Does this fee schedule shock you?
A midwife puts in ten times as many hours as an obstetrician and makes more money for it per birth but an OB sees more people than a midwife per hour. A doula puts in seven times more hours than the doctor but a good deal less than a midwife. While the doula is often the most expendable team member, many families say they would never birth without the continuous physical and emotional support of a doula and this service is invaluable.
Midwives are paid per course of care after a woman has been discharged. Doctors are paid per visit and billing happens following each service. Doulas ask for their fee upfront with a deposit, and paid in full before the birth.
An OB is an expert, the top of the chain, the resource we need and rely on should problems arise. Does it seem reasonable for a doula to receive more money than the obstetrician per patient? Does it seem right for doulas to earn as much as first year midwives? The answers are yours to ponder. No one has the answer to the questions other than you. This profession is currently not regulated.
Ultimately, the doctor will have the highest annual income followed by the midwife. While there should some parity for services between midwives and doctors, where does the doula sit in that paradigm?
The choice is up to the doula. It is not up to the other maternity professionals and it is not up to the other doulas in, or outside, of the region. It is up to each individual doula. As an independent business owner, understanding your business expenses, your cost per birth and what the region will support is how you set your fees. But understand this, midwives have been lobbying for pay equity in Ontario for a very long time. If the doula’s fees are reaching the level of junior midwives, there are going to be fewer referrals from our biggest support network and that’s also a reality. A living wage as a labour support person is entirely attainable however it must come from a thoughtful place of understanding the big picture of your life, your services and your community.