Eastside Doula Care

                                                        WHAT MAKES UP A DOULA’S FEES
                                                              (Adapted from www.gentlebirth.org)                               

The economics of professional labor support work are a mystery to many people. I offer this information so that you will have a better idea of what you are paying for:

Hours - Couples having a first baby may imagine that I’ll only be spending a few hours with them during the labor and birth. In reality, an eight-hour labor would be considered a fast labor. Most first labors last at least 24 hours. The longest continuous time I’ve spent providing labor support is approximately 46 hours. Average time spent with a woman for her labor and birth is approximately 15 hours. I spend at least another 12 hours in prenatal and postpartum meetings, another hour or two in phone calls, and approximately 6 hours travel time. Using these averages, my fee translates to an hourly rate of approximately $25/hour, before expenses and self-employment taxes.

Clients per Week - When I make a commitment to be available to attend you in labor and after the baby is born, 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 and/or in-hospital services is that one client per week is a full schedule. I find that 3-4 clients per month is a full-time workload.

Clients per Year - When I put your due date on my calendar, I commit to being available to you by phone 24/7 for questions, concerns, education, birth planning assistance and postpartum care. I block off 2 weeks before your due date and 2 weeks after that date. This means that when I schedule a two-week vacation or attend a conference, I have to add another four weeks during which I cannot accept clients. Because I always work with a back-up doula, sometimes clients hire me knowing there is an unlikely possibility that I won’t be at the birth. I average 23 births per year; in reality, there are some weeks where I have to turn clients away and then there are other weeks where I have no births on the calendar.

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, health insurance, and business expenses. As you may imagine, my communication expenses are high - business phone, cell phone and computer connection. I also have typical professional and office expenses, continuing education expenses, and unusually high fuel & transportation expenses since I primarily travel to people’s homes as well as their birth setting.

Putting It All Together - Although I am very dedicated to this work, being on-call all the time requires a very high level of personal sacrifice, including a willingness to be awakened several times in the middle of the night after half an hour of sleep to go attend a labor for the next 40 hours. About 1/3rd of my clients have some kind of early labor, which starts and stops, resulting in multiple phone calls and sometimes multiple home visits. In past years, I have spent my birthday or my children’s birthday at a labor, my family has spent holidays without me, I’ve had to cancel (and then reschedule) numerous appointments. I cannot take weekend trips away from the area, and even day trips 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.  I am not complaining -  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 also my experience from over one hundred fifty births and continual trainings on subjects pertaining to birth, postpartum issues and the care of newborns. As a doula, I must keep current on the latest studies, procedures, protocols, and policies surrounding birth and area hospitals and providers.  I need to be able to work effectively and respectfully with many different care providers. I see the variations from hospital to hospital and between care providers. I have the unique opportunity to learn their different approaches. I learn something new at every birth I attend. Because of this, 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 that everyone can afford, 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. 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 ways to find a free doula; 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 decide to select a doula who is undercharging for her services, I 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. 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.