Category Archives: Doula Business Practice

Firing Up the Spark

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Firing Up the Spark

You were so fired up to begin the doula training course and did a lot of reading beforehand. You loved the course, admired the people around you, loved their passion and the spirit of community in your class.  You felt like you were among friends in a room full of people you just met.  You could not wait to get your first client.  You are still a member of a few dozen birth professional social media groups, some good, some less inspiring and some awesome.

Summer came and went.  And here we are, months later and nothing.  You have not even spoken to your fellow students, though, you can see that they have upcoming clients from their posts.  What happened with you?

Life got in the way.  Things got busy.  Priorities shifted.  But the calling and the passion are still there.  And now, you are looking around and wondering how to reignite the fire.

Two decades ago, most trainings happened in your home community under one umbrella organization.  The doulas would have regular, in person, monthly meetings.  The groups became friends and people socialized with their families and everything was centred around birthworkers and the fire stayed lit.  Eventually, some of the doulas would move on in different directions and new doulas from recent workshops would move in.  There was a constant ebb and flow of energy and enthusiasm.  

Today, most doulas, train outside of their home communities with a variety of groups with a distinct difference in the priorities of the work itself. Doulas meet online, attend webinars and virtual conferences. They exchange ideas and opinions online and without tone, feeling, or emotion (unless it gets heated) and feel judged expressing themselves so many stay quiet.  The problem is we can’t go back and there doesn’t seem to be a forward button just yet.

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The First Step

Each doula must create her own group of people to talk to and rely on.  It sometimes takes a little extra effort to go out and meet doulas in the community.  Finding people who have the same core values and standards of practice can be tough, but those doulas are out there.  Certainly, if they are not, because of where you live, but you know someone who would be great to work with, encourage them to take the course and team up with you.

If you are feeling uninspired and the fire has gone out, reconnect with your trainer or one or two people from your group.  Take the course again or start looking for your people within  your Provincial or State Association.  

Doulas, like midwives, are a global community.  We can rely on colleagues near and far for much of what we do.  It takes a village to raise a doula and some of the villagers need to be within arm’s reach.

The Second Step

Go to a birth.  Find a way.  You don’t need to meet the OBs or the midwives, you don’t have to bring them gifts to remember you. You can, but ultimately, you are looking for pregnant women.  Remember, there are lots of ways to foster connections with potential clients and there are more pregnant people than careproviders.  Put your energy into the right group.  

The spark is there, you just have to to make time to fire it up and keep it burning.

 

Setting Reasonable Fees, Part V

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Setting Reasonable Fees, Part V

Fee Disparity

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This fee schedule is based on a woman coming into care at 12 weeks, with a low risk, healthy pregnancy, no interventions through pregnancy, labour, birth or postpartum.  It is based entirely on averages.

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.


This post is the last of a five part series.

Setting Reasonable Fees, Part IV

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Setting Reasonable Fees, Part IV

Continuous Support & Fees – A Guide for Doulas

Stats.jpgOne of the key components of all studies that support doula care is the continuous presence of the labour support professional.  That means the doula is there for the entire labour, whether it is four hours or twenty four hours.  This is the job we sign on for.  If for some reason, we cannot fulfill the hourly obligation, then we have the option to call in a back up doula to maintain continuous presence.

Some doulas are learning that this model is not viable from a financial perspective yet we have to realize that this is the type of care that was repeatedly researched and found most beneficial in the reduction of interventions.

There have been a great many discussions and lively debates about leaving a woman with an epidural, going home to get some rest, and returning when the client is in further need of our services.  The problem is that a woman with an epidural often has the need for emotional support, side effects from the epidural, does not sleep soundly or for long and sometimes things change ridiculously quickly after the epidural is administered and not always in a way that is anticipated.  Some doulas are also discussing their departure during unplanned cesareans and the return hours later, or even a day later, for postpartum support but again, without a magic crystal ball, you can’t foresee what type of care will be needed for the mother or her partner.  The key in the research to providing positive outcomes is continuous emotional and physical support and on occasion, this will mean sitting in a hallway alone.

Utilizing language that stipulates a timeline for supportive presence is dangerous for some parents and perfectly understandable and legitimate to others; you must know your audience and be able to adapt. As a doula, you can not predict outcomes or needs based on those same outcomes.  In addition, in 2015  The Doula Group in Ontario Canada reports an overall epidural rate of approximately 34%, a cesarean rate of 12% and the births that were more than 12 hours were only 11%.  A whopping 20% were in four hours or less. Doulas do not refund for those very short labours, and thus we do not charge extra for those that go longer but that is only the policy of this particular group. As an independent contractor, you get to decide how you want to be paid, but understand this: the benefited outcomes of a doula’s service is based upon continuous presence.

This five part series on setting fees is an aide for the new doula to understand all that goes into setting a reasonable fee that you feel is the best for that particular doula.

 

Setting Reasonable Fees, Part III

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Setting Reasonable Fees, Part III

Things to Consider When Setting Your Fee

How much do other doulas in your home neighbourhood charge?PAID

How much do doulas charge in your outlying region?

How much do midwives in your area receive for a full course of care?

How much do you need to charge –

  • to break even? 
  • to earn a living wage?
  • to make money at your job?

How many births will you need to do per month/year to make this a sustainable profession at the fee your are considering?

How much will it cost you to be a doula in general?  In your calculations, include gas, parking, time spent prenatally, in labour and postnatally, continuing education, professional organization affiliation, insurance, certification (or recert), childcare, labour bag materials, etc.

How much will it cost you to run your business? In your calculations, include marketing and promotional material, phones, office space or room rentals for events, etc.

If you are running a full business, then you can write off a certain percentage of your expenses.  Will you need to hire a bookkeeper?

What is the average base salary in your region?

If you break down your fee, are you making more than minimum wage?

Ultimately, fair and reasonable compensation for a service provided is the bottom line.  


This is a five part series on understanding setting fees for the new doula.

 

Setting Reasonable Fees, Part II

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Setting Reasonable Fees, Part II

Part II – As a new doula starting out, please remember that the fee decision is yours and yours alone. No matter what you decide to do and how you base that decision, there will be someone that tells you what you are doing is wrong.  Do what is right for you.

Please review Part I – Setting Reasonable Fees.

Providing Pro Bono Services

Pros:

  • You may get more births sooner than later as there are many people who need the service that cannot afford it.  
  • Certification may not take as long as if you were charging a full fee.
  • It can be personally fulfilling to do such meaningful work for those that are in need.
  • You can build experience and gain valuable professional connections.
  • Everyone deserves the same standard of care and the same shot at achieve birth goals.

Cons:

  • You may not get any births because no one believes you can get something for nothing.
  • When there is no exchange, there may be no value.  People may not keep appointments or may not call in labour.  You put in more than than you take get out of it.  
  • Burnout.  Period.
  • Sustainability and viability of perpetual on call services is very difficult to maintain and you may not have a lot of other doulas willing to work in partnership or as a back up.
  • It will cost you money to volunteer.  Gas, childcare, parking, time spent, it all adds up.
  • If someone can’t afford a doula, there are other ways to help them that may serve them better than professional labour support.
  • There are some doulas that will say that offering pro bono services devalues the profession and undercuts your colleagues.  

This point is debatable among doulas since your pro bono client was never going to hire a more expensive doula.  Many other professionals offer pro-bono services, including doctors, nurses, lawyers, chiropractors, plumbers, graphic designers, etc.

Successive Fee Building

Pros:

  • As you gain experience and knowledge, you feel more confident asking for more money.
  • People understand the fact that you are a newer doula who is building skills and are paying for services that may not be at the same level as a more seasoned labour support professional.  You are free to ask questions, make mistakes and learn on the job and people understand that.
  • Most jobs will hire at one rate and build from a starting place.  No one gets hired for a new job at top tier.

Cons:

  • There is still an undercut of service fees in your surrounding community.
  • What do you charge repeat clients in the coming years?
  • It may be difficult to handle a fee discussion when working for a former client’s friend or family member and your fee has gone up substantially.  Can make for awkward conversations.
  • How quickly do you raise your fees, is it time served or births attended?

Barter Or Exchange Of Services

Pros:

  • There is a general acceptance that someone else’s goods or services have value and if there is a fair exchange, and it works for both parties, it can work well.

Cons:

  • What if the labour is ridiculously short? Or long? Or surgical? Avoiding one party feeling like they did not end up at the good end of the deal can be tough to manage. What if the painter doesn’t finish the job or the organic market has a poor crop output year?
  • Give me the cash, I will buy your goods.  Business is business.

Charge the Full Going Rate 

Pros:

  • You are trained, but not yet certified.  You still have all the skills necessary to provide professional labour support.  Every doula, no matter how long he/she has been working learns from every birth.  You are no different.
  • You are not a student.  You are in the process of certifying.  That’s different.  
  • Your time, your expertise, your wisdom, your care: it is all got great value and worth.

Cons:

  • A lot of doulas worked many years and attended a lot of births and have done hundreds of hours of continuing education to charge the full going rate.  They feel they have earned that position and the newer doulas does not have the same skill set to offer.

Check out the other installments of this important series.