What makes up a Doula's fee?

What Makes Up a Doula's Fees?

(Adapted from  http://bigbellyservices.com/doula%20fees%20detail.htm )

How a doula sets her fees is a mystery to many people; I offer this information so that you have a better idea of what you're paying for.

 
Hours - Couples having a first baby may imagine that their doula will only be spending a few hours with them during the labor and birth.  In reality, a 6-10 hour labor would be considered pretty fast; most first labors last at least 24 hours; the longest continuous time I've spent providing labor support is around 36 hours.  The average time I have spent with a woman for her labor and birth is about 20 hours.  I spend another 6-10 hours in prenatal and postpartum visits, another hour or two in phone calls, text messages, or email, and up to six hours travel time.  Using those averages, my fee translates to an hourly rate of about $20/hour, before expenses and self-employment taxes.

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

Clients per Year - When I put your due date on my calendar, I commit to being available two weeks beforehand and two weeks after that date.  This means that when I schedule a vacation, or attend a workshop, or have a commitment that I cannot miss, I have to add another four weeks during which I cannot accept clients.  Occasionally, my clients may hire me with my backup on-call during times that I may be unavailable.

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

Putting It All Together - Although I am dedicated to this work, being on-call all the time requires a very high level of personal sacrifice, including a willingness to be awoken after half an hour of sleep to go attend a labor for the next 40 hours.  At times it is possible to be called to work with mothers who are, in fact, experiencing false labor.  I have nearly missed both Thanksgiving and Christmas within a single year, both of which were my youngest daughter's firsts.  I considered myself lucky to have had the great timing to be home with my family on both of those days!  I cannot take weekend trips away from the area, and even day trips to the spa or the mountains have to be judiciously chosen.  I never know what I'm going to encounter at a particular labor - I may end up wearing out my body supporting the woman in different birth positions; I may take catnaps sitting in a chair; I may eat nothing but crackers and dried fruit; I may end up holding a vomit bowl for someone vomiting with every contraction during transition; I may end up with blood, meconium or worse on my clothes.  Thank goodness I LOVE my work!  But the financial reward for this?  The annual income of someone providing labor support services with a responsible client load and a strong commitment to being available for birth is 1/2 the number of clients per year times their fee per client.

Experience Factor – When I step into a birth, I bring not only my heart and hands and training, but my experience from every single birth I have attended as well as any additional knowledge I have gained through independent study or workshops attended.  As a doula and educator, I must keep up-to-date on the latest studies, procedures, protocols, and policies surrounding birth and area hospitals and providers.  Did you know that doctors, midwives, and nurses usually only know their  way of doing things?  As a doula I see the variations from hospital to hospital, between care providers, and over time.  Being able to work with many different care providers, I learn all their different approaches and tricks, which I think is unique to the doula profession.  And considering that every birth and every family teaches me something new, I have a wealth of knowledge and skills to bring to birth.

Bottom Line - Nobody's getting rich doing doula work.  But every doula should be able to make a decent living as a doula without making her life unbearable.  I wish I could offer my services at a rate than everyone can afford (and I will do my absolute best to make this a reality, but sometimes it may be impossible), but that would require that I make even greater financial sacrifices than I am already making to do this work.  I am a self-supporting professional, and my options are to earn a living wage working with birth or to have a more conventional job, which would pay much more (I used to do that!).  The most common cause of doula burnout is feeling overwhelmed by the commitment and uncompensated for one’s time and dedication.

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