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Setting Reasonable Fees, Part V

Setting Reasonable Fees, Part V

Fee Disparity


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.


Mentorship, Social Media & Meeting Doulas



New doulas want to meet other doulas, learn the ropes, talk shop, share excitement.  Older doulas (Let’s call them veteran doulas, since old sounds, well, old.) are a little bit of #BeenThereDoneThat.

The question of mentorship often comes up.  There are two schools of thought on this one. Mentorship can be really helpful for learning how to read the tone of the room, how to relate to other care providers and finding your way around hospitals or birth centres.  On the other hand, it can also inhibit learning and growing in your  new, chosen profession and it can slow down the certification process.  It may not allow for you to express an action plan that may have been more beneficial had you been the lead doula thus not really building your confidence in the end.

The new doula will often turn to social media based doula groups for advice but this can be tough, too.  There are so many mixed messages out there and not all groups have the same philosophy.   Some of the groups can be quite negative and cross boundary lines which is very difficult for new doulas to navigate while other new doulas thrive in that environment and find they have a lot to add to conversations and really find their place in the doula world because of those discussions.

Doulas need to meet.  Face to face.  It is important enough that all other maternity care providers do this.  Obstetricians have OB staff meetings with midwives and nurses as well as advisory committee meetings, rounds and other team meetings.  Midwives also have practice meetings and case review time.  Nurses meetings also include face time at shift change.  For doulas, it has become much more difficult to manage.  It used to be that regional meetings were held and doulas made their way out each month to discuss cases and further their education.  Today’s doula finds it challenging to do this and with the advancements of technology meetings have moved online unless you are part of a collective in your area.  The idea of working with a doula partner, as part of an agency or an existing collaborative group has the in-person meeting benefits that other maternity care staff has. 

Talk to other doulas in your class or your doula trainer to find out what is already available in your region.