Cat Barf, Miscarriage Traditions, & Money; A Conversation with Liz Farmer of The Doula Classroom
The title says it all. Today's post is all about a weird and wonderful conversation I had with Liz Farmer over at The Doula Classroom recently. I hope you enjoy watching/listening/reading all about our thoughts on birth doula money issues (the main topic of this video). Transcript below video.
Liz: Hi Amanda.
Amanda: Hey Liz.
L: How are you?
L: Good. What happened with your cat this morning?
A: (Laughing) I knew you were going to ask that. I have a sick cat and as I'm eating breakfast I see my sick cat go throw up on my very new rug. It's not an expensive rug, it's just a very pretty rug. So, I had to make sure that was cleaned up ASAP. Really fun stuff.
L: I understand, I have a cat and he's just the worst. He just throws up all over the place.
A: What is that?!
L: I don't know, dogs don't do it nearly as much so I don't understand.
A: No! My dogs never, ever throw up. That's not a thing. They're messy in other ways (laughs).
L: God...Yeah I'm good, We had our book club this morning and we talked about The Midwife of Hope River, which is such a sweet novel and just really sad because it's kind of like one tragedy after another and made me really think about how much in other cultures and places in the world and times, babies just died like all the time. And women died more often. Not as frequently (as babies) because women, like, adults are just more hearty than kids and babies so...
L: But we were talking about how crazy it was that like you had 12 kids and you just knew that a percentage of them was not going to live.
A: Most likely, yeah.
L: Yeah. That was just a reality so...
A: I had this conversation with a client the other day in a childbirth prep session. She was talking about fears she had with her partner and he, you know, his fears were "You won't have a good time", "You won't love me the same way when we have a baby together." But her fear was "I'm going to die" or "My baby is going to die". So, I had to do a lot of softening around that subject but also validating that "Yeah, that's a normal fear when birth is happening, when you're getting close to laboring. It's a pretty normal fear. Yeah."
L: Yeah. I always found that giving them the statistic that in the United States maternal deaths are something like 7 out of 20,000 and that that 7 is typically in a different population than they are because most of my clients were wealthy and that statistic also comes from low income people making up a large percentage of that. But yeah, it's totally real and it's a possibility. Like, I don't know if you've had this happen but there was a maternal death in my doula community the first year I was a doula and it was a hospital birth and it was this awful, horrible thing where we were all like "oh my gosh"...
A: This happens.
L: This happens.
A: I've never experienced maternal loss in my practice but I've supported families who have expected infant loss and recently our team, the doulas on our team, supported a family who had an unexpected loss at birth with zero warning signs, zero indications, zero risk factors, and it really humbles you a bit. Or it humbled me a bit in this work. Even if we do all the right things, even if we plan in all the best ways, and have all the best support and all the best doctors and the best hospitals or midwives or whatever, sometimes things still happen.
L: Yes, that is so true. Life is just never a guarantee, ever...so on that note (laughs).
A: (laughs) Good morning!
L: Good morning! (laughs) I was actually just reading an interesting article, it's called "The Japanese Art of Grieving a Miscarriage" and it's a Japanese tradition where they take like a little doll and it's called the Jizo and in their cemeteries they have them lined up and then parents put little snacks and gifts at their feet because in Buddhist tradition, an unborn child has not made enough karma in this life to go to heaven. So they're sort of stuck in this in between place and but the Jizo takes those babies and hides them in it's pockets and gets them into heaven. That's a really sweet tradition since we have no tradition around miscarriage or pregnancy loss at all, unless you have, I mean a baby that's on the older side of gestation then I think it is common to have funerals and burials and things- but if it's in the first trimester and there is tissue but no body there isn't...
A: I think we do have traditions, it's to stay silent about it. Yeah.
L: Yeah, that is the tradition actually. You're right that is...
L: Yeah, yeah...really, really horrible.
A: You'll have to send me that article. That's super interesting.
L: Yeah I'm gonna send it to you and I'll also post it. Yeah, when I had my first first trimester miscarriage I was like on the internet and I was like, the thing that was really soothing for me was finding miscarriage art...which is plentiful and really beautiful and that was really...that was something that was really helpful to me. There was a tiny bit of tissue that I found, but I was like holding it and I was like "What do I do with this?" I mean we don't have much of anything and I'm Jewish but I don't think I've heard of a tradition around a miscarriage that we have so...
A: Yeah, it's something I wish that we had more discussion, at least discussion right? Even if we didn't have ritual around it, even if we didn't have real traditions around it at least we could discuss, at least we could talk about what we're going through. That would be really lovely.
L: Yes, and as a doula I did most of my doula work before I had my baby but I would always ask clients about losses they'd had because I felt like no matter what gestation it was even if it was you got a positive pregnancy test and then two days later, you know, you had a miscarriage or it was a chemical pregnancy, it still feels like a loss and there's a lot of anxiety that goes along with that and so talking to your clients about that even if they're like "Oh no it wasn't a big deal, it was only six weeks" or whatever, I always make a comment like if something does come up for you around that I want to invite you to share those thoughts and feelings with me and then they would be like "OK" because they don't think it's an issue but it might be an issue somewhere in their subconscious.
A: Absolutely. A lot of that stuff comes up in birth I find. Especially moments where women are like "I can't do this, I don't know if I can get through this, I don't know if I can survive this moment of challenge or this moment of intensity." I think that any past experience of death or demise in their lives- I've even had clients who mid-contraction will be thinking or all of the sudden there will be like a thought bubble coming up in their mind about a favorite pet when they were young that passed away and that was like really hard for them. Yeah, weird stuff happens in births so I think it's good to check in. I think it's really good.
L: Yeah, yeah. I often think of the pain or the intensity of birth because I'm often like, analyzing my pain and intensity during my birth and I was thinking the other day... I was having gas or something that was way more painful than any contraction that I had and I was just thinking like "oh the intensity of labor and the pain people talk about I think is so much due to the hormones that are happening rather than like the actual physical pain"... even though my experience was "this is so painful" but if I stopped it's actually not. There's something else so huge happening hormonally that it like translates the intensity of the hormones into pain in your body.
L: This might have been why my labor stalled (laughs) because I started having thoughts like this during birth.
A: Your conscious mind, right? And then your conscious mind is like trying to take control and that's not really how birth works.
A: Well I also think that birth is just like... laboring is so large and looming for most people before it happens and in the moment it can feel... I think it can be really easy to just be plunged into this big open space of emotion, this big open space of gosh...almost like a...I feel like the thing that always pops in my mind when I'm with women who are laboring is like a cyclone, it's like a potential spinning. Like you could potentially get to a place of spinning if you're really trying to dissect all the things that you're feeling, all the things that you're going through and I think that it's more easily like what you're talking about, I think that hormones or because it's a big life event, because it's a rite of passage, because your baby is about to be born- whatever it may b- that's causing it to feel like there's so much possibility for spinning and possibility for "cycloning".
L: Yeah, yeah I think that's true. Yeah I felt like in my case it was hormones. It was the hormonal surge. It was so intense.
Yeah, so let's talk about...I want us to talk about money stuff. We talked about it last week. And then I had some feedback from people around a blog article I wrote. I wrote a blog article called "Three Unique and Surefire Ways to get Doula Clients" and when I was a newer doula, I wasn't getting any bites. There were, in terms of clients, even births for free were pretty hard to come by for me for some reason and I really wanted to start going to births. I didn't feel like I was experienced and I really felt personally uncomfortable charging for births at that point. And so I was doing volunteer births through an organization that offered free doulas to low income women, and I then started charging for births but still getting any paying clients was hard. I mean, I think there were something like one hundred or one hundred and fifty doulas in my area and so it was a large urban city and so there's a lot of doulas. A lot of doulas would talk about going to interview with someone and they'd interviewed eight doulas.
Getting doula clients is hard and so I had this idea which I wrote about in the blog-I offered my...I contacted a few home birth midwives and was like "Hey, I'd love to offer, if you have a low income client or a medicaid client, and I've never been to a home birth, I'd love to go to some. I would love to offer my services for free." And I did that-and I went to, I think, four births with her that were zero dollar births. And they were not free because I was getting experience and exposure. And within the next few months after I completed that birth, those births, I think I made like a few thousand dollars in referrals from those midwives and set myself up for... I think one of the midwives- I did, like over my doula career in that particular area- over a three year period- I went to like seventeen or eighteen births of clients of hers because I did one zero dollar birth for a medicaid client she had. I felt really good about that and so I suggested it in my blog article because I have doulas that I mentor that are like spinning their wheels and they're not getting inquiries.
And they are much more experienced doulas here like "what do I do? I'm doing all the things." And I suggest that as an option for them and a lot of doulas have really big feelings about that, which were expressed to me in an online forum -which I'm totally fine with people having really big feelings and opinions about things like that. No one was expressly like mean to me but I definitely had a moment of like "Oh that kind of hurts my feelings" because I feel like I had really good reasons to do what I did and I don't quite understand charging a fee if you don't feel confident going to births yet.
And then someone mentioned that it was a place of privilege for me to be able to do those births because she has kids and she has childcare needs and you know it costs her a few hundred dollars to even get childcare. So my response to that is like "Then this is not for you, you know? If you need to be paid for every birth you go to I fully support that, I have no problem with that and anything you want to charge for" But, like, I didn't have the option of not getting clients. Like, I had bills to pay. I had food to buy. I didn't know what else to do and that worked really well for me, and I felt really good about it. And then I got more confident and then I was able to charge really well.
Then on the opposite side of the spectrum, I told doulas that the highest I've charged for birth is like $2,200 and I've gotten some like "How could you possibly charge that much?" so it just feels like I'm in the middle...
A: You're damned if you do, damned if you don't, right?
L: Right. Like I said, everyone has opinions and that's completely fine. I just feel like I'm not ...I just don't...I guess I just don't understand where they're coming from when they say like "I don't like that you're encouraging doulas to do birth for free" when it makes so much sense for that doula to do so. What are your thoughts?
A: Yeah so, I have pretty specific thoughts about this because I also did births for free but I was not in a...so, I feel like I was definitely more in a place of privilege to be able to do that only because I was working full time at a place that was giving me my clients (laughs). Because I worked in a place that served homeless, pregnant people -and because they needed people at their births- like I didn't get paid to go to 30 hour births, but I got paid full time to be an employee and have access to those people, right? But I fully took on births that were super, super low fees for me after that for the same purpose that you were talking about. I did a couple $200, $300, $400 births even after I had like more than a dozen births under my belt at that point. It was because it would be different experiences. Every time I got to go to a new hospital and learn the new policies of that hospital, learn about the culture in that specific birth setting, it meant something to me. That did feel like an exchange, right? So yes, I was working and I might not have gotten paid or I might not have gotten paid much, but it meant to me like I had an exchange for that service I was providing that was worth it, right?
But that's the thing, I think that's the key for people to keep in mind: everybody has a different threshold of what they're willing to do for a certain price or for no price and for some people that threshold is "I'm not willing or I cannot do it for my lifestyle, my needs for my family, bills" or "I can, but then I will or won't" And it feels like "I have created an exchange situation that is fulfilling for me"-or it doesn't feel like that. And if it doeskin feel like that, then don't do it. But for so many doulas, it absolutely is terrifying- the thought of like putting yourself out there and charging money for doing this thing and not having any experience doing that thing, right? Or having experience but only only in a certain place or only with, you know...so this happened to me. I want to say my first 25 births were in hospital settings, were medicated births, and they were planned medicated births, for the most part, with the exception of my very first labor experience, which was unmedicated at a hospital and beautiful and wonderful. So, all my experiences were in a hospital with an OB; I had never worked with a midwife; I had never seen an out of hospital birth, so even though I felt really confident in my ability to doula and support somebody I had no idea what that would look like in reality in a birth center or at a home birth. I had no... I didn't know how to fill the tub for birth. Like that's not a concept-like I couldn't even grasp like what would be different.
So I did an internship at a birth center- so out of hospital births- and that was for free. I signed on for 4 or 5 births at that point and got some experience out of hospital and I wouldn't... and it was hard (laughs) and my life was very challenging at that moment in time because I was working full time and doing free births and like doing some office hours for that internship or whatever. But it was so worth getting to know that particular birth center and their practices and their midwives. But also, it was worth being able to say "Yes, I've attended a home birth" the next time I got a client inquiry who was like "I'm having a home birth, do you have experience?" Cause otherwise what do you say? "No, but I have lots of experience in a hospital?" Ok, well for that client what does that mean for them? Right? That doesn't instill necessarily a lot of confidence in your ability in the environment they have chosen, right? Or for the wishes that they have for their birth. So yeah, I just feel like everyone needs to do their own thing and be ok with the thing they're doing. And I think that applies with choosing to do births for low income families, choosing to do births for free, choosing to do no births at low income costs at all. Like I know doulas who absolutely got into training and then charged $1,000 dollars per birth and they've gotten clients slowly, but they've gotten clients and built a business. I feel like that's fine. I don't have any qualms with that. But it's just... it wasn't my path. I didnt feel comfortable doing that.
L: Yeah. I thought a lot about, you know, why people feel the opposite way that I feel and I think that one of the big things is that maybe they feel it's insulting to the doula profession to not charge and that it's work and that you are working and so you need to charge something even if you're not charging your full fee. But then it comes back to, in my head, and in my feminist brain this idea that everything that is exchangeable in capitalism is money-based instead of --for me, the experience and the exposure and meeting the midwives and sharing that deep intimate space with a home birth midwife... she's going to refer me out way more than the midwife I had tea with, or in passing at a networking event. And for me that is, well A) that's money-that got me more money. It got me to the births that I really love supporting; I really love supporting home births. Hospital births are beautiful too, but they're very different and I also have an issue with the idea that as a doula I think that the experience and the craft and the skill comes from a lot of learning and time and the fact that you can go to one weekend workshop and have all that skill and you don't have to train in the field...
A: ...Or apprentice in some way.
L: Or apprentice in some way, that feels very odd to me. If you don't feel that way and you feel comfortable doing that, then by all means as long as you're... I don't if I mentioned this last week, but I went to an interview with someone who their first doula experience was hard because she didn't disclose to them that she'd only been to like one or two births and she was charging top market rates, so they assumed that she had been to many and she kind of like effed up at their birth... something that a new doula would do but a more experienced doula wouldn't have So, they felt like she wasn't completely honest with them even though they like never asked her outright... I guess I'm just like...I wish doula trainings were longer I wish there were apprenticeships that you had that you did with them. I felt like I was like flung into the ether after my training...
And, and I understand that this setup of our training makes this work accessible to a lot of women that otherwise and people that otherwise could not afford to do a like a year long intensive training to become a doula which is kinda what I think the training should be and that as like usually a woman cause doulas are typically women we have spent our life learning how to nurture and care for others and all of that expertise comes up in birth and we use all of that expertise but you know I didn't really know how to make a woman super comfortable until like many, many births in and I just I don't know I feel like I understand where they're coming from and at the same time I feel pretty like good about the way that I did things and about suggesting this path to other doulas if they can do it.
A: Yeah and that's the thing, so all you're doing is suggesting a path, right?
A: You're not saying "This is the way that you have to do it" and I think that that is something, I will say: I think that's something that happens in doula trainings, especially since there's so many different types of them now, but I just remember my doula training... that same "flung into the ether thing" absolutely was a part of my life after that. I just felt like "What is happening here?" even though I had attended one birth, so my first birth ever was before I was even trained as a doula. I was like a "birth coach" in this crazy environment and it was awesome but I had no specific training, and so I remember feeling like "This is all there is? It's a weekend?" I also recognize that for a lot of people- so that nurturing essence that you're talking about that a lot of people bring into the world and into their environments with their clients- I think counts for something, right? And I think a lot of people when they first become doulas, they're like "Well I'm also bringing my experience of life into this work that I'm doing. Whether I have children or not, whether I have you know experience you know supporting people in hard moments, it's a challenge." I have a friend who, for a long time, was a CNA before becoming a doula and she...
L: What's a CNA?
A: Certified Nurse Assistant? Yeah, and, so she did a lot of in-home health stuff with seniors and she talked so much about how the transition to birth wasn't that different for her specifically and her path was that she charged right away for births because she felt like she brought so much of her like loving energy and care into the environment- she had a lot of experience caring for people and loving people in a hospital setting. And doing all the little things to make them as comfortable as humanly possible in moments of challenge potentially. That worked for her. I thought of myself when she's talking about this and I'm like "oh my god I had such a...I wasn't even connected to like my feminine energy until 26." I needed to go to trainings, I needed to learn how to communicate with people better, more efficiently, more accurately, write with integrity. I needed to learn so many things so I'm personally right on the same page as you where I feel like doula trainings-I think those need to be so much more and that's why so many doulas do actually seek out so much more. I think a lot of doulas are really great at trying to find all the trainings and all the books and all the research, right? And all the resources... but yeah. I feel like the basic way that most doula trainings are set up is a few days or a couple days even. I feel like there's a lot to be a lot to be missed in those environments honestly.
L: And that's why I highly recommend finding a doula mentor. Those births that you're going to...you're getting paid zero dollars for typically, but that experience is just ...it was so valuable to me and it was part... I was like "I'm creating my own training. There's no industry standard for trainings for doulas." It's a certified profession. You don't have to be certified to call yourself a doula, you don't have to be trained. You could just one day be like "I'm going to make a website that says I'm a birth doula and I'm going to watch a YouTube video and that's going to be my training." You can make up your own training. And I was like "This is part of my training. All of this stuff and all of this marketing... I could go to all these networking events and spend hours and hours and hours passing out my cards and doing all the things, or I could go to 2 births with a couple midwives and spend that time actually getting experience. That's why I really, I really feel like it is the way to go.
A: I wanna address the piece where like maybe other people feel like you're denigrating the profession of doulahood by not charging. I get...I feel like I understand where people are coming from in terms of, you know, to be taken seriously in any profession you charge money in this culture right? But I have to agree with you, Liz, that there is so much more...there is so much more value in the things that we do than the money we get from it, and I think that some people see that and feel that and some people don't, right? So if you feel like the only exchange that is, or the primary exchange that is important in your doula work is to get financial compensation, then absolutely you should be pursuing that, right? But in my world, in my like world view I should say, and in my work, and in my practice- the money is just one part of it. The exchange of emotional information that I have with my clients, the exchange of conversation on a real intimate level, being allowed into somebody's home and into somebody's life in these really personal, intimate intense moments... that feeds me, it just helps me flourish as a human being; it helps me grow.
I never leave at the end of a birth the same person I was when I walked in, and that has value. So while the money of course is important because I need to live, I need to run a business that is successful enough for me to live off of... I also take into account what I'm going to get personally and professionally in other realms or in other ways. So there are some times where a client wants to hire me and I'm absolutely like "No, we're not a good fit because I know the exchange is not gonna be fulfilling." Whether the money is there or not, right? And then there are times where I have somebody who'll come into my yoga class and be like "Oh my god I love you, I love what you do, I love your approach. I feel like we're really in alignment with each other- please be my doula." And my heart breaks because I can't. That's like whether the money was a thing or not, I still would be called to that person. That has value for me and I think that some people feel that way and some people don't-and if you don't, then that's ok. You do the work and you get paid for doing work. But I think a lot doulas also have to take into consideration the other parts of themselves that they are getting and sussing out and working through by being a doula.
L: Absolutely. I also want to say that I think the doula should be paid really fucking well, like I think even top market rate in the areas that I've lived have been $1500 to $2000 and I think that that is too little. You know, when my husband and I were getting married and we were looking around for a wedding coordinator- we're really lucky that we both make good money and so we have the funds, and I understand that that's a privilege...but like the lowest the cheapest price was $2500 dollars for a wedding coordinator and they're not on call and they're not doing the emotional work... there is emotional work in being a wedding coordinator, but it's very different from what we do...and I was so sad that doulas make so little. Even to me, if you're making $60,000 a year as a doula, it's too little. It just like is. I think doulas should be paid way better and you can have a sliding scale and you can... there can be newer doulas to have the lower fee but like it breaks my heart when I hear of a doula who's been to hundreds of births, been a doula for years, and are charging $400-500 in an area where they should be getting paid $2000 for a birth. People have a huge issue with charging so much. That is not so much; do you know what people are spending their money on? They're spending their money on vacations and furniture, shoes and clothes. They could... there are a lot of people that you think couldn't afford to pay you a good wage that really could. I also feel like doula support is so important to specific families and it breaks my heart that doulas don't make good money.
A: Yeah, and I think this is what you're feeling right now and what you're talking about... and expressing... like wishing that doulas did make more money, feeling like doulas should make more money. I feel like people who have an issue with people charging zero dollars for births as doulas will cite this aspect like "We already don't get paid enough for our work so don't do it for free", right? And, so while I'm hearing you talk about it, I can hear one voice in my head saying "yeah, yeah and doulas don't get the respect they deserve and doulas aren't seen as a profession that should be charging a decent wage or even a higher than just decent wage." But I think it's hard because some people, I mean, so we're in this profession where a lot of people don't even know what we do, right? How many times have you said, somebody asks you what you do for a living and you say "I'm a doula" and they're like "what the heck are you talking about, what is that?" So we're already fighting in this culture to just get recognition, right?
And then people don't even know the difference between us and midwives so like there's so much education that's like not happening and just wide-scale wise doesn't exist yet, and there's so much lack of awareness about what doulas do, what doulas are...that asking in general for all of us to get paid more seems like such a reach, right? Because so many families can't even figure out that we exist and that we're for them, let alone put aside money to begin with whereas weddings, I mean people plan for their weddings for years, right? Most people start planning for birth at like 3, 4, 5 months pregnancy perhaps. Some people before that some people during fertility struggles are still are planning ahead for their birth but by in large people don't plan for birth until it's imminent and I think that that is another like aspect here to just keep in the back of our minds when we're talking about why people don't pay doulas. First they don't know who we are, then we have to like convince them. I feel like most doulas have to like convince people in general that they're worth it, right? And we don't come upon that struggle with our clients themselves anymore because we do have a presence in our community and we do have a fee that is commensurate with what we do and who we are in our community so most people that come to us now know who we are before we ever interact with them, communicate with them but it just feels like doulas in total are like having to talk about who they are, educate about who they are and also convince people that we are vital and important and part of this whole birth world. Which like you know an accountant never has to do (laughs). Everyone knows why you would need an accountant and in what situations you would need an accountant, right? So it's just that I feel that we're fighting through so much like muddied water and lack of education that we also, it's hard to think like yeah and if we all charged more it would be better for us, right? It's hard.
L: It's so hard. As you were talking I was thinking of this one experience I had. I had a client who hired me and I was seriously thinking about not taking them because the dad was like just the nightmare dad, you know, on his phone during the prenatal visit-just like not interested, not into me... not seemingly into his wife. He said multiple times like he's in the visits and stuff he's like "I just don't even... like I really don't know why we need you. Like you tell me and I'm like whatever." And my fee then was like $1000 and they paid me... they had a little bit of money, they weren't super wealthy. So the birth happened, it was a pretty straightforward birth. I think I was there for like 20 hours, which is like a standard time to be at a first time birth and the dad didn't really... he seemed like not to notice me during the birth and then I did the postpartum visit he was like "uhh here." He was such a dude, such a bro. Inside the envelope was $1000 cash and a note and it just said "I didn't know".
L: And I was like what? Like literally, I almost fell over. First with the money, I could not believe he gave me a 100 percent tip. I'd had tips that were like $200-300 before, but not like a thousand dollars. I was like "Oh right, people really don't know." They really, really, really don't know.
A: Yeah and it's hard because birth is this...as a topic itself, people don't know what it means until they've experienced it, right? That's why, honestly, second, third, fourth-time parents that hire us-it's not even a conversation about what they need and whether or not the doula will support them in the way they need it. It's more like "How can we hire you now? (laughs) The things you can provide to make things easier"... because they've been through that fire. They've become the parent, they've been through the labor and birth and they can see clearly with hindsight at their fingertips what they want to be different. But first time parents- the birth itself is just so magnificent that it's hard to imagine what that is going to entail in total, let alone what it would be like with the doula versus not with a doula. So that's, I guess, part of that convincing that I'm talking about. This idea that like people don't know, so then you have to say... you almost have to sell the concept of doula support and then follow through and provide it and then hope that on the other side they actually see it in the way we see it. It's so much, it's so much.
L: Yeah, I know. Ok well I think we've been talking for a long time.
A: We have (laughs).