Setting Birth Doula Fees: A Conversation with Liz Farmer of The Doula Classroom

In this week's video chat, Liz Farmer from The Doula Classroom and I discuss the crazy world of money within the doula world. Listen in as we explore how doulas set fees, options for figuring out what will work in your practice, and how to avoid drama in the doula profession! Spoiler alert-it doesn't have to be crazy at all. Full transcript below video.

Liz: Hi Amanda!

A: Hey Liz. Thanks for having me.

L: Thanks for joining us. So, today we are talking about money issues and competition and drama in the doula world. And I think those three topics go hand in hand with one another. So, I guess we’ll start with money because that’s such a huge…such a huge point of contention for a lot of people. I feel like there’s a lot of people-I feel like there’s this whole spectrum of ideas on what a doula should or should not be charging. There’s anger if the doula charges too little. There’s anger charges too much. There’s, you know, hurt feelings. And that all, I believe, ties into how women- because doula field is largely made up of women-our internalized thoughts and feelings around money, around giving care that is nurturing in nature.

I know other professions deal with this too that are dominated by women. Caregivers, nannies, daycare workers, school teachers…any of those nurturing type of professions typically don’t get paid very well. Doula work is a little bit different because we’re not working with anybody else. We’re working, we’re typically-most of the time doulas are working for themselves. And so, there’s some schools of thought in the doula community that doulas should charge top market rates right from the gate. There are thoughts that a doula should do several free births. I mean it’s so all over the spectrum and it’s hard to know, especially as a newer doula, what to do, what to charge. Maybe there’s a standard in your community, maybe there isn’t. What are your thoughts?

A: And does that standard even matter? That’s really my...what boils down to my question right now. After being in the doula world for a while, I realized that what other people were charging actually didn’t affect my business, what I charged, how I worked with my clients.

But yea, I hear what you’re saying. New doulas-it’s so hard to figure out what to charge. It’s so challenging to..I mean it’s a hard thing to even have to come out of your body and ask somebody else “Hey, what are doulas making in this area?” Because there’s no public info on the general salary, so what am I supposed to do? How am I supposed to negotiate my salary with my nonexistent employer? Myself, right? It’s a really challenging place to be.

L: There’s this..there’s this thought that if, you know, even in communities where there are people who have money, who are wealthy, who have an expendable income that could afford to pay a doula $2000 or more potentially- that doulas shouldn’t charge a lot of money because that would mean that people who had lower incomes did not have those services available. What are your thoughts on that?

A: Yea, that’s really complicated. So, I truly believe in sliding fee scale models and what that can do. If people are new and they don’t know what that means or haven’t ever worked on a sliding fee scale before-or have never utilized someone else’s services while on a sliding fee scale- generally all it means is that your base rate, what you charge is one thing and you could potentially go further down from that charge or from that fee based on the client’s needs. I really love that model in total because it does allow for a lot of mobility for people who can’t actually pay that top fee. And yet, I also have never been able to do the sliding fee scale, like offer that in my own life.

L: And why is that?

A: Because I couldn’t afford it. So, here’s the sad hard truth about being a doula. Most doulas are struggling financially while being doulas. Whether or not they were struggling before, they’re struggling at least for a couple of years to get this business off the ground. Which is just part of being a business owner as well, unfortunately, in our country. It’s something that I mean I could talk about for days about our small business practices, our tax laws, everything, in our country. But I won’t. It’s hard. That’s the end all be all line there.

And so I think that, for me, in my business, being able to offer services at all meant that I needed to make a certain amount per month. I had to charge accordingly. Whether or not other doulas thought my fee was acceptable in our community. Whether or not some people…and we definitely had doula interviews where I had potential clients across from me at a table saying “You know, you have less experience and somebody else is charging less.” And my response to that has to be “Yea, but we all charge what we think we’re worth, what we think our services are worth, and what we need to charge to be able to have this sustainable business.” I’m the breadwinner in my family, which means I’m going to charge what I need.

It’s a hard conversation to have, but I do think no matter how much…so let’s just say in a community like LA, right? If the average doula charges anywhere from $1000-3000..if the average rate is somewhere in there, does that automatically mean that someone who could only afford a couple hundred won’t find a doula? I don’t think that’s true at all. I think there are plenty of new doulas out there who are willing to work on a sliding fee scale. I also think it’s true that plenty of experienced doulas want to take on lower income clients as well, as part of their practice. Because they know it’s important for the overall culture of birth and our whole world, right? So, I don’t think it disqualifies anybody from getting birth support. I just think we have to open our mind to expanding our thoughts on what it means to make a business sustainable and what it means to be able to serve the most number of clients. What it would take.

I’ll say one more thing on this specific topic. So, if I make $2000 a birth and that means that I can take on 2 free clients every six months, does that like even me out? It depends on who you ask, right? Or if I make $1500 per birth steadily, can I take on just a couple clients at a lower rate per year because that’s what my sliding fee scale can offer? There’s so many ways that this can be done and I don’t think there is a right way, honestly.

L: Yea, I agree with what you said. One thing that I feel like comes up a lot is that there are some doula trainings that I won’t name. What they teach is to charge top market rates as a new doula. So, you know, your first birth potentially as a certified doula would be $1500 or $2000 or whatever top market rate is in the area you live in. And I actually have no problem with that because honestly it’s none of my business what someone else charges. And it does affect my fee, but what I really want is for those doulas, who quite honestly are not that experienced…you might be a very experienced human in how you hold space for people and that might be what they’re charging for. But you really have to be honest with your clients about what your expertise is and what they’re paying for.

I did have one situation where I got hired for a second birth and the parents told me “We paid $1700 for a doula for our last birth and we didn’t realize it was her second birth that she had ever attended and she was good in some ways and in other ways, when shit hit the fan and there were all these interventions being offered, she didn’t really know much. She didn’t really know what to do or how to guide us or what to offer. The doula just kept asking us questions and we were really wanting someone to be able to explain the procedures to us, which in our understanding from what we read on DONA’s website, is what a doula does. They explain procedures.”

As a newer doula you don’t have the experience just from your certification to know all the ins and outs of every little procedure and how to help support your clients. They did ask for a partial refund from her because of that. And they said “To be fair, we didn’t ask her what her experience was because we assumed she was charging top market rate and she seemed very grounded and wonderful in so many ways.” So, just to be very honest that this is what I charge, this is my experience. These are the situations that I may or may not be very helpful in.

When I was a newer doula I charged less and it was kind of my get out of jail free card. I supported a mama really early on in my career where I had never supported a Hypno-birth before and she had her baby at home on accident because I didn’t know and they didn’t blame me, but I didn’t know what a Hypno-birth looked like so I didn’t know that it looks very different than a non-Hypno-birth. She was about to have a baby and I thought she was at two centimeters. And she even said in the postpartum visit, “But we only paid you $400, so we knew that you weren’t experienced.” So I’m like, okay yea, that’s kind of my get out of jail free card.

A: Okay, I have thoughts on that. Because I understand where you’re coming from and I totally see that your perspective on that specific situation-why that would feel like a get out of jail free card. And yet- so this is something I talk to new doulas about when they reach out to me-even if you’re charging $0, somebody is expecting something from you. I just want to exactly reiterate what you’re saying. Being honest and communicative about your skill level, your experience level.

Not inflating your experience bubble around you is really important because I’ve absolutely had situations…so when I was working in the shelter environment and I had a birth lined up-I’m not getting paid to go to the birth. I worked at the shelter and I got paid a salary for that, but to go to the births was just me, right? So then when I needed a backup doula, it’s somebody I cannot pay, and people would often mistake $0 for meaning zero effort or zero expectations or zero liability…zero responsibility. And I don’t think that’s the case at all.

So, I totally get what you’re saying in that situation and there is a little bit of like “Well I’m charging less and you know what that means about our relationship.” But I do think there are some people who charge less and don’t talk about their experience level and I think there are some people who charge more and don’t talk about their experience level. And I don’t think it’s helpful for anybody involved on either side.

L: Yes, thank you for that clarification. Being invited to a birth, whether you’re getting paid or not is a huge honor and never means zero effort or not showing up on time or not communicating appropriately and all of those things. I would love to know your thoughts on what other doulas are charging affect your rate. Do you understand what I’m saying?

If other doulas are charging $400 but you want to charge $1500 then it’ll affect your income because other people will go with those newer doulas. I charged a very high rate. I mean at the top of my doula practice I was charging $2000 and there were tons of doulas that were offering lower fees and it never affected me, ever. In most large cities-you know, I can’t speak to small towns in rural areas because that’s not where I doula’d. But in most large cities there are going to be people who can absolutely afford to pay you top market rate and then there are going to be people who can only afford $100-200.

A: So my general thoughts on this: firstly, SEO has to play a part in this conversation because really what we’re talking about is that the average person when they’re looking…especially if they’re middle class…the average person is going online googling “Doulas in X County” or “Doulas in X City” and then whoever comes up first they’re going through those first profiles. Well, people who aren’t charging enough to make their websites viewable to a mass audience probably aren’t going to come up in that list anyway. So, part of this is like, if you are making a decent amount of money then you get to put out a decent amount of money to bring in more clients. Just making sure we touch on that marketing piece is important. Because I know doulas who have been charging under $1000 for like 20 years and they’re wonderful, experienced beautiful doulas, but I will get more jobs because my website comes up more often or because somebody saw my website and liked it better to begin with. Feeling out what your clients are actually doing to actually find the doulas is important in the conversation I think.

But beyond that, I just have never felt that doulas charging anything else-upwards on the scale or downwards on the scale-I don’t think that affects my fees in our practice. What really affects our fees is how many clients we’re getting for what we’re offering. So, there was a point at which my doula partner and I were charging $1200 and we wanted to up our price. We wanted to make more money. We felt like we had the experience and the package to do so. So, we added in a couple things in our package and we raised our prices by $300 overnight. It was not a gradual thing. It wasn’t like a well thought out thing. We named a price and we said “Okay, we’re $1500 now.”

And the next time someone called and inquired about our services, I listed off what our services entailed, what it meant to work with us, how much experience we had, what perspective we came from, and what our fee was. And by the end of that conversation, they were sold. It wasn’t like I had to try again to get new clients because we raised our prices. It was that people saw value in what we were doing, what we were offering. So, I don’t think that it has almost anything to do with whatever anyone else is charging.

I always go back to an accountant in my head-if I was an accountant running my own practice. Or even running an accountant agency. I don’t even know how these things work. If I was an accountant and I wanted to get new clients in, I would be focusing on what I’m offering, not what I’m charging for what I’m offering. Because people aren’t going to just choose some professional-most people, of course there’s always an exception. There’s always going to be a family who only chooses their doula based on the price. And that’s absolutely their prerogative, but that client wasn’t your person then, right? I always feel like when I go to look for a tax accountant every year, I’m not going to go to the cheapest person in the yellow book. I’m going to go to the person who specializes in what I need and understands what that means. And that I feel like there’s a real value for.

I feel like the most important thing when setting your fees in your own practices or in your groups, whatever that model may look like, it’s really being in tune with what you think that your fees should cover, does that make sense? Building a package that you’re proud of. And then being able to represent that or sell that package as part of your brand and part of who you are confidently and capably.

L: And, to not forget that when you are going over with potential clients what your fees cover, going over that that fee also covers on-call time, which people do not factor in. I would tell people that I charge $2000 and there were births I did not make minimum wage. Because if you factor in on-call time-and you have to because anyone who works an on call job gets paid for their on-call time; that’s just part of it. When nurses or doctors are at home but on call they get a small fee for that if there’s a potential to get called into the hospital. When you start to factor that in, our hourly wage looks pretty horrifying and when you start explaining that to people, they go “Ohhh.” And it’s not just, you know, I feel like people talk about “If you go to a movie, you’re going to have to leave or you go out to dinner and you have to leave or you have tickets to a concert and you can’t go.” Yea, that’s a small part. I don’t feel like that happens a ton.

A: No, not even in a busy practice. I never really experienced “I had to dash out of a movie.”

L: Yea, because you know I wouldn’t go to the movie if I felt there was a chance I might be called out of it. It is more of that on call time and also your recovery time. So a lot of people don’t take into account the fact that after a three or four or five day birth, you might be out for one to two or three days. You might not feel good for a week after that.

A: And you might need to pay out of pocket to go do things that help you feel better. My after-birth routine: massage, acupuncture, and chiropractic every time. I have to be ready in my body to go to the next birth, right? And the only way I can do that is if I’m caring for my body in a really vital way, so factor in those costs as well.

L: Yea, definitely…There is so much disagreement and contention in the doula community about money. I think it’s one of probably the biggest things that’s an issue. Especially in communities where there are lots of doulas. So in the big cities in the U.S. I mean on the West Coast-San Francisco, LA, San Diego-there’s a lot of doulas and just giving our doula colleagues the benefit of the doubt when it comes to running their own business and their own practices…I just don’t ever feel like it’s anyone else’s business what feels good to you and what doesn’t. And also, you might have different thoughts about it in a few years.

A: Absolutely. You know something that I always try to touch on with people. I get a lot of calls from new doulas or people who are interested in becoming doulas looking for guidance. And I love that. One of the things that kind of keeps coming up for me is that I absolutely would have answered this question differently three years ago. I would have answered this question differently before I charge what I charge now. So, one of the things I started doing is making sure when I’m talking to people about these really complex topics, especially money topics, that I specifically say “I’m saying this thing and this is my opinion right now but you should ask 10 other people if you’re going to be asking people.”

Don’t just come to the one person in your community that has responded to begin with and say ‘Oh okay, this person charges that and it’s based on that person’s experience and so based on what I’m comparing is her experience versus mine’…which may not even be accurate in our own perspective minds, right? I think you should get a feel for it. Which is where doula meetings can come into play if people are talking about money. Or just having one on one conversations with people who are open and willing to share about their practice and their fees.

But I also think at the end of the day, if I had one piece of advice for a new doula on money, I would say “Don’t ask anybody about money to begin with. Sit down, figure out your expenses for the year and figure out what it would take for you to cover those expenses and feel good about it. Make sure you’re factoring in your car wear and tear, your body wear and tear. Make sure you’re factoring in the amount of time and energy it will take to do marketing, to update your website, taxes. Factoring in the actual amount of taxes you’re going to have to pay. And then come in with a monthly budget and figure out how much you need to make each month and what that means for your practice. How many people would you have to take on at this fee? How many people would you have to take on at this fee? Those types of things. Ultimately, doesn’t that matter in your life more than what anyone else is charging around you?

L: And the way you decide if it’s appropriate to charge what you’re charging is if people are hiring you. People are hiring you and they’re feeling really good about what they’re paying and the services they’re getting. Then you can’t charge too much. I met a doula who charged, in LA, I think $3500 or something like that. Which is like kind of unheard of anywhere in the U.S. but she was going to 4-5 births a month. In LA, there’s some really wealthy people and she really…those types of people really liked her. That was her ideal client, so she was getting it. So is it inappropriate for her to charge $3500? No, if she’s getting it.

A: Yea, absolutely. It all comes down to what your client actually sees as the value you provide for them.

L: Okay, any last thoughts before we log off?

A: I want to just say something about competition. Because I think a lot of the question around money and doulas is based in this concept that we’re all competing against each other. And I just don’t think that that exists in most professions in America at this point. Again, going back to the accountant or the lawyer..whatever it may be. I mean yes, some firms like law firms, will be in competition with other law firms for big jobs or big contracts. Whatever. But, you’re working on teams a lot of times just like doulas sometimes have to work on teams.

If you talk about an accountant-he or she is never going to be like “Oh Accountant B down the street just upped their rates. We gotta think about this.” That’s not how they operate, so I think that it’s party again I think exactly what you’re saying, Liz, when we’re talking about women in nurturing positions…women who care for other people not charging enough money. I mean I see this in so many ways, especially with my grandmother and the healthcare issue she’s had recently. There are so many women who are just like “I’m just going to give you extra and not charge for it” because it’s a kindness of the heart quality.

But I also think there’s a lot of horizontal violence happening. This term has been thrown out a lot now, but if you haven’t heard of it go look it up and think about it. Think about the ways in which you are actively participating in horizontal violence. I think doula to doula violence is hardcore, just like nurse to nurse, and nurse to doulas, and doulas and midwives, and nurses and midwives…it’s so much. There’s such a big broad thing happening in our world right now and I think women cutting down other women, questioning other women’s practices, undermining other women…I feel like that’s a huge part of this whole money situation in the doula world and I don’t love it. I’m not here for it.

L: I 100% agree with you. I was just…in my interview with Cristen Pascucci of Birth Monopoly. We were just talking about doula to doula violence. It can be really devastating when a group of doulas or a doula team up against other doulas and have-I mean unless it’s something like really radical or crazy or extreme-just my advice to anyone who’s getting heat or drama from other professionals in your doula community is that that has way more to do with them than it has to do with you. It really isn’t any of their business what you are doing and they have different lives and different needs than you, obviously. Which is why they’re doing something else and a difference of opinion…try to stay out of it as much as possible. This is something that happens quite often…Women in general in all arenas. Doulas are typically opinionated, badass women. When you have a group of women like that, there are definitely opinions that are really set.

A: You know, I always say we’re bound…(interruption of howling dog in background) I feel like there are always going to be people we disagree with. In any industry, in any field, there are always going to be people who work differently, who approach the work differently than you do. And that’s fine. That is okay. I mean how many different doulas have said “I had this amazing nurse at this hospital and then I had this nurse who I really didn’t…whew…who was not on the same page at all.” Well, yea, because everybody has a different approach. Everybody has a different background and different experience to bring to it.

The same thing is true in the doula world and so to understand that as like a basic line in the sand and just understand that you’re going to be approaching things differently than other people. So, if you don’t want other people up in your business, literally, talking about anything that you do in your business, just check yourself as well. Don’t talk about other people’s businesses in derogatory manners, or even critically critiquing specifics in other communities or other people’s specific practices. Because you don’t actually know how they work from the inside. You’re not a part of those experiences from the inside. But also because you don’t want that for your own business.

L: Cool, thank you so much for another amazing conversation. And we’ll see you next week.

A: Alright, have a good one