Economics of A Doula's Fees (Adapted with permission from www.Gentlebirth.org)
Question: How do you set your fees?
Answer: The economics of professional labor support work are a mystery to many people; I offer this information so that you'll have a better idea of what you're 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 pretty zippy; most first labors last longer than 16 hours. The average time that I've spent with a woman for her labor and birth is about 16 hours. I spend at least another 9 hours in prenatal and postpartum meetings, and another hour or two in phone calls and email communication.
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 is that one client per week is a full schedule. However, because I am working to balance family and doula work carefully, I actually try and only take 2 clients a month.
Clients per Year - When I put your due date on my calendar, I commit to being available one week beforehand and 1 week after that date. This means that when I schedule a two-week vacation, I have to add another four weeks during which I cannot accept clients. 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.
Consultant Factor - The rule of thumb is that a self-employed professionals income is only half of what they earn, after deductions for vacation and sick time, self-employment taxes, health insurance, continued education and business expenses. I also have routine professional and transportation expenses. In addition, I bring labor support tools to your birth as part of providing doula care.
Putting It All Together - The annual income of someone providing labor support services
with a responsible client load and a strong commitment to being available for your birth is 1/2 the number of clients per year times their fee per client. So if I take 24 clients a year, this is about 12 times the fee per client, and, yes, that's before taxes, including extra self-employment taxes. 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 beeped awake after half an hour of sleep to go attend a labor for the next however many hours.
Bottom Line - Nobody's getting rich doing labor support work. I wish I could offer my services for free, 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, I want to earn a living wage working with birth so I can provide for my family while doing what I love. There are people offering doula services at significantly reduced prices. They are either offering significantly reduced services, are still in training, or are basically offering charity. If you need charity, I encourage you to get labor support however you can; and I do offer pro-bono work when a client can't afford my standard rate. However, if you can afford doula care and you looking for "a free doula" 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.
Advocacy Suggestions - Doula's have been granted a health insurance billing code which means I can help you bill your insurance for possible reimbursement. 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, although 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.