Expectations
Birth Doula
- You usually meet with your doula 2-3 times prenatally.
- She blocks off 2 weeks before due date and 2 weeks after to be available 24/7 by phone and to be at birth with several hours notice.
- Your doula stays with you at your birth from when you need support until you are settled post birth (usually once breastfeeding is established if that’s what you want).
- Your doula will visit with you1-2 times postpartum, and sometimes more as needed.
- You doula will likely have a backup in cases of illness or a very long birth, so you get fresh support. You have as much choice over backup as you do your primary doula & after you select your doula, she will recommend 1-2 back up doulas who are available, and who she thinks will be good for you. You will be asked before your backup is called in, and if she does come, your doula will transfer all info necessary to provide you continuous emotional, physical and informational support.
- There are a few doulas who are setting up their care packages differently, like partially charging by the hour for extra long births, so be sure to clarify terms when selecting a doula so you know what you’re getting.
- You will get support as you request and schedule it on an hourly basis.
- Postpartum doulas will often connect you with resources that fit your needs, and help you plan how to access the resources.
FEES
Birth Doula
- Many doulas offer a sliding scale rate: typically $500-1500 for a birth doula.
- Valley Medical offers a $500 reimbursement for birth doulas www.valleymedicalcare.com/for-patients/valley-medical-forms
- Once in a while insurance will pay for a doula.
- You can talk to your doula about trading services, and payment plans and schedules.
- Usually an hourly wage, between $15 and $25 according to services requested
WHAT MAKES UP A DOULA'S FEES?
(Adapted from www.gentlebirth.org)
How a doula sets her fees is a mystery to many people; we 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, an eight-hour labor would be considered pretty fast; most first labors last up to 24 hours. The average time spent with a woman for her labor and birth is about 13-16 hours. We spend another 10 hours in prenatal and postpartum visits, another hour or two in phone calls or email, and up to two hours travel time. Using those averages (about 30 hours per family), a $500 fee translates to an hourly rate of about $16/hour, before expenses and self-employment taxes. In Juneau, you can expect to pay between $600-$1600 for a doula's services. Contact a doula individually to find out her rates, and if she offers sliding scale fees, or partial packages.
Clients per Week
When a doula makes a commitment to be available to attend you in labor, she has to limit the number of clients she puts on her calendar so as to avoid birth conflicts and to ensure that she is 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 a doula puts your due date on her calendar, she commits to being available two weeks beforehand and two weeks after that date. This means that when she schedules a vacation, or attends a conference, or has a commitment that she cannot miss, she has to add another four weeks during which she cannot accept clients. Occasionally, clients can hire a doula with a backup on-call during times that she 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, communication expenses are high - business phone, cell phone and computer connection. There are also typical professional and office expenses, continuing education expenses, and unusually high transportation expenses since a doula primarily travels to people’s homes.
Putting It All Together
Although doulas are 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. About 25% of clients have some kind of early labor which starts and stops, resulting in multiple phone calls – often in the middle of the night. It is not rare for a doula to have spent her birthday at a labor, her family spend Christmas day without her, canceling (and then rescheduling) numerous classes and appointments, and find middle-of-the-night childcare when partners and husbands are away or nonexistent.
One professional doula paints this picture: “A few years ago, I was called to a birth Christmas Eve day and got home at 4:30am Christmas morning, just in time to wrap a few presents and get a few hours sleep before my 5-year-old son woke up. I cooked Christmas dinner and went to bed early, only to be called at 11pm Christmas night for another birth. I considered myself lucky to have had the great timing to be home with my family that day!”
A doula cannot take weekend trips away from the area, and even day trips to hike or ski have to be judiciously chosen. She never knows what she's going to encounter at a particular labor - she may end up wearing out her body supporting the woman in different birth positions; she may take catnaps sitting in a chair; she may eat nothing but crackers and dried fruit; she may end up holding a vomit bowl for someone vomiting with every contraction during transition; she may end up with blood, meconium or worse on her clothes. Thank goodness doulas LOVE their 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 a doula steps into a birth, she brings not only her heart and hands and training, but her experience from all of the births she has attended and continual research on subjects relating to birth. As a doula and educator, she 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 doulas, we see the variations from hospital to hospital, between care providers, and over time. Being able to work with many different care providers, we learn all their different approaches and tricks, which we think is unique to the doula profession. And considering that every birth and every family teaches a doula something new, we 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 doing the work she is passionate about without making her life unbearable. We all wish we could offer our services at a rate that everyone can afford, but that would require that a doula and her family make even greater financial sacrifices than she is already making to do this work. A doula is a self-supporting professional, and her options are to earn a living wage working with birth or to have a more conventional job, which would pay much more (most of us used to do that!). There are people offering doula services at significantly reduced prices. They are either offering less time and services, are still in training, or are in a financial position to offer free services. If you need free doula services, there are a few ways we can help you find a free doula (contact Shayna Rowher); otherwise, you are doing future birthing women a disservice by making labor support an underpaid profession that cannot attract or keep talented, skilled individuals. If you end up selecting a doula who is undercharging for her services, we strongly encourage you to pay her more than she is asking; otherwise, she may not be around to help you with your next child. 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.
How a doula sets her fees is a mystery to many people; we 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, an eight-hour labor would be considered pretty fast; most first labors last up to 24 hours. The average time spent with a woman for her labor and birth is about 13-16 hours. We spend another 10 hours in prenatal and postpartum visits, another hour or two in phone calls or email, and up to two hours travel time. Using those averages (about 30 hours per family), a $500 fee translates to an hourly rate of about $16/hour, before expenses and self-employment taxes. In Juneau, you can expect to pay between $600-$1600 for a doula's services. Contact a doula individually to find out her rates, and if she offers sliding scale fees, or partial packages.
Clients per Week
When a doula makes a commitment to be available to attend you in labor, she has to limit the number of clients she puts on her calendar so as to avoid birth conflicts and to ensure that she is 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 a doula puts your due date on her calendar, she commits to being available two weeks beforehand and two weeks after that date. This means that when she schedules a vacation, or attends a conference, or has a commitment that she cannot miss, she has to add another four weeks during which she cannot accept clients. Occasionally, clients can hire a doula with a backup on-call during times that she 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, communication expenses are high - business phone, cell phone and computer connection. There are also typical professional and office expenses, continuing education expenses, and unusually high transportation expenses since a doula primarily travels to people’s homes.
Putting It All Together
Although doulas are 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. About 25% of clients have some kind of early labor which starts and stops, resulting in multiple phone calls – often in the middle of the night. It is not rare for a doula to have spent her birthday at a labor, her family spend Christmas day without her, canceling (and then rescheduling) numerous classes and appointments, and find middle-of-the-night childcare when partners and husbands are away or nonexistent.
One professional doula paints this picture: “A few years ago, I was called to a birth Christmas Eve day and got home at 4:30am Christmas morning, just in time to wrap a few presents and get a few hours sleep before my 5-year-old son woke up. I cooked Christmas dinner and went to bed early, only to be called at 11pm Christmas night for another birth. I considered myself lucky to have had the great timing to be home with my family that day!”
A doula cannot take weekend trips away from the area, and even day trips to hike or ski have to be judiciously chosen. She never knows what she's going to encounter at a particular labor - she may end up wearing out her body supporting the woman in different birth positions; she may take catnaps sitting in a chair; she may eat nothing but crackers and dried fruit; she may end up holding a vomit bowl for someone vomiting with every contraction during transition; she may end up with blood, meconium or worse on her clothes. Thank goodness doulas LOVE their 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 a doula steps into a birth, she brings not only her heart and hands and training, but her experience from all of the births she has attended and continual research on subjects relating to birth. As a doula and educator, she 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 doulas, we see the variations from hospital to hospital, between care providers, and over time. Being able to work with many different care providers, we learn all their different approaches and tricks, which we think is unique to the doula profession. And considering that every birth and every family teaches a doula something new, we 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 doing the work she is passionate about without making her life unbearable. We all wish we could offer our services at a rate that everyone can afford, but that would require that a doula and her family make even greater financial sacrifices than she is already making to do this work. A doula is a self-supporting professional, and her options are to earn a living wage working with birth or to have a more conventional job, which would pay much more (most of us used to do that!). There are people offering doula services at significantly reduced prices. They are either offering less time and services, are still in training, or are in a financial position to offer free services. If you need free doula services, there are a few ways we can help you find a free doula (contact Shayna Rowher); otherwise, you are doing future birthing women a disservice by making labor support an underpaid profession that cannot attract or keep talented, skilled individuals. If you end up selecting a doula who is undercharging for her services, we strongly encourage you to pay her more than she is asking; otherwise, she may not be around to help you with your next child. 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.
