Actually, it’s quite the opposite.
Many of our clients ask how a doula sets her fee, and why there is variation in fees from one doula to another. Most do not understand the time spent behind the scenes preparing for a birth, or the economics of being self employed. Experience also plays a huge role in a doula setting her fee. Let’s look into this further. For this post, we will consider an average doula fee here in Denver CO, of $1000.
A normal first time mom may be in labor for 14-16 hours or more. Don’t let this scare you! Early labor is the longest part. Although most birth doulas do not join their clients in early labor, they typically spend time with them by phone consulting and checking in, until it is time for the doula to join them.
Some labors (ex: inductions or baby in a less than optimal position impeding progress), may go on as long as 24-36 hours or more, requiring extra time spent with a client in need.
Average time spent with a client (just in) labor and birth is 10 hours. This is an average for a normal labor and birth. At least 30% of births fall into the categories of prodromal labor (baby probably not in prime position or back labor, early labor starting and stopping) or inductions, requiring much more time from your doula. A birth falling into one of these two groups could end with your doula having spent 18-30 hours with you. Easily.
Doulas also meet with their clients before and after the birth of their baby, for prenatal and postnatal appointments. Depending on how many visits your doula includes in her fee, this could be anywhere (on average) from an extra 4-8 hours, on top of the time spent at your birth.
Most, if not all, doulas make themselves available to their clients for questions leading up to your birth, by phone and/or email. This also requires time. Depending on the health history and circumstances surrounding the client, this could be anywhere from 1-3 hours.
So what does this mean per hour? Let’s use an example of an average first time mom paying $1000 as a doula fee. This moms labor and birth happens completely textbook, normal labor and birth, averaging 16 hours from start to finish. In this example the family will receive two prenatal appointments and one postnatal appointment.
- Two prenatal appointments x 2 hours= 4 hours
- Phone calls/answering email questions prior to birth= 1 hour
- Phone calls in early labor and prep time for doula to leave=1 hour
- Labor support, active labor through birth and 1st feeding=10 hours
- One postnatal visit in clients home=2 hours
Total hours=18 hours=an earning of $55.55 per hour
That was fairly simple! But now we must remember, these figures are before business expenses (gas, liability insurance, marketing, office space, certification memberships, professional trainings AND taxes). Let’s deduct 30% for business expenses and Uncle Sam (a very low and probably unreasonable, estimate) and your doula is now making approximately $38.00 per hour.
Sure, there are times when a client may give birth quickly and the doula spends less than 4-5 hours with her. But this is very rare and these labors help to balance out the extra long labors that are more likely to occur.
Let’s put this into perspective. Your doula fee will be about (approximately) $1,000(+) less per hour than your OB fee. Average time spent by your medical provider (midwives not included), 10-15 minutes per appointment and 2 hours at your birth. No, I’m sorry, wait time in the office doesn’t count towards time spent.
Doulas are a rare breed. They can care for their families, their businesses, their clients, be in deep sleep and wake at the phones first ring, completely coherent and ready to go, at 2:00 am, whenever needed. Support a birthing family tirelessly, get home at noon the next day, take care of her family, get a quick snooze and potentially get called in to do it all over again.
Obviously, nobody can keep this up forever and this is why doulas limit the amount of clients they take each month. They must ensure down time to care for themselves as well as be ready to take care of their clients. Every doula I know has missed holidays, skipped vacations, missed birthdays, recitals, and more.
This is all part of the business. Yes, it is a business and one that a doula must love.
Don’t do it without a doula!
Stacey Melito ICCE, CD(DONA) has been an active childbirth educator and birth doula since 2001. She is also the owner of Natal to Nest, a pregnancy and new family wellness and fitness center located in Highlands Ranch, CO.