Doulas have fees that can range anywhere from about $350 - $1,200, depending on location, training/experience, and cost of living in your area. That can be a stretch for some budgets, especially right before adding a baby (or two!) to the family. If you want a doula, and you find one you like and who feels right for you, the cost is actually a small hurdle to get over. Here are some ways you can choose to make this investment in yourself, your birth and your baby happen:
A note on doulas in training: there’s a wide-spread belief that a doula in training (meaning one who still needs to attend a few births to certify with a doula training organization) is the way to go because hey, they’re free, right?
Now days, most doulas in training do not offer their services for free. Some will offer them for a reduced cost or are more willing to trade. Realize this: the service they are providing is incredibly time consuming and valuable. If they value themselves, they will most likely ask for a fee, even a small one. And believe me, you want someone attending you in birth who is confident enough in their abilities to ask for compensation. This isn’t about entitlement, it’s about the value of a service being offered. Please respect that, and I promise, with the options mentioned above, you will be able to work with just about any doula to find an arrangement that works for you.
That said, there ARE doulas who will offer their services to low-income and in-need families for a reduced cost or free. If you are in a situation where you honestly can’t pay a doula anything, or could only afford a portion of her fee, then speak up! Talk to doulas in your area and be honest about your situation until you find one willing to support you in your desires. We are human people, we know that it can be hard sometimes, and we really want to help you. We’ll work to find something that benefits both of us, and everyone will be better for it.
Also realize that not everyone NEEDS a doula. If none of the above seems to be an option or paying for a doula doesn’t appeal to you, consider whether you really need one. If this is you, there is a lot you can still do to prepare, which is the topic of another blogpost I might write someday. But here are some tips: 1) Get a care provider (doctor or midwife) who supports YOU and the birth you desire to have. Don’t settle for anything less than someone who respects and listens to you. 2) Be sure your husband or boyfriend or anyone who will be in the room supporting you truly supports the kind of birth you’re planning to have and won’t change their minds in the middle of your birth. You deserve someone to support you fully! 3) Do your research, and DO take a childbirth education class! Learn everything you can about birth, and make sure your husband learns some ways he can support you and help you have the safe, positive birth experience you desire.
The role of a Doula is a fairly recent one. It hasn’t always existed, at least not by that name. Throughout history, reaching as far back as the first people giving birth on the earth, other women have attended a woman in labor, giving physical, emotional, and informational support. This role was, and still is in many cultures, filled by close friends, family or fellow villagers. The woman in labor would be familiar with and often closely related to these birth attendants.
In America today, we have largely separated from the midwifery and wise-woman model of care. Birth care has been outsourced from the village to doctor’s offices and hospitals. Advances in technology and hygiene mean more babies are born alive and grow to adulthood. But the significant trade-off is that more women are isolated from places and people that are comfortable to them, and birth is something to be afraid of and managed by strangers in a strange place. Studies are beginning to pop up, telling the story of the rise of birth trauma and postpartum depression in the United States, which is not without causalities of its own. This can be seen especially in the current cesarean section rate in the U.S., an average of 33%. The World Health Organization admits that a cesarean rate of 10 - 15% is all that is needed to save the babies truly in need of emergency action. And yet, the rate has climbed 500% since 1970, and continues to rise.
So what changed, exactly? What has made this difference? There are many theories, but the biggest in my view is the outsourcing of care – the movement of birth from home to hospital, and the lack of knowledge and support women have in regards to giving birth. Enter the doula. But so many women either don’t know what doulas do, or they have massive misconceptions about having a doula and the role a doula has or the benefits one would provide. So here are the seven most common reasons women (and their birth partners) choose not to have a Doula, and why those reasons aren’t always valid.
#1: I don’t need a Doula, my Husband/Boyfried/Nurse/Mother/Best Friend will support me.
Husbands, or fathers of the baby, have only recently been asked into the birthing space. For thousands of years, and in most cultures, fathers of babies have been found pacing hallways, smoking or drinking and waiting with their buddies, sitting just outside the door trying to distract themselves while they wait for the child they helped create to arrive. Women did all of the work of birth. Midwives attended women, her sisters, friends, and mother held cold cloths, gave instructions and advice, and soothed her emotionally. Today, in America as well as other countries, it has become commonplace for the father of the baby to be in the room, watching his child be born and in many cases, acting as the main or sole support of the mother in labor. Men, in large part, are unprepared for this role. That’s not to say they don’t belong there – in fact, when they feel supported, confident and prepared, husbands and boyfriends can provide some of the best support for women, even some that a doula couldn’t provide because of how intimately they know the birthing mother.
But, despite birthing classes and months of preparation, articles pushed on them and books read, husbands are most often just as overwhelmed and caught up in the birth process as the woman giving birth is. They haven't spent years studying birth. They most likely have never even SEEN a woman giving birth outside of a television show or movie. Additionally, they tend to feel insecure in a hospital setting, and most of their confidence may leave as soon as he enters the doors. This happens for a lot of men when faced with a strange place or the authority of doctors and nurses, so having a doula to support your husband so he can support you is smart and often needed in the hospital (and even at home!), not to mention that when you hire a doula, you hire a professional who is trained to support women, and their husbands, in labor.
So what about my mother-in-law or other female support? They’ve given birth before, right, so they know how to support me?
In theory. But it’s not as simple as just having another woman in the room, although several studies have shown the benefit of this. Many women do choose to invite mothers, mothers-in-law, grandmothers, sisters, and friends into the birthing room. What about them? Aren’t they enough support to negate the need for doulas?
In most cases, no. Realize that they will bring all of their knowledge of THEIR birth experiences, as well as any fear, trauma, or belief, into the room with them. A mother-in-law might make you feel uncomfortable, or try to control your birth experience (mothers can do this too!). Sisters and best friends, while incredibly supportive, often don’t know what to do to support you, even if they’ve given birth before. If you want a natural birth, but your sister has only had epidurals, she won’t know what to do when your contractions start to hurt. The opposite is true too – if your best friend is an advocate for unmedicated birth, and that’s all she has experienced, she might get confused when you get an epidural, and she will have very little idea how to support you.
And most family members (and others that love us), including husbands, don’t do well when someone they love is in pain. They just want to make the pain stop and for you to feel better, and if they don’t know how to do that without medication, they’ll be asking you to “just get the epidural.” They aren’t trained in pain relief techniques that don’t involve medicine. Doulas are.
Does having a doula mean you shouldn’t invite your family members or friends to the birth? Definitely not! The relationship you have with them is really valuable. But a doula has knowledge they don’t, and you’ll benefit a lot from that whether you have an epidural or not (see reason #6).
Additionally, if your family member or friend stops being helpful, or if they are causing problems (as they sometimes do), your doula can be the one to ask them to leave, or give them a job to do outside of your hospital room or home so they still feel helpful, but they stop prohibiting your ability to give birth easily and safely. No matter who you have at your birth, a doula will always benefit you.
So what about Nurses? It’s their job to support me in labor, isn’t it?
Nurses are amazing people, incredibly dedicated to their jobs. They work constantly with pregnant women, supporting them in hospital settings as they labor to bring babies into this world. It takes a very special person to be a nurse, and the work they do is incredible. But the large majority of nurses are simply unavailable to provide the continuous emotional and physical support a woman needs while in labor. Consider this:
“Labor support does not always occur because nurses tend to have coexisting responsibilities for more than one laboring woman, spend large amounts of time managing technology or keeping records, and begin or end shifts in the middle of women's labors” (Hodnett, Gates, Hofmeyr, & Sakala, 2007).
Does the nurse have time to spend hours with one woman, giving counterpressure or using a rebozo to offer physical relief? Is she able to stay in the room, offering positive words of encouragement while the woman labors, or making suggestions to her birth partner to support him as he supports the woman birthing their child? The answer is no. In fact, one study notes that while providing labor support is an important component of nursing care, only 6.1% of nurses' time was spent in providing supportive care (Gagnon & Waghorn, 1996).
“Factors that hindered nurses' intrapartum care fell into six themes; (1) hastening, controlling, and mechanizing birth; (2) facility culture and resources; (3) mothers' knowledge and medical status; (4) outdated practices; (5) conflict; and (6) ethical/professional decline. Of these six themes, hastening, controlling, and mechanizing birth was most frequently mentioned” (Sleutel et al., 2007).
#2: A Doula would replace my husband/boyfriend/etc. supporting me
This is a common concern, but when you have a great doula, it’s an unnecessary one. A doula will be as hands-on or hands-off as you like. She will encourage and support your husband in supporting you by teaching him techniques she would use, or, if your husband is the type who would like to be more on the sidelines, she’ll be right in the thick of it, giving you what you need!
In the birth of our second baby, I had a water birth. My husband climbed in the tub with me, to hold me and support me as I changed positions to bring our baby out. Our doula was outside the tub, and when I became discouraged and started saying the baby would never come, and that I couldn’t do this, she was right there with a positive, affirming word, telling me I was bringing my baby and that she was definitely coming. She was ready with a cool cloth for my head or a drink with a straw to keep me cool and hydrated. She was the rock I leaned on all through transition. After the birth she got us settled, making sure breastfeeding was going well and making me a smoothie. Doulas do so much more than just attend your birth.
#3: A Doula is too Expensive / We can’t afford a Doula
Probably the most common reason of all, the cost of a doula is definitely a concern for a lot of couples. Doulas prices vary from location to location, and range anywhere from $300 - $3,000. In Utah, where I serve as a doula, most fees are in the $600-900 range. The reasons for the wide variation are found in different experience levels, cost of living in different areas, and how much a doula values herself or relies on her income as a doula for providing for her family. (For more on why doula costs are what they are, read this article.)
My belief is that there is a doula for every woman that wants one. If you think you can’t afford it, my challenge for you is to interview a doula (or several) and ask her (and yourself) this question:
“How can we afford your fee?” or “What can we do to make this a realistic possibility?”
The truth is that most doulas will do one of several things. They will:
· Offer a payment plan or accept a credit card
· Offer a sliding scale fee based on your income
· Take trades for part or all of the fee (commonly traded services are childcare, haircut/color, massages, website design, etc. I’ve even had clients sew or crochet things for me in exchange for my doula services!)
· Give you recommendations for another doula in the area who offers a lower fee than they do, or one who is in a position to offer a lower price or even a free birth as needed
In other words, keep interviewing doulas until you find one that will work with you! Cost should never be the only reason you don’t have a doula if you feel like you need one because, as I said before, there is a doula for every woman who wants one.
#4: We want birth to be an intimate experience, just my husband/boyfriend/etc. and me. A Doula is basically a stranger, and we don’t want strangers at our birth.
If you want to limit the number of strangers at your birth, first off, I recommend you consider giving birth at home or in the birth center. Most of the time you only see one or a few midwives during your pregnancy, and you’ll most likely meet her assistants before the birth. This is the most sure way you’ll have that intimate experience you desire.
However, if you are planning to give birth in the hospital, you might want to consider this: nurse shifts change, and sometimes doctors don’t make it. Your birth could be only a few hours, perhaps 6-8, or, especially as a first time mom, it could extend upwards of 24 hours or more. It can happen any time, day or night. You cannot predict or control who shows up to your birth.
Here are some other things to take into account when planning an “intimate” hospital birth experience:
If you have an obstetrician you’ve seen your entire pregnancy, he or she may, for any number of reasons might not make it to the delivery of your baby. Another doctor will come to catch your baby, and you may not have met him or her.
If you have a rotation of midwives, you might get one you’ve never met before. She may or may not support all of your birth decisions.
If your hospital trains other doctors, you may end up with a room FULL of people you’ve never met before, as they crowd in to watch the doctor cut an episiotomy, use forceps, or stitch you up as needed. They will be there to watch a live birth happen in the hospital, as part of their training, and unless you specifically request otherwise, a resident in training might even be the one delivering your baby.
If you think nurses will fill the role of a doula in the hospital, that’s another misconception. Skip back up to reason #1 for more on that.
A doula is, in fact, the only “stranger” at your birth who you can guarantee will be there! And you get to meet her in advance.
So how can a doula make your intimate hospital birth more of a reality?
If the nurse shift changes, and it’s a nurse you don’t like, she can help you request that another nurse be assigned to you so that you find one that is kind and respectful of your desires.
If the room gets noisy with others talking or monitors beeping, the doula can quiet them while you focus on laboring.
If the room is too bright, the doula will turn your lights down for you.
If your doctor or midwife doesn’t show up and it’s someone you don’t know, your doula will be right by your side, comforting you and your husband through each contraction and helping you focus on your baby, not on a stranger being there.
Your doula will also encourage your husband and support him so he knows what to do and how to do it, and that will bring you closer than ever in your birth experience. For more about husbands/birth partners in labor, see reasons #1 and #2.
Your doula can always leave the room and give you some space if you absolutely want to be alone, but she'll wait outside and be there the moment you need her!
A doula will also see you at least three times before you give birth. Once for the interview and two more times for prenatal visits where she will learn about your desires for and concerns about giving birth, as well as get to know you better. Some doulas offer more than two prenatals. If getting to know her is a concern, ask if you can meet an extra time or two so you feel more comfortable with her in the room.