*Note that this entry is specific to birth doulas. Postpartum doulas charge between $25-30/hour. Stay tuned for more entries relating to postpartum doula work.*
Do these questions sound familiar? One of the most frequent inquiries we get here at Richmond Doulas is about cost. In a 2013 survey, only 6% of women reported using a doula at their births. Barriers to hiring doulas are many--accessibility to doulas, knowledge that we exist, and ability to pay a doula's fee. Doulas are correlated with fewer interventions, thus helping to reduce the cost of birth. This cost reduction is attractive to Medicaid and insurers, but so far, coverage for doulas is patchy and unreliable. Some clients have luck being reimbursed with FSA or HSA and doulas are covered by Medicaid in a couple of states. But while national advocacy groups are lobbying to have doulas reliably covered by Medicaid and insurers, practicing doulas and their clients are left to figure out what is fair in the market for doulas to charge and what is accessible for clients to pay.
If you do qualify for Medicaid in Richmond, Urban Baby Beginnings is responding to this lag in coverage by providing doula services free of charge by trained and experienced doulas. These doulas are volunteering hours of their time, foregoing paying clients, and in some cases, paying for childcare in order to attend these volunteer births. This organization is truly worth checking out!
Another organization based in Richmond that "seeks to further Reproductive Justice by engaging in grassroots advocacy for the full spectrum of reproductive rights" is the Richmond Doula Project, a collective of full-spectrum doulas, providing affordable support to people through all outcomes of pregnancy. Their mission is "to offer support and education to people through all pregnancy outcomes, centering POC, LGBTQI, and other underserved communities, and their vision is "safe, inclusive, accessible reproductive health support for every member of our community."
Richmond families are fortunate to have two passionate organizations like UBB and the Richmond Doula Project. Do some asking around in your community to see if there are similar organizations in your location.
For clients who don't qualify for need-based volunteer doula support, birth doula fees are set by the market, and in Richmond, fees currently range between about $600 and $1000. Most birth doulas offer one obligation free consultation, two in-home prenatal visits, on-call 24/7 from 38 weeks till baby, physical and emotional support during labor until an hour or two after birth, and at least one postpartum visit for their set fee.
Whether the attendance at the birth is six hours or thirty, most birth doulas require the same set fee, rather than an hourly fee for additional labor support. (Some doulas charge hourly for attending a longer birth, usually at the "12 hour mark" though this practice is not common in Richmond). As a practicing doula, in my experience, the precipitous births help support the longer births and make doula work more sustainable.
One option to make doula services more accessible is to recognize that some doulas do offer a smaller, usually unadvertised package that costs less, usually $400-500 In Richmond. This package may include one prenatal, labor support at the place of birth and one postpartum visit. Doulas may not advertise this package because getting to know you prenatally and (if care provider approved) laboring with you at home before heading into the hospital is part of evidence based doula support. Personally, I would find it hard to offer less support for less money, but would do so if it was the only way a family could afford doula support.
While the concept of a newly trained doula offering reduced cost births to gain experience has been the subject of much debate and controversy in the doula world, know that there may be some brand new doulas who may be willing to work with you for a lower fee in exchange for the experience.
If you find yourself "bargain hunting" for a doula, try to balance this out with an interrogation of your own reasons for seeking out low cost doula support, and whether there is room in your budget to pay your doula full fee for her services. We are worth it and the price we ask is fair, based on many variables, like childcare, taxes, trainings, supplies, and our time. For many of us, this is how we support our families and put food on our tables.
If, after an interrogation of your own motivations and your budget, you are finding it impossible to fit full fee doula services into your budget and are considering not hiring a doula as a result, please do inquire as to whether any of our doulas can offer a smaller package or a reduced fee.
For longer labors, I spend up to 50 hours with my client (including labor support, prenatal and postpartum support). There are also the unquantifiable aspects of being on-call 24/7, staying in town and within cell phone service range, having on-call childcare ready to take your kids with very little warning, and not committing to anything with 100% certainty. A birth doula is ready to leave anything and come to the side of a laboring woman within sixty to ninety minutes. "Yes, I'll come to the party/wedding/training *if I'm not a birth*" is a common phrase in the birth world! In fact, when Richmond Doulas tables at events, we always schedule a couple extra people in case (and it always works out this way when we don't have extra people) one of us gets called to a birth and can't make it. This shows you the lifestyle change required of a doula!
Truly, this is what you are paying for. Presence. A birth doula is ready to join you and your family for your birth at any time of day or night. Birth doulas answer your email, your text, your phone call, your question. We are here for you.
Until insurance and Medicaid catch up to the amazing work that parents and birth doulas have been doing together for the last thirty years, we appreciate clients' partnership in navigating this ever evolving market. Humans have been supporting each other at birth for as long as we have been giving birth. But professional labor support is rather new in the long view of things! Controversies and uncertainties over fees, whether doula services are a luxury or should be accessible to all, even at a doula's expense, whether we should charge extra for longer births, or charge less for precipitous labors, what to charge as we gain experience--all of these discussions are just evidence of our profession's ever evolving growth and push towards legitimacy. Just like in pregnancy and postpartum, there is sure to be uncertainty, questions and discussions as we evolve and grow. Thank you for walking this path with us, as we walk your path with you.