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
I've spent providing labor support is 41 hours. The average time I have
spent with a woman for her labor and birth is about 13 hours. I 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, my fee translates to an hourly rate of about $40/hour, before
expenses and self-employment taxes.
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 (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 I also do a lot of teaching, I
find that two to three clients per month is a full-time workload.
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. I
have averaged about 20 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, 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.
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. About 25% of
my 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,
I have spent my birthday at a labor, my family spent Christmas day without
me, I’ve had to cancel (and then reschedule) numerous classes and
appointments, and find middle-of-the-night childcare when my husband was
away on business. A few years ago, I was called to a birth Christmas Eve day
and got home at 4:30am Christmas morning, just in time to wrap a few
presents and get a few hours sleep before my 5-year-old son woke up. I
cooked Christmas dinner and went to bed early, only to be called at 11pm
Christmas night for another birth. I considered myself lucky to have
had the great timing to be home with my family that day! I cannot take
weekend trips away from the area, and even day trips to the spa or the
mountains have to be judiciously chosen. 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 LOVE my 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 I step into a birth, I
bring not only my heart and hands and training, but my experience from over
three hundred births and continual research on subjects relating to birth. As
a doula and educator, 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.
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. I wish I could offer my services at a
rate that everyone can afford, 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, and my options are to earn a living wage
working with birth or to have a more conventional job, which would pay much
more (I used to do that!). 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 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.
