3 years ago I wrote my first blog post, in response to an article in the independent, accusing doulas of being money grabbing opportunists.
Today I feel compelled to write another blog post, as this time a medical professional is saying that we charge “extortionate prices”.
Dr Ahmed Rashid, an NHS doctor, wrote this piece in the British Journal of General Practise
” I first came across a doula as a junior doctor working in obstetrics and the idea has fascinated me since. In case you haven’t heard of them, they are trained or experienced lay women who provide social, emotional, and practical support during pregnancy and birth, but do not provide any clinical care. Although the practice has ancient origins, the modern doula movement began in the US in the 1970s and private doulas, hired by mothers (often for extortionate prices), have been popular in certain parts of the UK for some time. A recent Oxford study focused instead on volunteer doulas, trained by third-sector organisations. After interviewing 19 doulas and 16 mothers who had received their support, the authors concluded that they can play an important role in improving women’s birth experiences by offering continuous, empowering, female-focused support that complements the role of midwives, particularly where the mothers are disadvantaged. Perhaps it’s not such a bad idea after all.”
The part of this piece that triggered me, was the ” often for extortionate prices” comment.
Nothing could be further from the truth.
When I left a prestigious career in science to become a doula (you can read why I did that here), I also left behind a salary over 40K, regular and predictable working hours, and job security.
I did this to follow a calling, something that pulled at my heart, the deep need to support women through birth and make a difference to their experience.
I sure didn’t do it for the money!
I started as a new mentored doula (Doula UK, the association of doulas in the UK, has a strict mentoring process in place, which means that new doulas called themselves mentored doulas, and usually charge lower fees to reflect this, until their mentor feels that they have acquired enough experience and can become recognised doulas), charging £250 for a birth.
When I wrote my first blog post, after 2 years as a doula, I was still not earning enough to pay tax.
Now, 5 years down the line, I only just paid my first tax bill. And this wasn’t because of my doula work, this was because of my other hats, in particular the fact that I teach workshops. Most of us have “side jobs” to complement our income, because it is very difficult to make a decent living at a doula.
5 years down the line, I am still quite far from earning what I earned as a scientist.
Doulas charge as little as £300 to as much as £3000 for a birth. On average, most of the recognised doulas I know charge between £600 and £1000 for a birth.
My birth fee now starts at £950.
What does this include?
This includes several antenatal meetings (those tend to be at least a couple of hours each), and unlimited support on the phone/email, accompanying clients to medical appointments etc. Whilst I offer a system with a set number of appointments, I find that I cannot restrict my support when a woman needs it. For example, I have been supporting a woman pregnant with twins , there have been many complications to her pregnancy, and I have attended well over 10 appointments with her. I am also in contact with her several times a week. It takes a lot of headspace, and I am more than happy to do it, but, with this in mind, it is easy to understand why I feel so rattled by the accusation of money grabbing.
At 38 weeks, I go “on-call” until the baby is born. This can be a week, 2 weeks, or up to a month or more. The majority of my clients are first time mothers, and on average they tend to birth beyond 40 weeks (last year, one of my clients birthed at 43 weeks so I was on call for 5 weeks).
During this time, I need to be able to leave everything and go to my client at very short notice when she goes into labour, at any hour of the day or night. I (like most of the doulas I know) have young children so this means complex, multilayered backup childcare arrangements, sometimes including at night (which cost money).
Whilst on call, my phone is always with me (I even bring my phone to the side of the pool whilst going for a morning swim so I can check half ways through that she hasn’t called). I cannot go anywhere more than an hour away from home. I do not drink alcohol, and I always tell everybody I have made plans with that I’ll come “unless I’m at a birth”.
This also means that there is a lot of pressure on my family and social life, as births have to take precedent over almost everything. This means always knowing that I may not make important family events, like birthdays or other celebrations (yes even your kids). My husband and I rarely go out and I have had to cancel a rare evening out more than once as I was called to a birth. Being on call makes us lose “brownie points” with our friends and family – who as much as they try and understand it, still find it stressful. I remember once during a difficult on call period (my client was a repeat client and her first birth had been very traumatic, and I was very invested emotionally in making sure this didn’t happen again), my parents were visiting and my mum said “you’re not there”-meaning I was physically present, but mentally, I was with my client.
The on call period, up to 30 days, 24h a day. This can mean a total of 720h or more.
When on call we also tell all our other clients, including the ones who have hired us for postnatal support, that we may need to cancel at short notice. Of course, when we get called to a birth, it also means that we lose out on the money we would have earned for supporting other people that day.
Then there is the birth. Many of my clients are first time mothers, and it’s quite normal for a first birth to take anything between 24h and 48h. One year, all the births I attended were between 30 and 40h long (that’s the length of time I was with my client). The shortest birth I have ever attended was about 3h long, but I was there for 6h because I always want to make sure the mother is settled and her baby feeding well etc before I leave. The longest was 4 days (a long induction).
Then after the birth I make a postnatal visit (again at least a couple of hours), and I am available for 6 weeks for unlimited email and phone support. New mothers contact me for support, for example when feeding isn’t going well, and I do everything I can to help them. I put no limits on the hours I spent doing this. This means many unseen hours talking to them, sending them links, and signposting them to other professionals. For example, last year when my nephew’s daughter was born, and they had problem with breastfeeding, I couldn’t support them myself because they lived too far, I spent a couple of hours late at night, when I should have been in bed. contacting my network of doulas, until I found a breastfeeding counsellor who was able to visit them the next day. We doulas constantly pull incredible feats like this because we’re all very passionate in supporting women.
Many of us have discussed this in the past, and found that when we break down the hours spent on average with our clients, it usually works out at less than the minimum wage per hour.
To top this, up, I personally only take 6 to 7 birth clients a year. This is because being on call in an intense, emotionally demanding time, and I have suffered burn out in the past and learnt that I need to keep the Christmas, Easter half Term and the last 2 weeks of August free for relaxing time with my family in an absolute requirement.
Because I make a strong commitment to my client to be available for her, I also almost never take clients with overlapping on call times. This means turning clients down, or working as a shared-care team with another doula, splitting the fee in half. Most of the doulas I know do the same. So if you imagine taking on a maximum of 12 clients a year, even at my fee of £950, this only makes an annual income of £11400 before tax (and doesn’t take account of all the other expenses associated with this job, like travel, hospital parking fees, etc).
Even the rare, top of the range doulas, who charge £2 to £3K, assuming they took on a birth client every month, would be looking at earning between 24 and 36 000 a year. Hardly a six figure salary.
And let’s not forget that Doula UK has an access fund, which allows women in personal or financial hardship to access the services of a doula for free. The doula, in this situation, only gets paid expenses. I have done this myself, and so have most of my colleagues.
I love my job, I love supporting women, I love making a difference, seeing the transformation that true, unconditional support does, especially when women have had a traumatic first birth, and end up with a positive, empowering one with doula support.
I wouldn’t go back to my previous job for anything in the world.
The value of a doula, how transformative and life changing it can be for many women, goes well beyond how much we charge, and most of our clients, after they’ve been doulaed, feel that our support was worth a lot more than what they paid for. You can read some of the testimonials my clients have written about I supported them at the bottom of this page.
But please, do not ever imply that this is an easy, money grabbing job.