The Economics of Doula Fees

The economics of professional labor support work are a mystery to many people; we 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 they expect the doula will only be spending a few hours with them during the labor and birth.  In reality, most first labors last about 16+ hours; the longest continuous time I’ve spent providing labor support is 42 hours.  The average time spent with a woman for her labor and birth is about 16 hours.  Most doulas spend an additional minimum of 8 hours in two prenatal and one postpartum meeting, and another one to five hours in email and phone contact.  Doulas also do phone and in-person interviews at no charge, adding some time and transportation costs for each eventual client, as well as for many families who interview several doulas and do not end up hiring her.  The doula fee translates to an hourly rate of about $20.

$30/hour for an average client, before expenses, self-employment taxes, health insurance…etc (for the long labors, that can drop to about $10-$12/hour).

Clients per Week/Month – In order to make a commitment to be available to attend you in labor, a doula must limit the number of clients she puts on her calendar so as to avoid birth conflicts and to ensure she will be reasonably rested when you go into labor.  The rule of thumb for birth professionals is that one client per week is a full schedule.  If most of a doula’s clients are first-time mothers, three clients per month is often a full-time workload.

Clients per Year – When a doula accepts you as a client and puts your due date on her calendar, she also commits to being available two weeks beforehand and two weeks after that date, to cover the normal time-frame for full-term delivery, and to be available for any immediate pre- and postpartum needs.  This means that to schedule a one-week vacation, or to ensure that she doesn’t miss her own child’s birthday or a professional training she has paid for, she must take a whole month off with no clients at all (2 weeks buffer on each side).  Though it sometimes feels excessive, the normal delivery period is truly and regularly that unpredictable and most doulas are unwilling to risk being unavailable for the labor and delivery of a client to whom they have committed.  It runs quite contrary to one of the purposes of hiring a doula-to select one birth professional with whom you feel comfortable who you know will be there to assist and support you throughout your entire labor and delivery process.  In addition, clients and due dates sometimes come in bunches-there are some weeks where she may have to turn clients away and other weeks when she has 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, a doula’s communication expenses are high – business phone, pager, cell phone, and computer connection; there are also routine professional expenses (to obtain and maintain certifications and professional associations) and unusual transportation and supplies expenses.  The self-employed professional expenses include their own marketing, printing, and office as well as service (birth) supplies, which a salaried “employee’s” wages do not cover.

Putting It All Together – The doula’s fee must also cover the “intangible” costs of doing this work.  Expectant parents are often frustrated by the unknowns related to when, where, how, and how long their labor and delivery will end up taking place-the doula’s entire career and personal life are subject to this uncertainty on an ongoing basis.  Being on-call all of the time (as opposed to in regular shifts) requires a certain personality and passion for this work, including a willingness to be called after half an hour of sleep to go attend (and be fully present for) a labor for an unpredictable period of time, and possibly to be called for another labor the very next day.  About 50% of first-time moms have some kind of pre-labor which starts and stops, sometimes resulting in two trips by the doula to the client’s home and/or the hospital, and being beeped awake two or three times over several days or weeks for one client.  Social weekend and day trips more than an hour from home are not options for a doula in the month surrounding a client’s due date (too risky), and even dinners out, concerts, and visiting friends may be abandoned with no warning, or at least require taking separate cars, “just in case.”

Bottom Line – Though we all sincerely wish that professional labor support were covered by all insurance plans and available and affordable to all women in labor, this is yet to be the case.  So, though we’d like our fees to be affordable for everyone, to charge any less would be doing future birthing women a disservice by making labor support an underpaid profession that cannot attract or keep talented, skilled individuals.  Clearly nobody’s getting rich doing labor support work.  However, if you are unable to afford or justify this childbirth expense, the best way to get labor support at a further reduced price is to try to locate women who are still in training, who may be offering some services at a lower fee while they gain experience and confidence.

Advocacy Suggestions – Doula services are covered by many health insurance plans.  You can send a letter to your insurance company requesting these services be covered.  You can talk with your Human Resources representatives to ask them to lobby to include all doula services as a covered option in your pan.  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, although the doula might be someone you’ve never met before.

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