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Economics of A Doula's Fees
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, very
possibly beyond 24 hours. The average time spent with a woman for her labor and birth is about 16 hours. I spend another
10 hours in prenatal and postpartum meetings, and another hour or two in phone calls. My base fee translates to an hourly
rate of about $10/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 services is that one client per week is a full schedule. Since most of my
clients are first-time mothers, I find that 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 two-week vacation, I have to add another four weeks during which I cannot
accept clients. A full calendar is 32 clients per year; in reality, 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 professional's income is only half of what they earn, after
deductions for vacation and sick time, self-employment taxes, health insurance, and business expenses. As you may imagine,
my communication expenses are high - cell phone and computer connection; I also have routine professional and office expenses
and unusual transportation charges with gas at $3.50 and rising as well as supply and upkeep. In addition, I bring several
hundred dollars worth of equipment 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.
This is about 16 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 awakened 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 two trips to their home and being called more than once. I face loosing
holiday and sentimental events with my young family. I cannot take weekend trips away from the area, and even day trips to
Orlando or the beaches have to be planned around traffic conditions. 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 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. Given
all this, I'm sure you can understand why we can be upset when someone once asks why we charge "so much".
Bottom Line - Nobody's getting rich doing labor support work. I offer sliding scales for those truly in need, which 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 working with birth or pursue more conventional employment, which would pay much more.
I know- I've worked in those fields. But I believe very deeply that I am working my calling in life, and if that means I
won't be rolling in dough, then so be it.
Advocacy Suggestions - Unfortunately most insurance plans do not automatically cover doula and other non-licensed birth
support. I provide a form and letter you can submit to your insurance plan in order to attempt renumeration for my services.
I cannot file this for you, and it will be your responsibility. You can also talk with your Human Resources representatives
to ask them to lobby to include all doula services as a covered option in your plan.
([Ed. note - This is personalized version of text taken from http://www.gentlebirth.org. I have adapted some items to
fit my practice as a Birth and Postpartum Doula.]
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