What’s in a Fee?



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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