Sunday, June 17, 2012

Economics of a Doula

As I transition into this profession, I have done a lot of research in regards to what to charge for my services. Asking Doulas in the community what they charge as well as looking at other Doulas in different parts of the country and world. Having a background in Economics; its important to understand the "Cost-Benefit Analysis" for our services. No one is becoming a Millionaire by doing our work, yet we feel it is important to be paid our worth because there is a lot that goes into the price of a Doula.

Our fee is the same regardless of the length of your labor. Because of the nature of birth, an hourly fee would be out of reach for most families. Most doulas in this area charge anywhere from $350 to $950. The fee charged usually reflects the economy of the area as well as the doula's experience and certification status. If you feel you are unable to afford the fee, discuss this with your Doula before saying no and trying to find a 'cheaper' Doula. Its important to create an open discussion around fees and services, because by discussing the services a Doula provides, you just might decide that her services are more important than the fee she is charging.

The fee itself is non-negotiable, but in the spirit of encouraging doula-supported birth, we will do what we can to help you find a doula whose fees are within your financial means or offer payment plans and ways to make it affordable to you. We are a very flexible bunch! :)

Here is a Breakdown of what goes into Doula Services

A doula is a full-time resource, providing emotional support and strength even when not physically present. It's time spent gathering, compiling, and presenting information to help you make choices and understand the implications of those choices. We spend an average of 25 hours with each family, in pre-natal appointments, birth, post-partum. This is in addition to being on call full-time (24/7) for an entire month surrounding your Estimated Due Date. In addition, we are researching, networking, and continuing our education and credentials to provide you with the best service possible. The long hours we may spend with one couple translate into increased experience and knowledge that carries over into the next, possibly shorter, birth. 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 24 hours.


Clients per Week - When I make a commitment to be your Doula, 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. Two to Three clients a month is a full time schedule for Doulas in this area.

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 conference, or have a commitment that I cannot miss, I have to add another four weeks during which I cannot accept clients. Occasionally, my clients hire me with my backup on-call during times that I may be unavailable. We may turn away potential clients for the period around your due date to avoid conflicts and be reasonably rested when you need us. We will not go out of town (unless in the case of a family emergency) and are available to you at all times. Our family may need to take 2 cars when we go out. We may have to have pre-arranged childcare for children, substitutes for classes we are scheduled to teach, and coverage for other responsibilities. If for any reason we are not able to be available for any period of our on-call commitment to you, we will inform you of this and contract a back-up doula at our own expense.

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 - business phone, cell phone 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.

As an example: lets say a Doula Charges $600 for her Birth Services, she is doing this full time and does not have another source of income. She takes on a full client load of 3 births/month. If she never takes ANY vacation she will have helped 36 clients/yr...With her fee, she is earning $21,600 BEFORE: taxes, internet, business expenses, car, phone, insurance, professional fees. Not to mention normal everyday items such as food, gas, home expenses. If we follow the rule of thumb above, a Doula's take home pay is $10,800/yr Would you be able to live off of $10,800/yr? You can see how Doula's want to be able to provide services for ALL individuals, yet also need to make a living to be self-sustaining and not burnout.

Experience Factor
When I step into a birth, I bring not only my heart and hands and training, but my experience as an athlete, nanny, speaker and continual research on subjects relating to birth. As a doula, 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.

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. Many Doulas have clients that have had some kind of early labor which starts and stops, resulting in multiple phone calls – often in the middle of the night. We understand that we might spend Birthday's, Family Events, Christmas or any holiday for that matter in Labor with our Clients. Many women who are also parents have to find childcare in the middle of the night if one of their clients goes into labor. During the time period when I am on-call: I cannot take weekend trips away from the area, even dates nights or events with friends have to be chosen carefully... (spontaneity is something only the baby can partake in :)) with birth 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 have an extremely supportive husband!!) 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. (see example above)

Bottom Line

Nobody's getting rich doing doula work. Yet every doula needs to be able to make a decent living without making her life unbearable. I wish I could offer my services at a rate than everyone can afford, yet that would require I make even greater financial sacrifices and de-value what I believe I am worth as a Professional providing an extremely important service. Once I finish my certification, I will determine my rate for my services. It will allow me to do this work and not have to supplement my income from a normal 8-5 job, thus allowing me greater flexibility with my clients. If you need free doula services, there are many ways I can help you find a free doula; otherwise, we 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. DONA, the organization that I am receiving my certification from, has been able to create a "Doula Code" with Insurance providers. You can ask your Doula if she has a Doula code, that allows you to receive some amount of what you paid to your Doula by filing a claim with your Insurance Provider. 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.