*please note: that I use the word “dad” for ease of writing and it is not meant to exclude the presence of partners, friends, family member or other loved ones whom a laboring woman chooses to have at her birth. And some women choose to have only a doula with her.
In the interest of full disclosure I will remind readers that I am a doula, and I offer childbirth classes. So yes, I earn money for these services. For this reason, some may consider me a biased source. Fine. But I firmly believe in my bones that this is a valuable and important service or I would not devote my time to it. And if I could do it for free, I would. It’s time spent away from my family, it’s time and money spent on ongoing training, driving, reading, networking, researching. It’s time spent pulling myself out of a cozy bed at 2:00 am to drive to a hospital to support a family during one of the most amazing, exhausting and at times challenging experiences in their lives, for me it’s priceless, but frankly, worth every penny and then some.
I also had a doula at my birth, and so when I recommend a doula for every birth (all types of birth) it simply comes from my experience and feedback from clients. I also want to acknowledge that I have heard about cases where there is negative feedback about a doula at a birth. I would like to remind folks that in all professions, in all “lines of work” there are individuals who simply don’t meet the high standards of the profession. And, even with those who are considered excellent and skilled in their work, everyone is subject to imperfection. The best of us can make mistakes. The best of us can fail to meet our clients expectations. And probably fail to please everyone present at the birth. But pleasing all family, friends, care providers and hospital staff is not the doulas role.
Recently, especially with the economy the way it is, everyone is trying to cut back and save money. Trying to only pay for what is needed. In our society it is a fact that for most families having a baby costs money, sometimes lot’s of money. So is hiring a doula for your birth a good value? I think so and here’s why.
Please note that I am not going to go down the list of ways that having a doula at a birth reduces the chances of certain interventions and outcomes and thus reduces the actual monetary cost of a birth. Because for me, that means that the doula is responsible for those things. And I simply don’t believe that to be true. There are studies that show certain interventions and outcomes are more or less likely when a doula is present, but I think it has more to do with the unpredictable nature of the million unseen and unknown aspects of birth that contribute to what happens on the birth path, than whether or not a doula is present. Too many factors contribute to each moment of a birth to give one person credit, or blame for what happens.
One of the Dad’s that I recently supported during the birth of his first child, commented to me during labor “Doulas are way underpaid”. I agree with him. Doula fees vary greatly depending on experience and location. Many new doulas who are working toward certification often attend births for free or “voluntary donations”. And some very experienced doulas in urban areas are paid a couple thousand dollars. The rest of us are somewhere in between. Many may ask, “A couple thousand dollars? To hold her hand? To do what Dad or Grandma can do?” I think these comments come from a complete misunderstanding about what a doula actually does. Family can be a great source of comfort and support, but they also bring along their own stories and ideas about birth, and the relationship with mom as well. Doulas have stories and ideas about birth too, but for me, I try to leave most of my personal stories at the door, and open myself to the story unfolding in front of me.
So in determining the value of something we can look at the time output our money gets us, and then examine whether or not we actually think the “service” provided benefits us. Let's look at the time involved, and at some of the aspects of a doulas role, then you decide if the time and services provided seem like they are of benefit and worth the cost.
Prenatal Visits
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This is when the parents go over what they hope for and hope to avoid during the birth. It’s a valuable time for the parents to get to know their doula better and become more comfortable with her. With my clients I also explore what they expect of me and of each other. I also listen carefully about where mom and dad may be holding any “fears” and I try to fish out the questions that they haven’t asked anyone yet. I also take time to do some Birthing From Within processes from the classes that I do. Sometimes this involves practicing some pain coping skills, or exploring our held beliefs about what is “allowed” and “not allowed” during labor and birth, both for moms and for her partner. This might incorporate some art making, to help flush out our stories of birth, and bring to light how those ideas may affect the way we approach our birth, and how we form expectations of birth. I spend at least 4 hours of prenatal time with clients.
Email and Phone Correspondence
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Most if not all doulas provide ongoing support throughout pregnancy by phone and email, and in person if needed. Doulas are a resource. If mom is having swelling, new back pains, sciatica or any of the myriad of normal pregnancy complaints many times her doula is the first “responder”. Providing an ear to listen, and then suggestions on how to remedy, and reminding mom of her options including to call her care provider for more information. For many pregnant women, dad, friends and family will respond lovingly to most concerns with a “don’t worry so much about that, it will be ok”. Many woman find little comfort in this well meant response. I strive to really listen, and to ask questions, to validate her concerns and help her find her own solutions or if it’s something that can’t be “solved”, as many things in pregnancy and birth are, I guide her in exploring her inner resources, asking questions like:
“How do you know to be worried about that?”
“Why would that be a problem for you?”
“How might you cope with that if it did happen?
"What kind of help might you need to accept?
"What might you have to do that you don’t plan or want to do if that happened?”
I have also helped clients find pregnancy support groups, moms groups, breastfeeding classes/support groups, sources for a certain type of diaper or other needed baby item, information on things to do in pregnancy that can help get baby in the best position for labor and birth, information on options when things come up that need medical attention, suggestions and support for negotiating with family about their involvement in the upcoming birth. Often times I help mom process information she has received from her care provider. I would estimate that on average I spend about 3-4 hours on this type of support with my clients.
On Call Time
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24 hour On Call time. This means no leaving town, no wine with dinner, keeping your phone on your hip and always looking to see who is calling, not making any “real” plans because you can be called away at any time. Keep in mind, doula frequently are on call during holidays, and family birthdays, and have missed important events to be at a birth. Being on call can also affect our sleep. Our phone near our heads, doula bag ready to go, knowing that we could (and many times do) get the call in the middle of the night. And for those of us who have families, it also means they are “on call” too, ready for a shift of schedule and any plans being thrown out the window cause mom has to get to a birth. Some doulas with young children need childcare when we are at a birth, this may have a monetary cost as well, but regardless that childcare has to be available at a moments notice. I provide two weeks of 24 hour on call time, meaning I am on call 24 hours a day beginning two weeks before the due date.
So if we tally the time up, even before labor has begun, it is about 336 hours of on call time (24 hours x 14 days) plus four hours at prenatal visits plus about three hours for email/phone support that comes out to 343 hours. If we use the minimum wage for California $8.00 ($9.79 in San Francisco) that comes out to $2,744.00. And this is all before labor has begun. Still not convinced that a doula is worth what she’s being paid? Well let’s see what happens once labor has started.
Labor Support
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Let’s jump to the point where the clients are asking for the doula to come. So the doula arrives. When I arrive (whether it’s at home or the hospital) I try to come in quietly, with minimal disturbance and I observe. So long as mom is in her “groove” and many times she is, I watch. I see how those around mom are doing and how mom is responding. I notice what mom is doing and how it’s working for her. The body language of a laboring woman can tell us a lot. It might be pretty early on, and so it might make sense for me to give some suggestions and go home. I listen. Not only to the laboring woman, but to her partner and any other people present. Other times I sense a need to jump right in, with counter pressure, visualization support, maybe labor has hit a shift and mom needs suggestions on something different to do, or maybe she just needs to look into a woman’s eyes, who knows what she is feeling, who has seen other women go down this path and to tell her
“You are doing it, your body is doing just what it needs to, you can keep doing it”.
Dad may also need some reassurance, he may be seeing and hearing things that are a bit out of his comfort zone. Having someone say that all is well and normal can be a great comfort and allow Dad to experience the process coming from a more aware place, instead of a place of fear. It may be time for a walk, for all fours, for a shower or a bite of food. It may be time to turn off the lights and “rest while you can”. It might be time for Dad to make sure the car is packed, the house is locked while I am helping mom down the stairs. Laboring at home can be any length of time, a few hours, or many many hours. One of the things I watch for are the “Gates” along the way to Laborland. Most women display certain stages, signs along the path of labor. For example, the modesty gate. At some point, many women (not all) get to a place, where they not only don’t care who sees them naked, but where they want to be naked. They leave their clothes at that gate and move further into Laborland. It signals to me that the oxytocin is flowing, the endorphins are kicking in as her body is opening. It generally means labor is moving along well. So in the doula role, I am working to support that, to keep her body moving. Creating an environment conducive to opening. Frankly, it's a lot more than just holding her hand.
If the birth is not taking place at home, at some point the decision to go to the hospital or birth center is made. If needed a doula can ride in the car with mom. Once at the birthing place I’m able to be with mom as needed while Dad communicates with those who need to fill in paperwork. Once admitted, we settle in, following moms cues as to what’s needed, as well as setting a tone of calm for her to labor within.
I help facilitate the communication between mom and dad and care providers. Making sure mom and dad understand the information they receive and any suggestions or advice that is given. I remind them of options, of their intentions and then give them space to make decisions that fit where they are at that moment
Allowing space for her to get as wild,
deep into herself as she needs to.
Knowing that anything she needs to do,
any sound she needs to make is welcome and accepted.
I help facilitate the communication between mom and dad and care providers. Making sure mom and dad understand the information they receive and any suggestions or advice that is given. I remind them of options, of their intentions and then give them space to make decisions that fit where they are at that moment
So let’s jump ahead a few hours. Labor is moving along. We’ve walked the halls, been in the shower, tried the birth ball, had a massage. And now whether mom is nearing the part where she pushes, or if labor has taken a different path, her support team also needs to meet the shift in energy. The journey of labor makes turns, sometime long arching turns and sometimes fast and tight turns, the support team provides a buffer at those “corners” so mom has a hand to hold, a calm face to connect with as she walks, climbs, crawls, or runs around the corner to meet the next unknown part of her journey.
Labor can take a long time. Or it can be just a few hours. But it’s more common for a woman to be laboring for the better part of a day. Remember we are looking at the value of a doula, so let’s even use a conservative time estimate for the length of labor, let’s say a nice eight hours. Add that to our tally above and we’ve got 351 hours. Calculate with the minimum wage, and a doula would be paid $2,808.00.
And I have not even begun the postpartum time spent, helping with breastfeeding, holding moms hand during any needed sutures, making sure mom and dad get something to eat, and have time to rest, checking in during the weeks and continuing to be a resource as needed. And should anything unplanned or unexpected happen a doula is there to listen, hug and even cry with.
I barely scraped the surface in describing the skills and "tools" a doula brings to a birth consider my story a small sampling. So what do you think, is a doula worth the cost?
Next Month: A story of suing a BIG insurance company to cover an out of hospital birth, and winning! Why everyone should be able to have an out of hospital birth who wants one.
Copyright 2010 Kimberly Rivers. Permission needed to reprint, or use in any way.
I barely scraped the surface in describing the skills and "tools" a doula brings to a birth consider my story a small sampling. So what do you think, is a doula worth the cost?
Next Month: A story of suing a BIG insurance company to cover an out of hospital birth, and winning! Why everyone should be able to have an out of hospital birth who wants one.
Copyright 2010 Kimberly Rivers. Permission needed to reprint, or use in any way.
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