[I recognize there are some male doulas, but for the sake of simplicity, I will refer to doulas with female pronouns, as the majority of doulas are female, and the term itself is a feminine word in the original Greek.]
There is an ongoing discussion within the doula community. There are a number of blogs and articles which orbit around the general discussion of why doulas charge what they do, but to my knowledge, I have not seen any address this specific issue head-on in a blog. I believe the doula community is in the midst of growing pains–transition, even, to put it in terms of birth. There are a number of aspects to consider, very strong opinions on either side, and I hope there is a central truth that will be discovered in time. The topic of which I speak is that of payments and, by default, the value of doula care.
Multiple studies have shown that doula care is beneficial. It is not necessary or vital–not so much as midwifery or obstetrical care might be–but beneficial and a strong contributor towards safer birth outcomes, higher breastfeeding rates, and increased bonding and contentment in motherhood. Doula work has value and holds importance in our society. Traditionally, doula care was brought about by mothers, sisters, aunts, and cousins who came to accompany the mother during labor and birth. Because the environment and method of childbirth has changed (from the village to the hospital; from nature/instinct to modern medicine), so must the model of doula care evolve to meet the needs of modern parents.
Doula care in the past was innate to the experiences of generations before, passed down from mother to daughter. Today, with the variety of birthing methods, possible interventions, and support systems that are in place, a doula must also possess a working knowledge of the childbearing year (preconception through postpartum) which includes not only holistic and traditional models but also a comprehension of the healthcare system, modern treatments and interventions, and hands-on modalities. A trained doula undergoes months or possibly years of education, both in academic endeavors (reading, workbooks, etc.) and in experience (practicum). The trained doula is an asset to any birthing environment, so long as the birthing family desires her presence.
The trained, professional doula has invested her own finances, time, and energy to obtain this training. She is a professional in knowledge, in service, and in the way she conducts business. Doulas invest in marketing, literature, networking, and other means of reaching out to gain clients. This is in addition to “behind the scenes” investments, such as a business license, graphic design (for logo and literature), continuing education, researching and staying up-to-date on current studies, and collaborating with peers to network, establish back-up relationships, and build their businesses.
Because she is a professional, she ought to be paid as such.
But because the role of the doula is 1) unregulated, and 2) traditional, many “lay” doulas are able to call themselves doulas without any training, education, or certification. In some ways, the lack of oversight is positive. Most doulas recognize that as soon as we become recognized and the title obtained by licensing or credentials, the more costly and possibly restricting our profession will become. However, we also recognize that doulas without training, without education, and without enforcing payment, can hurt our profession as a whole.
I will briefly (I hope) lay out the varieties of business models that doulas (both lay and professional) currently use, and will shine some light on the general pros (what she gains, how it helps other doulas and the community) and cons (how it negatively affects other doulas or what frustrations/hurdles she may encounter).
The Professional Doula
This doula has been trained, certified, and has established herself within a business. It may be a sole proprietorship, she may be working in an agency as an independent contractor, or she may be independently contracted through a hospital or midwifery practice. She believes in the work of the doula, but ensures that she is paid for her services.
Pros: She can support her family with work that she enjoys and which is fulfilling to her. She supports the doula profession and respects other doulas in business. She has a positive impact on the value of the doula as well as the community she serves.
Cons: This doula may be prone to being competitive. She may also be so set on professionalism that she finds it hard to work alongside other doulas who offer their services for less (if not free). She may not be willing to make accommodations for mothers in need (marginalized, at-risk, low-income), and may view doula care as a luxury, rather than an impactful asset to the birthing family, which may be contrary to the traditional view of doula care.
This doula is more focused on the traditional role of the doula. She may not work as often, or may not be as dependent on the income from her doula work. She is more willing to offer reduced rates, barters, or free services. She values the doula’s place in the “village” and believes every woman deserves a doula. This doula may or may not be certified/trained.
Pros: She is available to those who may benefit most from doula care (unsupported mothers, single or teen mothers, etc.), and offers her services at a reasonable rate. She is carrying on in the tradition of the doula while supplementing her family’s income (moderately).
Cons: This doula may not screen level of need or ability to pay, and thus may take potential business away from professional doulas. She may feel so obligated to her calling that she runs herself ragged, not receiving the due reward for her services, and may be prone to feeling burnt out, overwhelmed, or underappreciated.
Best of Both Worlds Doula
This doula is trained and certified, and may offer reduced rates, but is careful to screen need and ability to pay, working with sliding scales or specific discounts, ensuring that she is able to cover her own expenses (childcare, gas, food, etc.) and sets a limit to her charity.
Pros: Still available to those in need while raising the value of the doula and supporting the doula profession as a whole. She is careful to meet her family’s needs (finances, her time, energy) and desires balance in her career.
Cons: This doula may feel torn between her convictions and her need to support both her family and the doula profession. She may feel guilty for turning someone down when they ask for free services, or may not screen well enough so that she burns out and is frustrated by her lack of income.
Depending on which organization this doula trained with, she may feel pressured either to charge a high amount, or to charge nothing at all. Not every organization requires certifying births (or the same number of births required), and so this will vary greatly depending on the organization.
Pros: A student doula may be willing to charge less, or do a birth for free, in exchange for a review from the mother which she sends into her certifying organization. This is helpful to mothers in need. Conversely, a doula who charges more right out the door helps to raise the professionalism of the doula community and may feel more respected by standing up for herself to charge her worth.
Cons: A student doula who charges too little may get “stuck” in not charging enough, even after she is certified. She may also find that word of mouth works against her, and friends of those she offered discounts to may demand lower rates. However, if she charges too much, she may have difficulty finding families to hire her, as they may be put off by her lack of experience. This doula may feel torn and uncertain whether she wants to be a Community Doula or a Professional Doula.
This trained doula may work independently or may work for a non-profit agency which provides doulas to low-income mothers who meet a specific criteria (income level, family support, housing situation, insurance status, etc.). The Charity Doula either volunteers her time through a hospital or birth center, or she is paid through grants and donations.
Pros: This doula can provide professional-level services to mothers in need. Because the screening process is careful, and because the doula is either compensated or limits her time available to be on-call, she still manages to support professional doulas. She is not taking clients away, because these particular clients are those who would not be able to pay. Because it is through an agency, hospital, or non-profit, she does not feel obligated to offer free services to anyone who asks, but has the strict screening process to support her and ensure that her services, free to the mother, do not contribute to a decrease in the perceived value of doulas overall.
Cons: This doula may be receiving a lower rate for her work, and so she may feel underappreciated or burnt out. There tends to be more turn-over in these non-profits and hospital programs. There may be confusion or misconceptions in how these programs impact the doula community, and she may receive criticism from Professional Doulas who feel that “free” doula services are a threat to their business.
This is an untrained, uncertified doula who offers her services either for a small fee or for free. Most commonly seen, these are young mothers who find the work enjoyable and have read a few books or started training, but have not undergone or completed formal training, and consider doula work a hobby or community service rather than a profession/career.
Pros: This doula is available to many at a low cost, which can be beneficial to moms in need. Because it is not her profession, this doula is free to accept or decline any client, either to offer services or not, and only takes clients as she feels willing (she doesn’t need to work in order to pay her bills).
Cons: Without proper screening, this doula can take clients able to pay away from professional doulas, reducing the perceived value of the doula overall and hurting the incomes of Professional Doulas. Why should mothers pay when they can get one for free? Because she is either not being paid or is being paid very little, this doula may feel burnt out and may feel unbalanced. Additionally, because this doula is not certified and/or trained, she may not understand how to work alongside clinical providers, may not understand the scope of practice of a doula, and may hurt the caregivers’ overall view of doulas.
I have not come to any conclusions regarding this topic. I tend to hover around the “Best of Both Worlds” identity, though I have been a Community-Focused, Charity, and Student doula in my past. I can understand and appreciate each one in our world, and I find myself bouncing back and forth, trying to find peace in this discussion. Though I’ve not found firm ground just yet, I believe continuing this discussion and recognizing that various types of doulas with which we must all interact is vital to growth and maturity as a profession. My goal in this introductory post is to lay the groundwork for further discussions, not to make any definitive statements of what is “best” for everyone. As we navigate through this time of transition and growing pains, I hope that we can, at the very least, treat one another with respect as we continue to explore this topic.