What is a Doula Worth? How We Come Up With Our Fee.

by guest blogger, Allison Connor of Birthroots Doula

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. (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 24 hours; the longest continuous time we’ve spent providing labor support is 51 hours.  The average time we spend with a woman for her labor and birth is about 13 hours.  We spend another 10 hours in prenatal and postpartum visits, another hour or two in phone calls or email, and up to six hours travel time.  Using those averages, our fee translates to an hourly rate of about $25/hour, before expenses and self-employment taxes.

Clients per Week – When we make a commitment to be available to attend you in labor, we have to limit the number of clients we put on our calendar so as to avoid birth conflicts and to ensure that we are 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.  Because we also do a lot of teaching, we find that two to three clients per month is a full-time workload.

Clients per Year – When we put your due date on our calendar, we commit to being available two weeks beforehand and two weeks after that date.  This means that when we schedule a vacation, or attend a conference, or have a commitment that we cannot miss, we have to add another four weeks during which we cannot accept clients.   We have averaged about 25 clients a year the past few years.

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, our communication expenses are high – business phone, cell phone and computer connection.   We also have typical professional and office expenses, continuing education expenses, and unusually high transportation expenses since we primarily travel to people’s homes.

Putting It All Together – Although we 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 our clients have some kind of early labor which starts and stops, resulting in multiple phone calls – often in the middle of the night.  In past years, we have spent our birthdays at a labor, our families have spent Christmas day without us, we’ve had to cancel (and then reschedule) numerous classes and appointments, and find middle-of-the-night childcare when our husband’s were away on business.  We cannot take weekend trips away from the area, and even day trips to the spa or the mountains have to be judiciously chosen.  We never know what we’re going to encounter at a particular labor – we may end up wearing out our body’s supporting the woman in different birth positions; We may take catnaps sitting in a chair; we may eat nothing but crackers and dried fruit; we may end up holding a vomit bowl for someone vomiting with every contraction during transition; we may end up with blood, meconium or worse on our 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 we step into a birth, we bring not only our hearts and hands and training, but our experience from over one hundred fifty births and continual research on subjects relating to birth.  As a doula and educator, 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 we 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.  But every doula should be able to make a decent living as a doula without making her life unbearable.  We wish we could offer our services at a rate that everyone can afford, but that would require that we make even greater financial sacrifices than we are already making to do this work.  We are a self-supporting professional, 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 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 we 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, 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.


BirthRoots Doulas
offers labor support in Southern and Central New Hampshire.  Our doulas provide caring support to birthing mothers and their families.  They attend births in hospitals, freestanding birth centers and homes in Southern and Central New Hampshire, including greater Concord, Manchester and Nashua areas and the Monadnock Region.

Dr. Jessica L. Caruso, is the owner of Healing Hands Chiropractic Family Wellness Center. Dr. Jess is certified in the world renowned Webster Technique for pregnancy. She is also a proud member of the American Pregnancy Association, Holistic Pediatric Association and International Chiropractic Pediatric Association. Dr. Jess highly recommends doulas to all her pregnant patients. Learn more about natural pregnancy care at Healing Hands Chiropractic Family Wellness Center‘s website.


Birth Your Way

“What do you think of your body?”

It’s a question that elementary school children have been asked recently, in hopes of shedding light on the body image crisis. But it’s also a question that every woman of childbearing age should ask herself – and most do, albeit unconsciously.

Medical anthropologist Robbie Davis-Floyd writes that a woman’s choices regarding her birth often reveal her deepest beliefs about the abilities of her body, and by extension, her beliefs about nature and technology. A woman who believes that nature has made her body powerful and capable will choose a birth with minimal interventions – a labor that begins spontaneously and is allowed to progress without interference. A woman who believes that technology is superior to nature and that medical knowledge is superior to natural (and often unpredictable) body processes will choose a more “controlled” birth, where the labor process is carefully monitored and perhaps managed by outside influences. Even if the type of birth is not consciously chosen in advance – in fact, it rarely is – these same belief systems are often evident in a mother’s choice of care provider (midwife or OB/GYN) as well as the location for her baby’s birth (home, birth center, or hospital).

Of course, many women begin pregnancy unsure of what they believe regarding medical technology and its relationship to nature. The attitude of today’s average expectant mother could be summed up like this: She wants to believe that a natural, low-intervention birth is safe, realistic, and worthwhile. But by the middle of her pregnancy, she has heard, read, and viewed so many birth horror stories, she is no longer confident in her body’s ability to birth without the “safeguards” of modern medicine. She likely still hopes for a normal birth, but has taken on more of a “wait and see” approach to her birth plan.

Several studies indicate that a mother’s level of satisfaction with her baby’s birth is only loosely related to the choices that were made, but very closely related to the mother knowing she played an active role in making those decisions. A mother who feels pressured to submit to an intervention she would prefer to avoid (or even a mother who feels she was denied an intervention she wanted) is often left feeling very dissatisfied with her birth experience.

Regardless of the decisions she makes, every mother deserves to give birth with confidence in her choices. Just as the physical work of pregnancy reaches its climax with labor and birth, much of the intellectual and emotional work of pregnancy is to be informed and stay confident. Pregnancy and childbirth classes are an excellent way to get information. The face-to-face interaction with childbirth professionals as well as with other parents gives both the mother and her birth partner the chance to ask questions and explore their beliefs about a natural pregnancy and birth. Most importantly, birth classes encourage dialogue between the mother and her birth partner. (This is often a more effective source of communication than handing your husband or boyfriend a copy of the latest pregnancy book and then wondering if he’ll actually read it.)

Prenatal yoga classes offer pregnant women another opportunity to increase confidence in their birth choices, no matter what they are. Yoga’s emphasis on “tuning in” to the self helps a woman build confidence in her intuition. Pregnancy hormone jokes aside, Woman’s Intuition is not cutesy sitcom fodder but in fact a powerful and valuable player during pregnancy and birth. For many women of childbearing age, the value of intuition has gone the way of body confidence: we lost it in early adolescence. Pregnancy is an opportunity to reconnect with both.

Not sure what you want for your birth? Be honest with yourself. Do research. But most importantly, practice tuning in to your deepest thoughts and feelings. With time, you will begin to discover the choices that are best for you and your baby.

Healing Hands Chiropractic offers a number of prenatal care services to help you have the healthiest pregnancy and birth. In addition to pregnancy and childbirth workshops, we offer prenatal yoga, prenatal chiropractic care (including the Webster Technique), prenatal massage, reiki, and acupuncture.

PREGNANCY CLASSES NOW OFFERED IN LONDONDERRY, NH (GREATER MANCHESTER – NASHUA AREA)

LONDONDERRY, NH – Healing Hands Chiropractic, A Family Wellness Center in Londonderry, NH announces additional prenatal education services. Healing Hands’ prenatal education program now offers two distinct classes: Celebrating Your Pregnancy, for women in their first or second trimester along with their partners; and Honoring Your Birth, for women in their third trimester and their birth partners.

The Celebrating Your Pregnancy series is designed to help parents make healthy choices for pregnancy and while planning baby’s birth. Topics covered include:

  • Nutrition for optimal health & complication prevention
  • Safe exercise habits
  • Choosing the right practitioner for you
  • Understanding prenatal testing
  • Physical, emotional, and sexual changes during pregnancy
  • Fetal development

Healing Hands Chiropractic offers some of the only classes in the greater Manchester and Nashua areas that are not affiliated with a specific hospital. This independence allows them to work for you, the parent, rather than an institution. While some hospital-sponsored birth classes may cost a bit less, parents can benefit significantly from the independent nature of these classes.

Classes are available in weekday evening or Saturday afternoon formats. The cost for either series is $59 per family. Upcoming class dates are Wednesdays, March 25th and April 1st, 6:30-8:30 pm; and Saturday, April  11th from 12-5 pm.  For more information, please call 603-434-3456 or email Jenny Everett King at jenny@healinghandsnh.com.

Also available at Healing Hands Chiropractic are prenatal chiropractic care (including the renowned Webster Technique), prenatal yoga, pregnancy massage, and childbirth education. For more information on Healing Hands Chiropractic, please visit www.HealingHandsNH.com

Dr. Jessica L. Caruso Announces Prenatal Program at Chiropractic and Family Wellness Center in Londonderry, NH

December 20, 2008

LONDONDERRY- Dr. Jessica L. Caruso (formerly Leavey), director at Healing Hands Chiropractic- A Family Wellness Center in Londonderry, NH is currently accepting new patients. Healing Hands Chiropractic is a full service wellness center offering chiropractic care, massage therapy, reiki therapy, yoga, meditation and childbirth education classes; focusing on prenatal care, family wellness, women’s health, and pediatrics.

Healing Hands Chiropractic is pleased to announce the addition of a comprehensive prenatal program to their schedule, beginning January 2009. Dr. Caruso is certified in the Webster Technique; a safe and effective technique for expectant mothers used to restore proper pelvic balance and function; allowing the baby to get into the best possible position for birth. In expectant mothers presenting breech, there has been a high reported success rate of the baby turning to the normal vertex position. This technique has been successfully used in women whose babies present transverse and posterior as well. More may be learned about this technique at http://www.healinghandsnh.com/chiro.html.

Healing Hands has also added additional pre- and postnatal yoga, as well as Yoga for Women’s Wellness classes to their schedule. Prenatal yoga classes are a traditional series of beginner and intermediate asanas, tailored to the specific needs of expectant mothers. The mission of their prenatal classes is to help you find the balance between preparing for the profound experience of birth, while also caring for yourself in the present moment.
Pregnant women may also participate in any of their traditional Asana classes. Instructors at Healing Hands can show you how to modify poses when necessary. Babysitting services are available on site for most yoga classes at Healing Hands Chiropractic. Classes with childcare may be found at
http://www.healinghandsnh.com/yoga_hours.html

Healing Hands Chiropractic also has childbirth education classes available. Classes meet in two formats: Weekly classes are two hours each, and run for six weeks. The seventh week is a casual question and answer time, where students have the opportunity to speak with new parents as well as holistic health professionals who specialize in prenatal care and/or pediatrics. Weekend sessions, an alternative for those who can’t attend during the week, meet two Saturday afternoons for five hours each time. Exact dates and times of classes may be found at http://www.healinghandsnh.com/child_hours.html.

A free prenatal consultation is available with Dr. Caruso by appointment. Appointments may be made by calling Healing Hands Chiropractic at (603)434-3456 or online at www.HealingHandsNH.com by clicking the ‘Book Now’ icon.

Healing Hands Chiropractic is located at Landmark Crossing, 25 Nashua Rd., Ste F2 (RT 102); Londonderry, NH 03053.

http://www.free-press-release.com/news/print-1231263951.html