A Doula for Everyone…But How?

A few months ago, I wrote a  post called No Free Births!  It was aimed at birthworkers who hope to build a successful private practice by giving their work away. It sat quietly in its own little corner of the blogosphere, minding its own business, until a few days ago. Then… KA-BLAM!  Suddenly, it has had more attention than anything else I’ve ever written.

The responses have ranged from “Right on! Sing it!” to “This heartless woman shouldn’t be a doula!” The question that has come up most often has been, “But what about the mama who needs a doula and can’t afford one?”  Women who become doulas choose this path because, at the heart of who we are, we are compassionate, kind, and often generous people who really just want to help others. That’s exactly as it should be… if we aren’t in this work as an act of service, there really isn’t much point.

First, a word of caution: beware the person who is looking for “something for nothing”. Marketing research has shown repeatedly that the people who ask for discounts are more often able to afford whatever it is they are looking for… they are simply financially savvy enough to seek out “the best deal possible”.  Over the years, discernment has taught me the difference between someone desiring my service because we’re a good fit, and the person seeking me out because I’m the cheapest one they’ve spoken to. (The new cars and the boat in the driveway were a good tip-off…)  There is a significant difference between wanting to help others who would not otherwise have support, and giving away one’s work until the magical “someday when I start charging what I’m worth.” So, what do we, as compassionate people who also value ourselves and our work, do to provide labor support for others when fee is a genuine issue?

It helps to break down the numbers, to recognize exactly what it is we are investing into a free birth. Most doulas incur expenses for every birth we attend. In addition to training and certification, we have expenses for transportation, childcare, meals, internet for email access, cell phones for being on-call, and hospital parking, just to name a few. On average, I have a minimum of $165 in costs per birth, and that’s before I pay taxes on any income I may have. “I’ll do it for free”, when looked at this way, actually becomes “I’ll pay you to let me attend your birth.”  When we’re attending births in this way, it becomes an expensive hobby more than a profession. Most doulas simply do not have the means to work in this way long-term. So, what is a doula to do?

1) Volunteer for a Non-Profit organization.  Many such organizations already exist – a simple web search for “non-profit labor support” and the name of your state may turn up several results. The non-profits that exist in the area in which I live also act as a referral service for their doulas who volunteer, so that those who can afford doula care are more easily able to find the doulas who serve in their area. Non-profits have standards to determine who qualifies for care, and are able to not only provide labor support, but parenting guidance and health education to mamas in need. Through doulas volunteering for small and specific amounts of time, far more women are able to receive help than would be served by one doula alone. The same 40 hours you would contribute to one mama might instead help many! Not a non-profit in your area? Maybe it’s time to consider starting one. Non-profits generate income through grants and donations from outside sources, so that those running the show are able to receive income for the work that they do. Businesses are far more eager to donate time, money, and services to non-profit organizations, because they also benefit from the tax deduction.

  2) Donate to your own charity.  Many people have been raised with the tradition of giving a portion of your income to the greater good of others. For every birth I attend, I set aside a percentage as a charity fund. Then, when I am working with someone who is in a position of not having the means for my full fee, I am able to say “I am currently able to offer you a discount of this amount”, that being the cumulative amount that has been set aside. The more I work for pay, the more I have in this fund to offer. The more I am blessed with abundance, the more I have to give to bless others. Rather than working for free, this practice creates sustainability for future services.

  3) Do It Like the Doctors Do.   Do it as a group! Physicians who work in groups have support in sharing appointment times and on-call schedules. Doctors who thrive in private practice work may sometimes choose to offer their time in community clinics or in mission work. The difference between this service and a doula taking on a “free birth” client is that the physician, as part of a group of volunteers, is able to offer a reasonable and finite period of time in a way that serves the greater good of many at once. It is a widely accepted truth that “many hands make light the work”. When everyone gives a little, no one needs to do more than her share. A group of doulas coming together to offer support are able to each give a few hours of their time in a way that benefits many. Women’s shelters, support networks, and many other service organizations may be eager to receive volunteers.  Offer low-cost labor support classes for women at your local library, or in a doctor’s office. Teaching a free ” labor support” class, which I do once a month for a couple of hours, can provide support 4 to 6 mamas at a time in creating a better birth experience for themselves. It is not up to one doula to spread herself as thin as possible, when there are easier ways to teach others to offer good support to mamas in need.

   4) Offer a sliding scale or a “pay as you can” program.  Have a passion for supporting teen moms, or military families?  Offer a discount. Be clear about the value of your services, and also be willing to make it affordable. Those facing true financial challenge through difficult life circumstances benefit from being allowed the dignity of making an arrangement that works for them.  It’s perfectly fine to say, “This is my typical fee range. I am willing to work with you on ways we can make this possible for you. I need you to let me know honestly what will be reasonable and affordable for you. If I can accept that, we will create a payment schedule together.” Put your agreements in writing, and hold one another accountable for being in integrity with your word, just as you would with any other client. A doula’s fee is an investment that the mother makes in her own empowered birth. People value more what they have invested in for themselves. Be mindful of the difference between empowering and enabling.

5) Be willing to barter. I’ve not ever turned a family away based on ability to pay, but I do treat every family as though they, too, have worth and something of value to offer. Money is simply a means of exchange. We put forth our time, energy, and effort into our work. In turn, we are paid in money. We then exchange this money for the other things we want or need. If money as a means-of-exchange is not available, then there is likely a solution that involves another way of trading time, energy, and effort. Those who are offering a service can reasonably expect a fair offer in exchange for their service. I prefer the energy of this sort of exchange, whether it’s barter or pay-what-you-can, over the message of “you have nothing worth offering to me, so I’m not even going to go there”. For me, it’s choosing a message of empowerment over one of pity. This doesn’t mean that there must be a dollar-for-dollar value “equal exchange”, but that the energy exchange for all involved is proportionally and equitably balanced.

  6) Mentor a Student.  Experienced and seasoned doulas are in the wonderful position of being able to share our wisdom with those who are just starting out. Offering a few hours of time to a student doula supports not only the new doula, but the doula community as a whole. If newer doulas in your area help contribute to the reputation of doulas  as being well-trained and highly skilled service providers, everyone wins. The busier new doulas are, the more people will know about doulas, and the busier we will all become.  Student doulas are sometimes in the position of having lower fees than more seasoned doulas may be. I do not hesitate, when speaking to a mama who is facing financial challenge, to say “I’m currently working with a student doula. Her fee may be more affordable to you, and you will have the benefit of her being able to call me for support and guidance during the time that she is providing your doula care.” In this way, I’m seeing to it that the mama has good support, and the bulk of my time remains free to take on paying clients (who in turn are contributing to my charity fund, which in turn opens the way for more to receive care. Again, the goal here is to provide sustainability.) All I need to be available for is a couple of phone calls along the way from a student. My cost involved is minimal.  Comparing apples to apples, when I contribute in this way, I’ve helped 20 births with the same 40 hours that I would otherwise have given to one woman for one birth, the student receives fair pay, and my expenses have been lower.

  7) Be a Birth Activist.  Though many insurance companies are beginning to reimburse for doula fees, many more need to get on board. Encourage your mamas to call their insurance companies and ask them to cover for doula support. You can talk to your local hospital, and encourage them to provide universal doula care, so that this expense would be covered in the same way as their in-house lactation consultants. Talk with doctors and midwives about providing doula care for their patients by having doulas on staff.  This would decrease the overall expense to your doctor or hospital, and would also make doula care available for all! Lobby your state legislature to include doula care in their state-provided medical coverage, so that low income families have the benefit of doula care.


Those of us who value our work, and know the worth of what we do, are able to be compassionate and of service to those in need in a myriad of ways. These are some that have worked for me and others connected to my practice. What has worked for you?


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