Tuesday, December 14, 2010

Doula Boundaries re: Finances

Occasionally I will have a client who finds out that when she must have a planned Cesarean, she feels she no longer wants doula services, or wants extra postpartum care instead. If this is planned in advance and all are on board, this is fine. Doulas are flexible, and usually don't mind doing some extra postpartum visits instead, or a friendly termination of services if this is appropriate.



I have heard a few doulas tell me, however, that their clients decided at the last minute they felt a doula at their Cesarean birth was pointless, and demanded other services that were not really within the scope of the birth doula's work, like night nanny-ing or older child care, in order for the doula to earn the fee. If this is something the doula is really happy with, whatever a client and doula want to do is their business. I feel, however, as a reasonably experienced doula, that contracts are essential to establishing clear boundares. I know they can feel uncomfortable to a doula who is so willing to give everything and bend over backwards to serve all the desires of her client. Doulas serve. This is our essential definition. And because birth is so incredibly unpredictable and changeable, flexibility is part of our natures. But boundaries are important. Doulas need to honour their worth and refrain from feeling badly for taking pay because, for example, a birth went very quickly, or from allowing their family income to take a huge financial hit because they weren't comfortable standing up for themselves. This can cause resentfulness and burnout. Contracts make things clear. They are important for doulas, especially for newer doulas who are scared of making a client uncomfortable.



If a client signs on for a birth and has agreed to the listed things in the contract such as "if you choose not to have your doula after your prenatal meetings, you are still responsible for the remainder of the fee", this fee is still owed. Period. Doulas meet with their clients before any official prenatal work is done in order to ensure both parties like the chemistry. That can usually be sensed immediately. If the client decides at the last minute she'd prefer her best friend to you after the work you've done together and fails to contact you for the birth, your contract protects you. It is certainly her right to not have you come at the last minute, but your fee is still due. If a baby comes too fast, for example, we still must be paid. A planned Cesarean is still a birth. It is wrong to assume that a doula's presence is not very valuable for a Cesarean birth. While she cannot go into the operating room with a client much of the time, especially if the mother's partner is going in to support her, there is much we can do after the surgery.

A doula's work is so unpredictable, and outcomes are beyond her control. She should not be penalized for her client's last minute choices. She will not have had time to book another client with such short notice, and this can severely affect her livelihood.


Sometimes clients will expect special services because they decided a doula at their C-section was not necessary, and this is not fair. A doula lovingly and thoroughly prepares her clients for the birth of their baby, however that unfolds. We cannot guarantee a vaginal birth. We can't guarantee anything. To expect that we'll just do something convenient for the parents in place of birth attending is like their asking for a free dessert from a restaurant because despite the effort of our crafting a wonderful and elabourate meal that was requested by them, for whatever reason it turned out they didn't want to eat it, or pay the balance. As it was the customers who came to the restaurant in the first place and placed a request that you have refused other requests for in order to accommodate this one, it is only fair there is financial accountability for the original order instead of having to delve into the chocolate mousse resources to "make up" for the balance they owe. It's not the restaurant's fault the client now doesn't want the caviar and truffle souffle. Now, granted, if the meal were terribly prepared and served, this would be another issue, and should be something the parents can dispute. But generally, signing on for all the prenatal preparation, postpartum follow up, and a birth means that regardless of how the birth has to go, the doula has been asked to provide a service and must be paid according to her contract and not get ripped off because she didn't replace her service with another coveted one. Birth doulas are not babysitters or night nannies. We attend births. Cesarean is birth. The vast majority of clients who want these other services don't even ask whether or not this would require a different payment structure or a different service provider...it is apparent to most. But occasionally some don't, and when this happens, the doula must be firm in standing up for herself, even if this means taking action to get the pay her contract states is owed to her.

I had a client recently who knew before our first face to face meeting she would have to birth via C-section. We decided to do less prenatal visits, decided I would be at the hospital for her and her partner while she birthed, and that I would do extra postpartum work. We were all very happy with this arrangement. I have had other couples ask me, "If I end up having to have a planned Cesarean, I don't feel I'll need you there as I've been through Cesarean before. Can we have something in the contract which states I can refrain from paying the birth attending fee?" And I will agree to that if they know a few weeks ahead of time. This gives me the opportunity to book someone else in their spot. Requested flexibility is not an issue. However, if a client signs her contract in advance knowing she is bound to pay for birth services, whether she asks her doula to be there or not, then that's what she needs to do.

Birth attending is an amazing joy. Sometimes births are short and we make quite a great wage if you add it up hourly. And sometimes with loooonggg births, especially if we missed another birth because someone's birth was very early and loooonngg and another person went very late (this can happen even if you only book one lady per month), you can end up in the hole financially. We have to plan for these occasional contingencies, and take those rare but sad hits. But if our flexible natures which love to serve and to please our clients make us pushovers, we will inevitably get taken advantage of at some point. And yes, it IS true that if we speak up for ourselves and claim our right to decent pay, we can get the reputation of being hard assed. But it also shows we respect ourselves and value our work. Being firm has in fact only helped my business as opposed to send clients running to someone else. When YOU know your value, it is apparent to potential clients as well.

I personally don't quibble about my prices. I don't give people money off here or money off there because they feel my price is high. Every doula knows the feeling of walking into the home of someone who owns a BMW or you see a $1000 stroller in the corner, or the couple just came back from a big vacation to Jamaica, and then the clients want to negotiate a "better deal". I have never had a problem lowering my price for people who clearly are struggling with finances and who seem very committed to investing in their birth experience. A colleague of mine was recently approached by a pregnant teenager who said, "I need a doula, but I have no money. I can bake, and I can knit." This honest, upfront approach impressed her, she agreed, and they both had an incredibly rewarding experience. If women are genuinely disadvantaged, I send them to a doula organization which specifically helps women in need. But for the vast majority of my clients, my price is my price. Those who initially found it quite high change their minds after the birth is done. The 24 hour on call committment, doing our best and pulling out all stops in terms of support in the throes of extreme sleep deprivation, helping clients gather enough information to make choices that in the end spare them from a potential C-section and the recovery time and breastfeeding challenges ensuing from a high tech birth, having to reschedule sometimes 2 days of appointments, missing our 2 year old's birthday party, etc.....this kind of service is incredibly valuable, and the far reaching effects of a satisfying birth and postpartum experience are global. When the birth is done, clients are very aware of all you have done.

Doulas out there, you are amazing. Within a scattered, unpredictable, crazy making job, a firm backbone of boundaries in the area of finances is crucial for your mental and emotional health, as well as that of your family. Never doubt your worth.