What Is a Doula?

The word doula is a Greek word that is used for woman servant. While most often it refers to a female who helps families during the birth of a baby, there are now more and more doulas who are male. Doulas use informational, physical, and emotional support to help families during the birth. There are also postpartum doulas, who care for families after the birth of a baby. Informational support means looking at the various options that a person has during pregnancy and birth. The doula helps the family gather additional information from their care provider and other sources so that they can make an informed choice about their care. The emotional support component is simply being a calming and steady presence both for the laboring person and their family. This might mean helping to promote relaxation, setting the tone in the room, or helping the family converse with the other obstetrical team members. The physical support is what most people know and expect from doulas. This would include labor positioning to help the pregnant person stay as relaxed and comfortable as possible, including movement when requested and appropriate. It may also include massage or other relaxation skills on the part of the practitioner. It might mean using tools like water therapy, a rebozo, a birth ball, or one of many other tools that a doula uses to help a laboring family. Doulas are trained by various organizations to learn the skills necessary to assist families in this critical time period. The oldest organization is DONA International and they’ve certified more than 12,000 doulas in 56 countries in their 25 years. There are other organizations, like CAPPA and ToLabor, which certify birth doulas too.

Why Do You Need a Doula?

Using a doula has been shown to have many benefits for both you, your partner, your labor, and your postpartum experience. Research shows that when a pregnant person uses a doula, they are more likely to have a vaginal birth and less likely to request pain medication or require Pitocin. It’s also important to note that people are less likely to rate their birth experience negatively. The bottom line is that everyone has a much better chance of being healthier when a doula is used during labor and birth. The American College of Obstetricians and Gynecologists notes: “Published data indicate that one of the most effective tools to improve labor and delivery outcomes is the continuous presence of support personnel, such as a doula."

How Much Does a Doula Cost?

The fee for a doula will usually cover the prenatal period and a set of visits set aside to help you and your chosen doula to get to know one another and talk about your choices for your upcoming births. There are usually also postpartum visits covered, but this is not the same as a postpartum doula, who does light housekeeping, baby care, and other similar things to help.​​ The doula fee will also cover the birth, though be sure to know how your doula defines birth. The vast majority of doulas define the birth time frame as whenever you are having regular, painful contractions and need doula support. Some doulas will prefer to join you only when you’re in active labor and at your intended place of birth (hospital or birth center). A handful of doulas have caps on the amount of time that they will spend before added costs accrue. A birth doula costs on average between $800 and $2,500, depending on location, the local market and cost of living, the experience of the doula, and what services the doula provides. A postpartum doula costs on average between $20 and $50 per hour, also dependent on location, experience, and whether the services are provided during the day or night. If the cost is too high for your budget, some doulas-in-training will work for less when trying to get experience or achieve their certification. Also, some hospitals offer in-house doula services at a discounted rate.

How Is the Fee Paid?

In addition to knowing how much a doula charges, it is important to know how the fee is structured. For example, you may pay half the fee when you contract with the doula for services, and the remainder at the time your doula goes on call for your birth. Some doulas may also offer payment plans. This allows you to stretch the fee over a longer period of time. This is also one of the benefits of finding a doula earlier in the course of your pregnancy. You will not only have more options for doulas simply due to availability, but you will have longer to figure out payment issues. Some doulas will also barter, so if you have skills, services, or goods that might be worthy of a trade, it might be worth part of your doula’s fee in exchange for those services. This might be something as simple as babysitting services or as complex as car maintenance. Either way, do not hesitate to ask your doula if they have a structure in place for bartering.

What Goes Into a Doula’s Fee?

Here is a breakdown of just some of the things that are included in a doula’s fee.

  1. Education: It starts with the training the doula receives. It can cost over $1,000 to become a doula. Even once your doula is certified, there is recertification, which includes continuing education courses, conferences, and other educational requirements.
  2. Costs of Doing Business: The costs of doing business, even in absence of a physical location, can include business cards, handouts, and materials given to clients, software or apps used to help keep records and files, professional licenses beyond that of certification and recertification, listing fees for referral services, car maintenance, cell phone or pager service, a lending library, website, etc.
  3. Work-Related Items: If your doula provides you with items like a birth ball or massage tools, this will be reflected in your fee.
  4. Child Care: A doula may need to pay someone to care for their children while at prenatal appointments or at birth. This may also involve paying for an on-call childcare provider, meaning the doula pays for childcare even if they don’t use it.
  5. Back-Up: A back-up doula is a person who shows up to your birth in the off chance your doula is unavailable. This is usually reserved for unusual circumstances like the original doula being ill or at another birth. The contract between you and your doula will talk about the use of a back-up doula. However, the most usual scenario is that the doula and back-up doula have a separate agreement. This means that a back-up doula may make a small fee whether or not their services are used. It is also important to understand and value the work that doulas do. Doulas work very hard at a job that has weird hours, not much flexibility, and requires a lot of physical and emotional work. The number of hours that a doula puts into a client is not simply measured in terms of how long labor lasts. There are also the prenatal hours, the hours spent on call, and the hours spent with the client postpartum.

Doula Fee Scholarships

A few doulas may also offer scholarships or participate in groups that do special incentives for families who meet certain requirements. An example might be income-based, but there may also be population-based assistance, like refugee families, teens, families giving birth with certain programs or at certain income levels. Be sure to ask if this is something you need.