How a Doula sets her fees:
People often wonder how a doula sets her fees this is an article from Gentle Birth to help you better understand how a doula sets her fees (adapted from www.gentlebirth.org )
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 at least 18 hours; with some lasting for days. With another 6 or so hours devoted to prenatal and postpartum visits, another two or three hours in phone calls and email's, and up to six hours travel time. Using those averages, the fee translates to an hourly range of about $24/hour, before expenses and self-employment taxes.
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) as 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 must add another four weeks during which she cannot accept clients. Occasionally, clients hire a doula with a backup doula on-call during times that they 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. Doula's also have typical professional and office expenses, continuing education expenses, and unusually high transportation expenses since they primarily travel to people’s homes.
Putting It All Together - Although doula's 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. Doula's have spent Birthday's and Christmas' at births. Doulas end up canceling (and then rescheduling) numerous appointments, and must find middle-of-the-night childcare when their husband is working. They cannot take weekend trips away from the area, and even day trips to the spa or the mountains have to be judiciously chosen. A doula never knows what she is 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 we LOVE our 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 being present at many births and continual research on subjects relating to birth. As a doula, we 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 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 I think is unique to the doula profession. And considering that every birth and every family teaches us something new, we have a wealth of knowledge and skills to bring to birth.
Bottom Line - Nobody's getting rich doing doula work. However, every doula should be able to make a decent living as a doula without making her life unbearable. Many doula's wish they could offer services at a rate that everyone can afford, but that would require that we make an even greater financial sacrifice than we are already making to do this work. We are self-supporting professionals, and our options are to earn a living wage working with birth or to have a more conventional job, which would pay much more. There are some 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 many ways I can help you 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 end up selecting 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. 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.
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 at least 18 hours; with some lasting for days. With another 6 or so hours devoted to prenatal and postpartum visits, another two or three hours in phone calls and email's, and up to six hours travel time. Using those averages, the fee translates to an hourly range of about $24/hour, before expenses and self-employment taxes.
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) as 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 must add another four weeks during which she cannot accept clients. Occasionally, clients hire a doula with a backup doula on-call during times that they 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. Doula's also have typical professional and office expenses, continuing education expenses, and unusually high transportation expenses since they primarily travel to people’s homes.
Putting It All Together - Although doula's 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. Doula's have spent Birthday's and Christmas' at births. Doulas end up canceling (and then rescheduling) numerous appointments, and must find middle-of-the-night childcare when their husband is working. They cannot take weekend trips away from the area, and even day trips to the spa or the mountains have to be judiciously chosen. A doula never knows what she is 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 we LOVE our 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 being present at many births and continual research on subjects relating to birth. As a doula, we 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 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 I think is unique to the doula profession. And considering that every birth and every family teaches us something new, we have a wealth of knowledge and skills to bring to birth.
Bottom Line - Nobody's getting rich doing doula work. However, every doula should be able to make a decent living as a doula without making her life unbearable. Many doula's wish they could offer services at a rate that everyone can afford, but that would require that we make an even greater financial sacrifice than we are already making to do this work. We are self-supporting professionals, and our options are to earn a living wage working with birth or to have a more conventional job, which would pay much more. There are some 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 many ways I can help you 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 end up selecting 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. 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.