I would rephrase with "what do you actually pay for when you hire a doula"? If you think doulas are crooks or they exploit the situation of vulnerable parents to be millionnaires, maybe I won’t convince you, but if you want to understand the costs behind a doula’s fees, please keep reading.
Behind the fees of doulas, whose basic birth packages cost on average between 1000-1500 € in Finland, are all the obvious fees that parents can witness and experience but also all the "behind the scenes" expenses.
The visible:
Time spent with parents during pregnancy Preparing for birth, acquiring all the necessary knowledge to make powerful informed decisions. Building a strong birth team: connecting physically and spiritually. Establishing trust. This is the main key to navigate confidently and empowered through the Birth waves.
Time spent during labour, birth and immediate postpartum. I’ve been to births that lasted between 5 and 31 hours. Doulas tend to stay after the birth, keep company if baby is taken to NICU, help establish breast/chestfeeding, wait for parents to get a room and settle.
Time spent in early postpartum (postpartum home visit, debrief, postpartum care, sealing ceremony…). A few days after birth, emotions and tears might rise to the surface: questions, pride, regrets, fears, sometimes anger, mixed feelings that are difficult to untangled alone. It is important to express all these emotions, for each parent. Articulating one's dark cloud-feelings can help dissipate them. Having the attention one deserves, feeling validated, brings strength and confidence that can go a long way. All the physical and symbolic postpartum work, can support the release of stuck memories and the healing of traumas, in addition of accelerating the body recovery. These postpartum visits facilitate the transition.
Communication with the family Keeping in touch, keeping that link alive brings comfort to parents. Knowing that they are not alone and that they can contact their doula in case of doubt or to share both their joys and fears, is a relief.
Different material and accessories (TENS unit, electrodes, birth and peanut ball, books, affirmation cards, ethically made rebozos (from Antama for example), essential oils, gua sha combs, massage tools, etc.) Some birth accessories are expensive, take room and only serve during pregnancy or birth. Renting/borrowing is a great concept: ecological, economical and space saving. To me, there's even an emotional aspect to it: imagine using the same rebozo that helped birthing many babies before yours. Can you feel the strength of all these beautiful people? Can you feel that they are all behind you supporting you? I do. I want to.
Plants and minerals Organic herbs (for steaming), calendula and other flowers, essential oils (aromatherapy, postpartum womb massage), optional gem stones, palo santo, ingredients for ceremonies (raw cacao and spices), etc. I, like other doulas, want to work with the best quality and fair-trade products.
Food and travel Doulas don't teleport yet. Doulas still need to eat. Labour can be long, very long and doulas need that fuel to shake your apple tree.
Certified education Anyone can call themselves "a doula". There is no license per se. However there are certifications. Certified birth doulas have attended a doula training, either an international training such as DONA or CAPPA, or a local training in Finland such as Doulakka, Doules or Doula Akatemia. That means that they have not only completed the program (in my case about 400 hours), studying the physiology of birth, the protocols in place, hands-on techniques, but they are also committed to follow a standard of practice, and respect a code of ethics.
The invisible:
On-call time During this time the doula stays in the region, ready to join you any time, often in the middle of the night. Doulas are commited. They can't overlap with other clients to optimise for your birth. They also team up with a back-up doula to ensure that if any unfortunate impediment might occur (disease, accident), you wouldn't be left on your own.
Time preparing, shopping and cooking Your doula tries to tailor to your needs as much as possible. Depending on your existing knowledges or your special needs, they will deliver the best solutions, references, studies and contacts for your specific situation. They also need time to shop according to your situation or diet, preferences or possible allergies. When doulas cook for you (especially for the postpartum) it requires time too.
Time researching and connecting People have different needs and wishes. They might want to see an osteopath, an acupuncturist, or look for prenatal yoga or ballet courses. Doulas will suggest you professionals in their network or will work to find the best fit for you.
Continuous education A doula is learning and acquiring new skills constantly through workshops, courses or conferences, whether online or in-person, to better serve clients.
Time spent reading books and evidence based literature It is necessary to know the basics of birth and postnatal care literature but also keep up-to-date with last publications on the matter and most importantly all the significant and unbiased studies made about different interventions, procedures and protocols as well as the on-going research.
Writing Blog posts, guides, hand-outs. This can take time to collect and organise ideas in a pretty way.
Time spent on networking Doulas meet other professionals: other doulas like them or complementary perinatal professionals (midwives, physiotherapists, lactation consultants...) so they can choose the best back-up doula for their client, suggest a doula who better fits their requirements (specialty, mother tongue), refer them to specialists they trust and finally build up a solid perinatal community.
Website designing/building and hosting costs Whether "homemade" or created by a professional designer, websites take time, money and often both.
Marketing (business cards, ads) That is useful for us to find you and you to find us. Our business cards look also really good on your fridge or inside your Ina May's guide to Birth as a book-mark.
Cost of doula/birth association membership(s), for example Suomen Doulat or Aktiivinen Synnytys
Taxes! VAT in Finland is 24% (kind of one quarter, yes, that's a lot)
When I think of the benefits of such an investment, I have in mind all the medical aspects: less chances of needing an intervention, more chances of breast/chestfeeding success (if such is the wish of the parent), less time spent in the hospital. Moreover, I think of the emotional aspects, the possibly enhanced bond with the baby, the self-confidence as parents, all the well-being that material can’t buy. To see the full evidence on birth doulas, check out Rebecca Dekker’s website and the article Evidence on: Doulas.
First-time parents often overspend in childcare articles, a UK study revealed. Companies compete to sell you "indispensable" or "must have" accessories. What does a baby really need? Loving and caring parents, milk (human or manufactured), warmth, a safe place to sleep, nappies (not so many if you practice Elimination Communication), something to carry them and stay close (arms, sling, baby carrier).
What do new parents need? Feeling supported, validated, encouraged, loved. They need to rest, eat, keep hydrated and smell the sweet scent of their baby. They don’t need to worry about the rest.
If you struggle financially, there are still ways to hire a doula. We’ll see this in my next blog article, 7 steps to afford a doula.
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