Much Ado About Gratis

Lately, there has been a slew of women contacting doulas, myself included, about free or reduced doula services. I understand that this is a financially difficult time for many people, and, although many women have good reason to be asking for help with the cost of a doula, I know that some do not have good reason.

I know, I know that some of you out there are booing me right now, but let me make myself clear before you bring out tomatoes and rotten eggs.

Some of the many reasons I have been given recently for why women are seeking free or reduced services include:
  1. "I had a cesarean previously and don't know if I will wind up in a second. I really don't want to invest that type of money into a service that I may or may not use."
  2. "My husband is not sold on the idea of a doula and I am not sure if we will call you when we are in labor. We would rather play it by ear and call you if we decide we need you... and we can't see putting that type of money into a service that I may or may not use."
  3. "We don't have insurance/are on state assistance."
  4. "We are at a financially difficult time right now. I cannot/don't work because of _____ and my partner's hours are _______"

I, like most doulas, believe that every woman deserves a doula. For this reason, if she cannot financially afford a doula but truly wants one, I make every effort to work on price, to barter if she has a service or skill I could use, or to help her find a doula who can provide services for free. So, please understand this as you continue reading.

Something to remember is that a doula will turn away paying clients who are due around the same time as the the gratis or low-cost clients. This results in a loss of income for our families, which is part of the reason I make the process so much more stringent.

An additional concern that I have is that the emotional, physical, financial, and mental investment that we make has no return. Basically, if I make the effort to go to a woman's house, provide her with educational and physical support throughout the prenatal period, but yet she makes no commitment other than to be at her home for our allotted prenatal meetings, she is less apt to make the emotional, physical, financial, and mental investment necessary to ensure that she 'gets' the birth that she states she so desires.

It even happens, at times, that women who seek out free services without a valid reason will simply not call when she is in labor. These scenarios don't occur as often when a woman has a valid financial reason for not being able to afford doula services, as they truly value our service, but cannot give us the financial value of our services.

With all of that said, I would rather save my free or reduced fee services for women who will make the necessary sacrifices to ensure the best birth possible for her and her baby.

Now let's take a look at the reasons I have been recently given and my reasoning for my responses (by the way, these are the actual last 4 requests for free or reduced services that I have gotten):
  1. "I had a cesarean previously and don't know if I will wind up in a second. I really don't want to invest that type of money into a service that I may or may not use." 
    1. My friend, another doula, calls this occurrence the FreeBAC. I can understand the reasoning. But, on the same token, you have to understand that I depend on the income I receive for doula services for my family. I also will be paying out of pocket for print-outs, supplies for clients, and gas to and from your home and place of birth. 
    2. Also, if you have a TOL but still end up in a cesarean, your doula is still with you during labor, putting in time and work for your birthing time. And also, even if you choose or medically need a CBAC, doulas are very instrumental in helping these go as well as possible
    3. Likewise, if you really wanted a VBAC, you would passionately and whole heartedly pursue it, making some difficult choices that will better ensure that you get the TOL or VBAC you deserve (such as switching providers). Unwillingness to make such a small choice/financial commitment is an indicator of willingness to make the bigger choices/commitments 
    4. And finally, women still benefit from using a doula when they have planned or unplanned cesareans. 
  2. "My husband is not sold on the idea of a doula and I am not sure if we will call you when we are in labor. We would rather play it by ear and call you if we decide we need you... and we can't see putting that type of money into a service that I may or may not use."
    1. Again I depend on the income I receive for doula services for my family. I also will be paying out of pocket for print-outs, supplies for clients, and gas to and from your home and place of birth.
    2. Another thing to think about is 'who will be laboring'? Of course we are there for partners as much as the laboring mom, but ultimately, a woman deserves to have what and whom she wants for birth, after all, she is the one birthing.  
    3. A doula will turn away clients who want and will commit to using a doula if they take on a woman who may or may not call based upon her partner's desires. This is not a fair trade off, IMHO.
  3. "We don't have insurance/are on state assistance."
    1. This might be a valid reason, which is why I require they show proof of this along with proof of income. The reason is, if you don't have insurance (self employment, smaller company, etc..) but have income, women are often still eligible for state assistance during pregnancy, birth, and the first 6 weeks postpartum.
  4. "We are at a financially difficult time right now. I cannot/don't work because of _____ and my partner's hours are _______"
    1. Ok, show me that you are in financial need and I will be happy to work something out with you. 
    2. I have a form that they must fill out and documentation that they must provide (proof of state assistance, pay check stubs, etc..).
Some times, when there is a little financial need, but I can see where families could find the money to pay something for a doula, I might state something to the effect of "well, what do you think a doula's services are worth?" This way, they can name a price and we will work around that.

Other times, if I know the family has a specific trade, skill, or life choice that I am interested in, I offer to barter services; I give them a service that they need/want, and they return the favor. From bartering, families have received doula services, and I have received in return:
  • organic produce from their garden for 6 months
  • knitted uteri and a few newborn caps for postpartum visits
  • babysitting while I was gone to prenatals
  • website design
  • website optimization
  • a weekend at their family time-share
Yep. I love bartering. :)

Like I said before, if I cannot help by providing free or reduced services (either I am booked, I already have a gratis or reduced fee client, or I simply don't think your reason is valid enough to influence my income for that month), I can always refer you to other doulas who do offer free or reduced services all the time.

These doulas are either doulas-in-training, doulas who offer less services (not as many prenatals, have the clients come to them, etc..), newer doulas, doulas who are financially set/not dependent upon the income for their families, or who over-book themselves and cannot give reasonable assurance that they will be at your birth. When I refer you to doulas who offer these discounted or free services, I ensure that my recommendations fall into the categories of newer, in-training, or financially-set doulas. 

Beyond this, though, many people wonder just how, exactly, a doula sets her fees. Well, let me tell you how I have set my fees (adapted from Big Belly):
  • Driving - a doula has a lot of wear and tear on her car. She must ensure that the tank is always full and that it is in good running order.  Likewise, she must pay for gas to and from prenatal visits, postpartum visits, and labor/births. With gas prices like they are, this can equate to a large chunk of her income from clients.
  • Consumables - there are some supplies that we use during labors/births that we need to restock on. These can include: high protein snacks for the families (no matter how many times I remind them to pack snacks, I cannot recall how many times I feed the families, and happily), massage oils and lotions, homeopathics, emergency childbirth kit supplies, and birth balls, sea bands, and ribozos (that sometimes get ruined at births)
  • Self-Employment - self employment means we have to deduct income for vacation and sick time, self-employment taxes, insurance, marketing, promotional materials, lending library materials, and the handouts that we provide to our clients. Our communication expenses are quite large, when you consider we are on-call 24/7, and with business phone lines, unlimited plans on cell phones, and internet connection. We also have general office expenses such as printers, paper, computer equipment, maintenance, ink cartridges, folders, business cards, and more.
  • Hours - Couples having a first baby may imagine that their doula will only be spending a few hours with them during the labor and birth. In reality, an eight-hour labor would be considered pretty fast; most first labors last at least 24 hours; the longest continuous time I've spent providing labor support is 41 hours. The average time I have spent with a woman for her labor and birth is about 13 hours. I spend another 10 hours in prenatal and postpartum visits, another hour or two in phone calls or email, and up to six hours travel time. Using those averages, my fee translates to an hourly rate of about $25/hour, before expenses and self-employment taxes.
  • Experience and Education – When you are looking for a doula, you want one who has experience and education - a wise woman to attend you during your birthing time. This means that your doula has continued education expenses from conferences, peer review, association dues, recertification costs, and CPR and NRP recertification costs. We keep up to date on current research, procedures and policies, and spend a number of hours making sure that we bring a current and competent doula to every birth. Additionally, many doulas, myself included, make sure to tour their area facilities, schedule meetings with area doctors and midwives to talk about personal policies and practices, and generally make sure that we know the ins and outs of our birthing community better even than most of those who work within the profession as doctors and nurses (who are usually only well versed in their particular way of practice).
  • Clients - When I commit to being available for a woman's labor, that means that I have to limit the number of clients I take on per month so as to ensure the best chance that I will be available for her birthing time and not have to use my back-up. When providing in-home services (unlike those who work a shift in a hospital or job-share) one client per week is a very full schedule.
  • Personal Commitment - Being with a woman in labor means that I might be gone from my family for anywhere from a few hours to a few days. Beyond that, when I return home, I require about 24 hours of recuperation time to be back to my regular and completely alert and competent self. This means that my family makes this commitment with me with every woman I take on. Additionally, this means that family vacations, celebrations, and holidays are often missed out on, rescheduled, delayed, or cut short. If I want to ensure that I can go on a trip, to a conference, or be at an event, I have to add 2 weeks on either side of that date wherein I cannot accept clients.  

Doulas commit to being willing to work up to 56 hour shifts away from their own families, functioning on 1 hour of sleep after being gone for an indeterminable length of time, and living the life of someone on-call, all the time. We are willing to be conferenced during dinners, during birthday parties, and during vacations.  

South Bay Homebirth Doula

We have carefully woven our own support system (babysitters, spouses, peers, and friends) so that we can support you in the way that you deserve during one of the biggest events of your lifetime. 

And we love it! We love it and are passionate about it, please don't misconstrue all of this to say that I am not happy or fulfilled with my calling. We all wish that we could do this work as a community service to every single woman... but the truth is, we are self-supporting professionals that have had to choose to either run our businesses very judiciously in order to ensure that those who truly want this service can have it, or to leave our callings and go back to a 9-5 job that will pay much more and take much less from our lifestyles.

This is all to say that, before you ask for free or reduced services, please make sure that you really need the financial assistance. Although I am fully dedicated, fulfilled, and joyful of my calling, this line of work, the life of a doula is not glamorous, it is not easy, and it is not for everyone. It is also not something that I will give away freely without a good reason.


the grumbles said...

Interesting to hear how you go about the process. With my first I was planning for an unmedicated birth and would have loved to have a doula but couldn't afford it so we went without. Luckily things went pretty great. :D

However for future births I'd love to have one. You give me hope with your willingness to bargain! Maybe I can bargain my way towards a doula next time. As much as I know all women should be afforded a doula's awesome services what you do IS hard work and you should be compensated for that. I would be slightly offended (but understanding) of demands that you work for free.

Utahdoula said...

I absolutely agree with you and I get pretty tired of all the asking as well. I sometimes come across the mistaken belief that doulas who are in training are required to do births for free. I don't know where this belief comes from, but I try to educate people when I can.

Lisa said...

Thank you for this extremely practical and honest post. It was really helpful for me to think about how to approach clients who want free or reduced services.

Emily said...

here here! This is a great comprehensive post, I hope you don't mind if I share it.

I was just recently told from a couple that because the woman developed preeclampsia and ended up with a c-section her first time, and might end up with a c-section again this time, can I do their services for free and then they can cancel on me if they end up just scheduling a c-section for a health problem? (Similar to your #1, and I declined this situation).

I have encountered more and more couples turning me down lately because of fees, which are not high, but because they know that free doulas exist. Yes, they exist, and I'd be happy to refer them to you, but for all the reasons you stated here, experienced doulas deserve to be paid if the couple can legitimately afford it.

Maggie said...

I've recently hired a doula for my first birth so I'm coming from a different perspective, but I really love this post! I can understand that everyone has different incomes and ideas about what their limits for these kind of services are, but it's hard for me to believe that people can't understand how much time, effort and coordination have to take place for even the most routine birth. It's disheartening to think that a client would just neglect to call at their birthing time, even though everything has been planned and your schedule has been arranged to accommodate their birth. I don't really have anything great to add but wanted to say that this is such an informative post and I hope that it might shed some light for folks who are just trying to save a buck without realizing all that goes into the services a doula provides.

Trish said...

Great post. You wouldn't go to the grocery store and expect to get free bread from the bakery. You wouldn't go to AT&T and ask for free cell phone service. It should be no different for someone who is a professional doula!

can i get pregnant said...

I definitely love your post become I myself likes to read articles on personal experiences during pregnancy. It helps us motivate ourselves on our own pregnancy and learn tidbits that really counts.

Lyssa Kaehler said...

I did my first three births for free. It made since to me at the time because I had zero direct experience with birth at the time. I couldn't guarantee them that I would be the one puking and shaking in the corner.

Now that I'm doing this as a business, I have set aside one birth per quarter to be gratis, and have an application to get it. So far, no one has applied. Go figure.

bethany becker said...

I think it's sad that you've even had to deal with requests like that, although I do understand the ones from women who truly are struggling financially. I had a doula for my son's birth, which ended in a c-section, and she was invaluable and more than worth her fee. I hired her again for my daughter's birth (an HBAC, just last month :) and she was even more amazing. I guess because I've had such great experiences with her, I can't imagine anyone not thinking a doula is worth every penny she charges...

Sara r. said...

I did my first birth "expenses only". After 8 hours of great progress the mom asked for an epidural and had a c-section 12 hours later. There is a part of me that wonders if the client would have taken me more seriously if she had been paying me ( she and her husband could afford it and they had offered). She was so close to pushing out her baby even though he was posterior ( spontaneously pushing at 7cm) and she just couldn't believe me when I told her she was almost there. Next time I will be charging at least a small fee- sometimes free services aren't seen as really valuable..

Rebecca said...

What blows my mind is when people say they can't afford a doula and I see what they ARE spending $$ on. If you're buying a fancy stroller, crib, mobile to hang over the crib, piles of baby clothes, etc. etc. then you CAN afford a doula - you just choose not to pay one. "Oh, but my mom's buying us the stroller!" Ask her to pay for your doula instead! "Oh, but we're getting a lot of stuff secondhand!" The point is that you don't NEED all that stuff - cut back on a few unnecessary things and you can at least offer your doula a token sum, enough to pay for her gas and meals at least.

There are people who truly cannot afford a doula - I know, I have worked with dozens of them - but there are people who just don't see it as a priority and use finances as their excuse.

BTW I cannot believe someone would try to "hire" you and say they weren't sure if they would call you or not. To give them the benefit of the doubt, they must just not have understood how havign a doula works, because to those of us who do, that is so ridiculous and totally disrespectful of your time and energy.

Karelys (Beltran) Davis said...

This is angering because the knowledge that doulas have to work for cannot be free.

Not only that but when you ask for services for free you are putting the other person in a very difficult position and their hearts can be resentful.

Imagine that someone would ask you to go to work for free!? to pay your own gas, to do your own thing, to have a clear schedule in case you are needed, but you don't get paid? ugh!


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