I’ve been thinking a lot about my business and my services lately. Really meditating on the quality of services I provide and want to provide and the reason for which I do this work. As I was telling a friend yesterday, I think I can safely say that all doulas begin this work because of a strong desire to serve other women during pregnancy and birth, helping them achieve safe and satisfying birth experiences and often to help push the pendulum in the direction of normal birth becoming more of the norm. We understand just how very important it is to be loved, supported, encouraged, and empowered during our births. We understand the imprint birth leaves on the heart of mothers. And we want to make a difference. We want to be world changers, pendulum pushers. _
I can’t think of a single person who started in doula work with the desire to make a lot of money doing it. Many families may see the price tag of doula services and think “Gosh, that’s a lot of money!” And I get that, $700 is a large amount of money. But, once you subtract all of our expenses of childcare, gas, website, printed material, education, certification and training, and supplies for our doula bag then divide the remainder out over the amount of hours we spend with the average family during prenatal visits, answering emails/phone calls, supporting the birth, the postpartum visit, and all of the time spent with our own lives sort of on hold during the on-call period, that large amount of money is suddenly not so large.
Doulas are constantly trying to balance their personal with their professional lives and being fairly compensated for the time and energy they give to their clients while still being affordable enough for as many families to be able to hire a doula as possible. And of course to be charging a fee comparable with other doulas in the area who have similar levels of training and experience.
A few weeks ago, I was introduced to the H.E.A.R.T. doula pledge. And it really touched my heart that was already thinking something needed to change with my practice. I am now proud to say that I am officially a HEART doula business. And with that, I have decided it was time to make a change to my services offered and their fees. A year ago, I introduced 3 packages of doula services in the hopes that I would be more accessible and affordable to more families. But, after much prayer and thought, I have decided it is now time to simplify and pear down those packages. So, as you will see by visiting my services page, I have made some changes. It was time to simplify and “get back to my roots.” The core of my doula work has been and will remain to be the things the HEART doula pledge stands for. Honest. Ethical. Accountable. Reliable. Thoughtful.
It is truly my desire to lovingly support families during pregnancy and childbirth.
Let's talk more about a doula's fees. I sometimes get messages asking me to give a discount or take on a client for free. I understand that money is tight for many and I strongly believe that every woman deserves a doula. However, I just can't afford to do those things. I love doula work. I really really love it. Really. I feel so incredibly blessed to be able to do something I love so much while making a small financial contribution to our family. I spend a lot of time and energy immersed in the doula world. And my time is valuable. Especially when it's time away from my husband and three young children. Some feel that a doula's fees are expensive. I'd like to show you a breakdown of those fees and why I charge what I charge.
Total fee - $450
Childcare - $75/client
Gas - $25/client
Printed materials/handouts/marketing/website - $20/client
Bag and Supplies (includes snacks and toiletries for myself during the birth, essential oils, massage tools, etc) - $20/client
Phone and internet costs and PayPal fees - $15/client
Lending Library - $5/client
Training, education, certification and organization/membership fees - $25/client
Remaining fee after subtracting expenses - $265
Average amount of time spent with client (3 prenatals, the labor and birth, and one postpartum visit ) – 22 hours
Average amount of time spent driving to and from meetings and the birth place – 3 hours
Average amount of time spent reading, researching, creating and printing handouts, continuing education, and doing other prep work – 2 hours
Average amount of time spent answering phone calls, texts, and emails – 2 hours
Total amount of time put into each client - 29 hours
Average amount of money I make for each client - $9.14/hour
This doesn't include time spent in interviews (which are free of charge), time spent marketing and networking (doula speed dates, the baby fair, and other events), time spent keeping up with my website and business facebook page and pinterest page, and the time I spend on call for each birth, which can be as long as 5 weeks. It's hard to place a value on needing to be packed and ready to drop everything and leave at a moment's notice (even if I'm at a birthday party or a wedding or having a date night) for weeks at a time. This also does not include taxes, which I do file and pay yearly as needed.
Doula work is time consuming, physically exhausting, and emotionally draining. And I love every minute of it. I love to serve birthing families. I love witnessing a mother and father working together to bring their child into the world. I love making a difference in the lives of growing families. And if I want to continue to do so, I have to charge a fee that fairly compensates me for my time and sacrifice from my family.
Stay tuned for my next blog in this 3 part series, The Luxury of Doula Care! In Part 1, I discussed The Value of a Doula. And coming up in Part 3, I will discuss just How to Afford the Doula of Your Dreams.
**Update** My fees have changed since I wrote this blog to allow me to be more fairly compensated for my time, resources, and skills. And in an effort to meet the needs of families with lower incomes and/or different needs for prenatal support, I now offer three different packages of doula services and individual birth plan assistance and labor support training. Please see the services section of my website for more information.
The number one reason I hear from parents for not hiring a doula is the cost. I hear and read things such as, “a doula isn't in our budget” and “a doula is a luxury we just can't afford” or “I'd love a doula, but they're too expensive.”
Bologna. If you see something as valuable, you will find a way to pay for it. I'm going to inform of you why a doula is not a luxury, but in fact a necessity.
Let's start by just addressing the financial side of this. Bear with me as I go through some sorta dry statistics. I promise you these numbers are super mega important, though. You need to know them.
In the Omaha area, the average doula costs $450 (price varies a bit by experience...$450 is the average and is my current fee, so we'll go with that.)
According to a Cochrane review published in 2012 by Hodnett and Colleagues, women who receive continuous labor support provided by a doula experience:
28% decrease in cesarean
*The average out-of-pocket cost of a cesarean in America is $15,000
31% decrease in the use of pitocin
*I'm not sure of the average cost of pitocin, but considering that hospitals are notorious for charging a half a day's pay for an aspirin, I'm certain it costs more to have it than not to. Pitocin is administered by IV, so there will be costs associated with having the IV placed, as well as just the medication itself.
12% increase in the likelihood of spontaneous vaginal delivery
*I'm also not sure of the cost of either vacuum or forceps assisted births (despite my amazing google skills) but would imagine it costs more to use them than not to.
9% decrease in the use of pain relief medication
*The price of an epidural is in the neighborhood of $1,000-$2,000.
14% decrease in the risk of her newborn being admitted to a special care nursery
*There are a lot of variances to this one. It depends on whether it is a level II special care nursery or a level III NICU, how long the stay is, and the reason for admittance. Have you ever heard of a $450 NICU stay? Me either.
34% decrease in the risk of feeling dissatisfied with the birth experience
*The ability to be an active participant in my birth while feeling loved and supported by everyone around me coupled with the feeling of intense joy and empowerment after my two VBACs attended by a doula is priceless. Priceless.
Doula care has also been shown to:
Improve breastfeeding success
*The average price of one can of infant formula is $25. One can per week for 52 weeks (one year) comes out to be $ 1,300.
Decrease the risk of postpartum depression
*We can't put a price on mental health. We could put a price on antidepressants and counseling services, though. Let's say you spend $10 a month on prescription antidepressants and see a counselor twice a month at a cost of $40 per visit (after insurance, of course) for six months. That comes out to a total of $540 for six months.
My $450 fee can potentially save you tens of thousands of dollars.
Now, let's look beyond the financial side of a few of these areas.
Nebraska's current cesarean rate is 32%. I said above that the evidence shows that doula support decreases a woman's risk of cesarean by 28%. That is a pretty big number. I also said above that a cesarean costs around $15,000 out of pocket. That's for an “uncomplicated” cesarean. A cesarean is major abdominal surgery, folks. So, of course it comes with risks. Things like infection, blood loss and damage to other internal organs like your bladder. It also increases your risk of placental abnormalities in future pregnancies like placenta acreta or placenta previa. Some of those abnormalities can be deadly to either mom or baby. Take a minute to let all of that sink in...the financial cost, the emotional cost, the health cost of a cesarean can be astronomical for some, especially those that experience some of the complications that I mentioned.
As I said above, doula support decreases the risk of mom receiving pitocin by 31%. Pitocin is a drug used to either induce or augment (speed up) labor. It is a synthetic form of oxytocin which is a hormone mom releases during labor. Oxytocin is referred to as the “love hormone” as it is the hormone released (in different levels) during hugging, kissing, orgasm, labor/birth, and breastfeeding. It is the hormone responsible for mother-infant bonding and those overwhelming warm, fuzzy nurturing feelings moms have towards their children. Pitocin effectively causes contractions, but does not have the same emotional effect that oxytocin does. A mother who receives pitocin does not make as much of her natural oxytocin as she would have otherwise. A price can not be put on all of this. But, think about the possibility of not reaching the full potential of bonding with your new baby. Pitocin also carries with it risks such as hyper-stimulation of the uterus. And moms receiving pitocin are required to undergo continuous fetal monitoring. No walking the halls. No baths or showers (which have shown to decrease mom's discomfort by up to 60%). Mom is now on a leash.
Spontaneous Vaginal Delivery
As I mentioned above, I'm not certain of the cost of births assisted with vacuum or forceps, but I would imagine it costs more than a birth without. And it certainly has more risks than birth without. There's increased risk of tearing for mom and increased risk of injury to baby, including some pretty serious things like bleeding on the brain. Doula support increases the likelihood of spontaneous vaginal delivery by 12%.
Any intervention given during birth messes up the natural physiologic process. Birth was designed with an incredible cocktail of hormones flooding the mother's body as she works to birth her baby. Adding any kind of artificial drugs, whether it be pitocin or some kind of pain medication changes that cocktail. IV pain medications are narcotics. They do affect the baby which can cause difficulties with breastfeeding. They can make mom feel sleepy or loopy or even sick. I know that I'd much rather be fully present for such a milestone moment, not only in my life but in my husband's and baby's lives as well. Epidurals don't affect moms or babies the same as the IV pain medications. But, they severely limit mom's mobility. A glimpse at pelvic anatomy will confirm that women were not meant to give birth on their backs in bed. And of course, epidurals don't come without risk. There is a possibility of nerve damage and spinal headaches, which are awful. Imagine spending the first week of your baby's life with the worse headache of your life. And if you buy the epidural package, there are other things that come with it, of course. Things such as an IV, continuous fetal monitoring, a pulsox clippy thing, and a catheter. Mom will be stuck in bed, tangled up in all sorts of wires, belts, straps, lines, cords and machines, with no control over her bladder, needing someone else to empty it for her. And sometimes no control at all of her legs, requiring help to even roll over.
AND, it has been shown that once mom receives an epidural, her partner and other support people sort of check out. Mom doesn't need help focusing or breathing any longer. Mom doesn't need counter-pressure or the physical support of certain labor positions any more. Plus, it's now hard to even get to mom through all of the straps, wires and belts to do just offer a hand to hold. Mom is often now laboring alone while dad gets a nap, facebooks from his phone or watches TV.
Feeling Dissatisfied With the Birth Experience
No monetary value can be placed on this, but let me assure you, it is of paramount importance. The birth experience will impact you more ways than you realize and for the rest of your life. Birth is the beginning of the mother-baby relationship. The way in which you birth your baby and the circumstances under which you first meet your baby set the tone for your postpartum period, and really your entire parenting journey. Imagine beginning that journey feeling as if you failed. You may be set up for failure. What impact would beginning that journey feeling as though you were trapped, cornered and had no options or as though nobody listened to you or took you seriously have on your parenting? Beginning that journey feeling as though the baby being healthy is all that matters can potentially set a new mother up for an incredibly emotionally hard postpartum period. That mama matters, too. This issue can piggyback off of the decreased risk of postpartum depression that mothers who receive doula support during their births experience. Birth matters.
In my experience, dads have been particularly grateful for my doula services. It helps take the pressure off of them to do all and be all. Even the most prepared dad will forget some (or most) of what he learned in childbirth class once contractions start. Even the most calm, even-keel guy can panic once he sees his lady in discomfort. A laboring woman isn't always able to verbalize what she needs/wants. I've been trained in that area. I've given birth before. I've doula'd for many other mamas. I have been blessed with a motherly instinct and a servant's heart towards birthing women that I tend to follow more often than not.
Mamas, you deserve the love, undivided attention, education, encouragement and support of a doula.
Daddies, you deserve the help that a doula can give you so that you can be all you can be for the woman you love.
Families, you deserve to have the best chance possible of starting your new relationship, your new family off on the right foot in a loving, gentle, educated, and supported way.
You get one shot at this one birth. There are no do-overs.
How can you afford NOT have a doula?
This is Part 1 in a 3-part blog series about the cost of a doula. In Part 2, I will discuss a thorough breakdown of my fee and explain how I came that amount. In Part 3, I will discuss ways in which you can afford a doula for your birth.
Thank you for reading!
Amber Piller - Professional Birth Doula and owner of Agape Birth Services. Serving Northwest Houston including Jersey Village, Cypress, Tomball, Spring, and Katy Texas.