per the IRS code to deduct the entire month of internet unless that’s all u r using it for which means u aren’t writing blogs like this and posting them with your internet and even then u r charging one client for the entire month of internet instead of spreading it out between them? Talk about inflated estimates. This article is the biggest joke. So many professions encourage people to donate their time for the greater good but by all means discourage doulas who want to do that themselves so u can line your greedy pockets bc u choose not to. Sorry u don’t get to make the rules for an entire profession. How patronizing to assume u can talk down to women who choose to run their business a different way than u do

        • Andy, you are right that the entire internet (or phone, or other services) can’t be deducted, it needs to proportionate to the amount of use that is business related. But where do you get the idea that this blog isn’t business related for Jodi? Or that she only has one client per month?

          Jodi has addressed the issue of donating time–it is something she encourages. But it is not greedy to desire to make a living wage from work. Nor is it “making rules for the entire profession” to speak out against a practice that leads to rampant doula burnout AND suppresses wages for those who struggle to remain in practice.

          Further, many doulas can tell you from sad experience that when they work for free, often their clients do not value the work that is done, which can result in poor treatment of the doula. It’s not always the case, but it’s more often the case than with paying clients. Basic psychology tells us that we value what we “pay” for. Even the most cash strapped expectant mom has something of value she can offer to the doula as payment for services.

          • I don’t think u understood the comment. The accounting was supposedly for how you get to $800 for ONE client and $70 for internet was listed. The point is if u have more than one client how is $70 for internet being charged? Not to mention u can get high speed internet for a fraction of that. And on top of that your entire phone bill? Those costs can be consolidated. And who charges for the time driving to and from work? And child care costs? All that list does is show people r getting ripped off. No one should have to pay more for the same service bc someone else chooses to have kids. 50% of your income to taxes? How is that even possible? The highest tax bracket isn’t that high. The best way to ensure that you are making what u should be is to offer value and what everyone else does should have no bearing on the value you provide. Personal trainers r a dime a dozen but if u r good and provide results you can make good money. And your comment regarding basic psychology is wrong. Not to mention restaurants and other businesses that don’t charge set prices have shown people actually donate more than would normally be charged.

          • Jodi was just presenting some simple numbers. She actually left a LOT out. Advertising costs, certification costs, continuing education are fairly high.

            For transportation, yes, a business person is allowed to count mileage driven from their office (even if it is home based) to a client meeting as a business expense.

            I agree on childcare. I don’t think that should be considered a “business expense.” Though childcare expenses are tax deductible for self employed and those who work for a company they don’t own.

            With taxes, self employed people pay higher taxes than those who collect a paycheck because self employed people have to pay the “employer” portion of Social Security and Medicare taxes. Then you add on Federal, State, and local taxes. 50% is a bit high…but not much depending on what state you live in.

            Jodi’s point (which I agree with) is that doulas do provide value. A study has shown that just in reducing the cesarean rate, doulas provide an average of $400 in value per birth. That doesn’t look at the value provided in avoiding other interventions and in making the birth more pleasant for the mother.

            Would you care to provide a reference for your statement about my basic psychology being wrong? Because I have a minor in Psychology, and that is what I learned in my Social Psychology class.

            I’d like to also see more data on restaurants not charging a fixed fee. Panera tried this in select locations. What they found is that 20% of customers pay slightly more than the suggested price, 60% pay the suggested price, and 20% pay significantly less. This was in a Wall Street Journal article. If it really had been a success in getting people to pay more, I expect that we would have seen them roll it out in more restaurants.

          • Mileage does not equal time spent driving which is what was referenced. If u r paying anything close to that much in taxes you are operating your business poorly and your customers shouldn’t have to pay more for that. Start an LLC, lower your overhead, etc. no wonder so many small businesses fail. Not to mention many of your comments r re: tax breaks not how those costs r reasonably charged to clients. Even the insinuation that those costs r conservative is laughable. I’ll have to look up the article re: the restaurant but it only works if the business is designed right and it particularly applied to non-profits; unfortunately I’m at work right now but I’m sure you can google it. There are many restaurants operating successfully under such a model. Panera is ill suited for such a business plan so I’m not surprised that it wasn’t successful. Another example is Radiohead released an album which was pay what you want and it was their highest grossing album of all time. The blanket statement you applied is what is wrong re: your psych comment. It is true in some contexts but not others. What do you want a cite to? Any case where it’s not applicable? I’ve never seen a study that says it’s true or not in context to doulas so since u r the one proposing that it in that particular regard maybe you should be the one to cite your info. I am not saying value isn’t provided but that everyone should be able to choose how to operate their business based on whether they desire to operate for profit or not, whether they r inexperienced, how much value the particular person can provide based on their specific talents/skill/etc. and that no one should judge that person bc they choose to operate their business differently bc they fear someone else’s business decisions might influence their bottom line. And of course that the itemized list is inflated. I do believe in doula services but this turned me off from them more than anything else

  40. Pingback: how to get births - Mothering Forums

  41. I think the thing I disagree with in this pot is the assumption that money is what brings you worth. There are so many other ways to place value on something and by defining it by just how much you make belittles what we are doing.

    I don’t necessarily think that it is good or bad for doulas to offer free services. Some people can’t even if they wanted to, but I don’t think we should bring in the concept that you have to be paid to make yourself or others feel like doulas are worth it. We then begin to buy into the concept that we are only of value when we can put a price tag on our services.

    We simply don’t need that. Doulas are worth it because research has backed that up and more women are coming to understand it’s value based on personal experiences, not how much someone charges.

    I understand that not being paid causes some concerns that doulas will not be taken seriously or valued, but to me, that is more a problem with how our culture views worth.

    If you need to charge, for goodness sakes charge. We all need to make a living. But if you should choose to give of your times and talents free or for less, you should not feel guilty for doing so.

  42. Interesting article, I’m not sure I completely agree. As a graduate doula who has not yet attended any births I intend to offer my services for my first few birth supports gratis. Why? Because I feel like birth is a sacred space, that it is generous of the woman giving birth to allow me into that space to watch and learn, and that I need hands on experience in birth support before I can start charging someone for it. I don’t see this as sending out the message that I am worthless or not good enough, rather I am saying I am ready to learn and I appreciate you giving me the opportunity to that by having me at your birth. And if the situation were reversed, I would be reluctant to pay someone to provide me with a service that they have no practical experience in, however I have gladly offered myself up for people who are new in their field to ‘practice’ on! Nothing that I do sends a message that I’m worthless and money is most certainly not the only measure of value that I have anyway.

    • I would encourage you to check out the “Business of Being a Doula” group on FB to discuss the idea of doing your first few births for free in more detail. I’d encourage you to read some of the discussions first before you chime in.

      • Thanks for the response Knitted in the Womb. I certainly have given the idea a great deal of thought and consideration before making this decision, I appreciate that everyone has a perspective on this, I am just sharing mine. Not so much ‘chiming in’ for the sake of it but rather sharing a considered perspective.

  43. This is all grand for doulas, but what should a low income family do when the lowest cost for a one day request for a doula to be present for a birth is $650-$900? I’m currently 3 months pregnant and my husband may be giving plasma for the next six months to try to pay for the one day birth help. Are doulas merely for the wealthy?

    • I’d suggest that your husband (or you) get a part time job rather than selling plasma…though the per hour pay isn’t as much, the weekly pay can be greater.

      There are grants available to fund doula programs for low income families. Push to get a doula program set up that uses these grants.

      Push to get medical insurance to cover doulas.

      But please don’t ask doulas to work for less than a living wage. We work far more than being present for one day of a birth. As Jodi explains in her post, it is typical for a doula to spend upwards of 20 hours interacting with a first time mom client through face to face contacts, e-mail, text, and phone. In addition to that we have “administrative” and “continuing education” time attached to each client.

      Of course Jodi already answered this much more fully at http://www.jodithedoula.com/2013/07/25/a-doula-for-everyone/ AND she linked to that at the end of her post. Did you not read the whole post, or did you just stop after you got angry at the idea you wouldn’t get free service from a doula who believes what Jodi believes?

      • Hi Jenn,
        First, there are no per hour doulas that I have found in Tucson.
        I read the entire article through, as well as all the comments, as well as many blog posts on the subject. I’ve tried getting a part time job- to no avail with my availability- as I care for my 2 year old. My husband has already begun donating plasma, on-top-of his 45 hour work week w/ 2 hour commute to work daily.
        Also, I have (already) been treated rather rudely in many other blog forums by quite a few doulas at this point. I’ve been treated to quite a few verbal spankings on craigslist when I posted a “trade” deal with any local doulas. I’ll never try that again.
        All I requested was a doula present for the birth. I do not need all the “extra” duties and days of work before or thereafter. I just wanted a doula present for the birth, that’s it. I’ve already collected $400 (by canceling eye appointment/contacts & cutting grocery costs at every turn.) I’ve tried finding insurance to work with doula costs… what an incredible pain. Interesting that insurances are not responsive to the “doula” experience. Strange, indeed.
        Since my comment, I’ve found a midwife to do my home birth. She says that she prefers to work without a doula. I found that quite interesting. She will also act as my doula if, for some unforeseen reason, I am transferred to a hospital.
        I’ve been rather taken aback by the responses that I have received in doula forums. I am currently 4 months along in my pregnancy and I am almost decided upon not even bothering to try and save up the grand for a doula.
        This all said, I have not been angry once this ordeal, just taken-aback. The doulas responses have seemed angry, however. I was just trying to speak up as, you know, one of the lower income subjects who do not seem to receive the same care as, say- people with more money. That is all I was trying to project.
        I wish you the best in your doula journeys.
        Thanks, I think, for your response.
        Tami

  44. This is good advice, but advice I have taken that is getting me nowhere! I can’t help but think about nursing students, for example, that do clinicals and don’t get paid. How is this any different? I did doula training almost 10 months ago and have not done a birth yet, when people ask me about experience and I tell them I have none, their faces melt. I’ve had inquiries and interviews but that’s as far as it’s went. I have refused to budge on my fee, to free and I think it’s costing me clients and I’m running out of time to obtain my 3 births for certification. And yes, I am actively networking and know the other doulas in my area specifically the group that has a monopoly on my area because they have connections with the hospitals and providers….

Leave a Reply

Your email address will not be published. Required fields are marked *