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.

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by Jenny Everett King, childbirth educator and prenatal yoga teacher

Because we promote natural childbirth at Healing Hands, some people assume that our practitioners are opposed to epidurals and other pharmacological methods of labor pain relief. This is absolutely not the case. Rather, what concerns us is the idea so prevalent in today’s culture that women need medication for labor pain. We encourage natural pain relief methods because we want every pregnant woman who walks through our doors to know that non-medicated birth is a viable option.

Some mothers who plan to use medication for pain relief do little else to prepare for the discomforts of labor. But women who plan on epidurals for labor and delivery still need other coping techniques. If you go into labor at home, you will still need to cope with contractions during the car ride to the hospital as well as the admission process. Even at the hospital, the window of opportunity for receiving an epidural can be relatively small – typically between four and eight centimeters cervical dilation. Request it before 4cm, and you’ll have to wait until your labor has progressed. Request it at 8cm or more – for most women, this is the most intense part of labor – and you’ll likely be denied because the “pushing” stage is imminent. It’s also a good idea to let an epidural wear off somewhat before pushing begins, so that you can feel your contractions enough to work with them. That means that you’ll probably have some discomfort during the second stage of labor. Additionally, epidurals do not always provide total pain relief. Planning in a scheduled cesarean? In the absence of medical need, it’s unlikely that one will be performed before 39 weeks gestation. But full-term labor can happen as early as 37 or 38 weeks. Every pregnant woman, therefore, needs to prepare herself to deal with labor contractions.

Our childbirth workshops teach several ways to cope with and minimize labor pain, including relaxation techniques, the best positions for labor, massage, counter-pressure, acupressure, and vocalization. We also discuss epidurals at length, so that parents who are interested in them can make an informed decision and know when pain medication may be the right choice.

The other services we offer at Healing Hands, particularly pregnancy chiropractic, acupuncture, and prenatal yoga, are extremely useful for minimizing labor pain, because receiving these treatments during pregnancy can help your baby get into the best position for birth. The worst discomforts women feel during labor are usually due to the baby being in a less-than-optimal position. (The horror stories told to vulnerable pregnant women about “back labor” are really stories of a baby facing backwards for birth!)

Our practitioners welcome your questions about handling labor pain and optimal fetal positioning. For more on coping techniques in labor, please join us for “Love Your Birth” on January 26^th or April 20^th.

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 Healing Hands Chiropractic located in the Manchester|Nashua, NH Region, offers a comprehensive prenatal program with pregnancy chiropractic care, prenatal yoga, pregnancy & birth classes and massage. 

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