So, you think you want a doula. You’ve heard about them, maybe from a friend or on a TV show, and you think it sounds like it might be helpful to you. Maybe you’re worried that you might have to deliver alone, because your partner will be working or is absent altogether, or you don’t know how helpful they can be, or you just want someone else there. Or maybe you know you want a doula, because you’ve been reading a lot, and a lot of the more progressive books recommend them, and you want to try to have a particular kind of birth, and you know a doula can help you.
You’ve decided, so you sit down and start looking. Maybe you’re extra savvy and you know where to find us, or maybe you just do a simple Google search for doulas in your community. Then the results come up, and you find someone in your area who appears to be available—score! And then, below that, the number. Chances are, you’re having some sticker shock. You see a number that’s higher than you expected, and higher than the amount of wiggle room you have in your budget for this expense.
Despite the fact that even Suze Orman has come out and said that doulas are a need, not a want, needing something doesn’t change the fact that having a baby is already tremendously expensive, in some places more than others. You’ll hear a lot about the lifetime cost of raising a child, but the fact is that the points at the ends of that long line of expensive years are the most expensive for a lot of people. The “start-up” costs, even if you’re lucky enough to live in one of the countries where those costs don’t include $10,000 or more in medical bills, are high. For some of you, you’re not going to have another expense this big for this child piled into a single year until you start paying your child’s tuition. The endless hours of number crunching can be heartbreaking, especially if your numbers never seem to go far enough as it is. You may be fully sold on the whole doula idea, but the money just isn’t there to match the fees listed on the websites.
Wanting or even needing a doula doesn’t erase the expense if the expense is more than you have to give.
Here’s the good news: Most doulas want you to have a doula, if you want one. For many of us, it’s a major part of our mission. Doula work is also often our livelihood, however, so most of us do need to recoup some costs. We can’t offer our services without fair compensation for our training, supplies, transportation, and time. What counts as fair compensation depends on our area’s cost of living, but there may still be a gap between the going rate for doulas in your area and what you have to spare. So then what?
Don’t give up. Like Suze Orman, or Dr John Kennel (who famously said, “If a doula were a drug, it would be unethical not to use it”), I, too, believe a doula is an important part of a good birth, regardless of what that means to an individual. I believe every family welcoming a new member deserves—and needs—someone with knowledge to support them during that time, especially if their organic support network is limited. But like you, when I’ve taken a moment to sit down and price doula services, I’ve been forced to admit that I probably won’t be able to afford the listed fees of experienced doulas in my area. My household income isn’t high enough to be able to justify upwards of $1200 on anything at once, and that’s the going rate for experienced, certified professional doulas where I live.
Because I’m a doula myself, though, I now know that there are plenty of options for making a doula realistic, and I want to share them with you.
· Start early! The more time you give yourself, the more likely you are to be able to find someone who suits you and who will work with you. It also means you have more time for things like payment plans or service exchanges, as most doulas will want a portion of their compensation before they attend your birth (because they provide a portion of their services before that, too). Usually, if you start looking at around 20-25 weeks, you'll have enough time to interview several doulas and work out more payment options.
· Find some options: You want to start by finding as many options for doulas as possible, and at least two or three that seem like they're what you're looking for. The major certifying organizations (like DONA International, CAPPA, or Birth Works International, to name a few) usually have an online database of their certified doulas, and a phone number you can call to be put in touch with their non-certified members, who are usually trained and either working on certification or have held certification in the past but not renewed it. You can also consider regional organizations (in Ontario, mine is DoulaCARE), who often do the same. Other options include DoulaMatch and Doulas.com, whose listings include both certified and non-certified doulas from various organizations, searchable by service area.
Find a few doulas who you think might fit your needs. Remember that while experience is important, it’s much, much more important that you have a strong connection with your doula, because your birth is going to be a physically and emotionally challenging time and you want someone who makes you more comfortable, not less. For some, the comfort does come from knowing the doula has experience. For others, personality is much more important. Keep in mind what you need, and be prepared to interview several doulas to find the right fit for your family.
· Make Contact: Once you’ve got a list, start making contact. Explain your situation and what you’re looking for, including letting them know that you’re concerned about being able to afford a doula. Not everyone is in a position where their fees are negotiable, and that’s ok! If you truly can’t afford a doula’s fees, and they truly can’t afford to reduce them for you, that doula is just not a good fit, and that’s alright. Keep trying. If you need to expand your search area, go ahead—anyone within an hour’s travel of you and your birth location should be a reasonable bet.
There are a few extra options for making a doula more affordable, and while not all of them will work for everyone, you may find one or two that work for you. Consider:
- Some doulas who are working toward certification or who have attended a smaller number of births, or doulas who attend births as a hobby and not a job, will offer fee discounts relative to the going rate in their area. Please do not expect these doulas—or any doulas—to work for free. While some doulas do occasionally offer no-fee services, it’s not a good idea to assume unless it’s offered, because the work we do is demanding! If you truly cannot afford any fee, contact your regional doula organization (and in some areas, even your public health offices) to see if they have a volunteer service or can put you in contact with pro-bono doulas.
- Finding a doula who lives very nearby may mean you can ask if her transportation costs are part of her fee, and if that can be reduced because she’s less likely to have to travel to reach you. Keep in mind, however, that not all doulas work from home, nobody’s home all the time, and unless you’re having a home birth she will also have to travel to your birth location, so some amount of transportation is still going to be in her expenses.
- If you or your partner is in the military, there are some programs and private doulas who offer reduced rates or income-based sliding scales to families like yours. Mention this when you contact a doula.
In addition to these options, your hospital or birth center may already have a doula program, and these are often lower-cost than private doulas and may even be free for you. Ask your care provider if there is an internal or affiliate doula group. There are some special things to consider with hospital doulas, however. For some families seeking a doula, the appeal is that she’s employed by them, not the hospital. A doula employed by the hospital will be restricted by their liability policies in a way an independent doula is not. At the same time, remember that almost all doulas who regularly work in hospitals, private or not, want to have good working relationships with the medical team, and that no doula is likely to wage an independent crusade against your hospital’s policies while you’re in labor. While we can remind you that it's your choice whether or not to have a procedure or medication, we also can't directly refuse something on your behalf or argue with your doctor for you.
The other important thing to remember about hospital doulas is that they usually work in shifts, and while a doula will generally never leave you just because her shift is up, you probably won’t have the same level of prenatal and postpartum care from a hospital doula, and you also probably won’t have an opportunity to choose which of the hospital doulas is present when you are. Additionally, a hospital doula will be with you in the hospital, but won’t be able to join you at home for early labor, which can also be challenging. This may or may not be important to you, but it is something to think about.
Making Room in the Budget
If you're on a tight budget, you’re probably still going to feel a bit of a pinch somewhere if you’re trying to come up with money to pay a doula’s fees, but there are ways to make that pinch more reasonable. Here’s more good news: many doulas will accept alternative forms of payment or service exchange in addition to monetary payment. This isn’t true of everyone, but it’s true often enough to be worth mentioning! Some other things to consider:
- Do you have a family member who wants to help, but you don’t have space to host them or they live too far away? Would they be willing to chip in for a doula rather than trying to arrange a visit for an unpredictable event? This may also be a good option for family members who want to help but know that sharing space in a stressful time may add stress, rather than relieving it.
- Could you add some or all of the cost of birth or postpartum doula services to your baby gift registry? BabyList is an excellent universal registry tool, and many doulas have listings in their directory to make adding them to your registry even easier.
- Is there something you’re planning to buy for baby that you don’t expect them to use for the first six months of life? Could some of that expense go toward your doula fund instead?
- A biggie: do you or your partner have any special skills? Doulas with some flexibility are often willing to exchange services. Could you offer web or graphic design services? Design a perfect scheduling app that hits all the points she’s been juggling for months? Do you provide tax or accounting advice or services? Do you make something you sell already or have considered selling? Could you provide on-call childcare services to a doula (we sometimes have a hard time finding childcare since our hours are ever-changing and unpredictable)? Do you teach something (yoga, music, dance, language, subject tutoring, etc) and could offer classes to your doula or their family members? Would you be willing to clean or do yard work? All of these are things you can offer as part of the doula’s compensation. Although not all doulas are willing to exchange services, some are. Consider the skills you already have as part of your budget.
- Ask about payment plans, especially if you’re looking for a doula before the beginning of your third trimester. Most doulas split their fees in half (a deposit and a full payment), but you may be able to divide it into smaller, more manageable chunks, if you’ve given yourself enough time.
My number one tip, if you’re going to negotiate fees, is to make sure that what you offer is a fair exchange for what you get. Consider input costs, and remember that for some doulas you’ll need to add in childcare expenses, more transportation, and sometimes costs for working in certain hospitals, among other possibilities. Remember also that experienced doulas may want more than minimum wage compensation for their time, and that’s a completely reasonable thing. The single best way to get a doula to refuse to negotiate with you is to start with an offer that devalues her work, her time, and her training. Regardless of her philosophy or her situation, she wants you to have a doula, and she wants you to be able to afford care, but she also needs to support herself and her business. Making an offer, whether in dollars or services, that is inconsiderate of that fact will often cost you an option that might otherwise have worked out for you. Be fair, and many doulas will happily negotiate something that can work for everyone.