Publish 2013 -Birth outcomes of two groups of socially disadvantaged mothers at risk for adverse birth outcomes, one receiving prebirth assistance from a Certified Doula and the other representing a sample of birthing mothers who elected to not work with a Doula, were compared. All of the mothers were participants in a prenatal health and childbirth education program. Expectant mothers matched with a Doula had better birth outcomes. Doula-assisted mothers were four times less likely to have a low birth weight (LBW) baby, two times less likely to experience a birth complication involving themselves or their baby, and significantly more likely to initiate breastfeeding. Communication with and encouragement from a Doula throughout the pregnancy may have increased the mother’s self-efficacy regarding her ability to impact her own pregnancy outcomes. (read more here)
On the surface, the Doula’s fee may seem like a lot to charge for one long day of work. But, in reality, an eight-hour labor would be considered pretty fast, and the longest continuous time we’ve spent providing labor support is over 48 hours. The average actual time spent with a woman for her labor and birth is about 16 hours-24 hours. This does not include prenatals, phone calls, texts and emails as well as the postpartum visit. Of course there are other expenses that go into the fees of Birth Doulas such as our travel time to meetings and births, which are on the average of 45 minutes to an hour and the logistics of hiring a Birth Doula in NYC require that taxis are used most of the time to alleviate parking problems as well as necessitate speed.
Considering the number of hours per client and level of commitment involved, taking two to four clients due per month is a full-time workload for most birth Doulas. Otherwise, how can we be sure to be available for your birth, even with our dedicated back-ups? When our Doulas commit to attending your birth, she must limit the number of other clients she takes on during your “birth month”, the two weeks before and after your “due date”, to avoid needing to be in two places at once.
Being a Doula also means having no set schedule. So, we can’t know if we pay for a class or training if we'll be able to take it. Having another “normal” job where we have to be there for a set schedule is not possible.
When your contract is signed & your due date is added to our calendar, we commit to being “on call” for the two weeks before and two weeks after your estimated due date. If your birth should occur before or after your 38-42 weeks when you are considered term, we make every effort to be there. A full calendar is 32 to 40 clients per year; in reality, there are some weeks where we have to turn clients away and then there are other weeks where we have no births on the calendar.
Whenever we schedule anything from a meeting or doctor’s appointment to a vacation or a day trip, the commitments we make to our clients and on call schedule is taken into consideration. If we schedule a vacation, we need to add two weeks on either side during which we cannot accept clients. Whenever we are on call we need to be ready to leave at a moments notice. We also guarantee arrangements with a backup Doula in case we get sick, or if we have an emergency or are attending another birth. We pay that Doula ourselves, so a portion of each fee must be set aside until after the birth when we can be sure that it won’t be needed.
Doulas are self-employed and we don’t get paid sick days, medical insurance, paid vacation or days off. A Doula, just like any other business person, has business expenses. We have professional association fees required for Certification as well as required yearly continuing education costs. And of course we have regular business expenses for our offices and other carrying fees. Because we must be reachable 24/7 our transportation and communication expenses such as cell phones and email are higher than average.
Being On Call
We never know what might happen after we receive “the-call”. Not a day goes by that we do not take our on-call schedule into consideration when scheduling appointments & making plans. We spend many major holidays either working with or on the phone with a client in labor. We cannot take weekend trips away from the area, and even day trips have to be planned around traffic conditions.
Being “on call” means every day we need to be ready to go, every night we may get “the call” and spend the next 24 to 48 hours at a birth. We may not have gotten to sleep – but we are still ready to go.
We offer more opportunities for you to have your lead Doula at your birth than most of the chosen medical practitioners. We have a better than 99% rate of birth attendance with the lead Doula of your choice. We pride ourselves as a Doula Service that is quick to answer your phone calls, texts and emails. Does your medical practitioner offer these statistical rates?
Why Do We Do This Work?
We do it for the same reason as most Doulas – We love it. It is our passion. The moment of birth is a blessing and transformation. It is an honor to be a trusted to share this sacred experience. It is a joy to offer support to the new mother and her new family.
Understanding Our Fee Structure
The annual income of a birth Doula is the number of clients per year times 1/2 of her fee per birth. To calculate how much Doulas should be paid you should take what you consider would be a reasonable salary in your area based on the cost of living there, then subtract 25% to get what the “take-home” income would be for an employee, then double that to see what your Doula needs to gross to get the same “take-home” income, then divide that # by 36 (the # of births she can attend in a year), the resulting # is what the Doula should be paid per birth.
Therefore, in order for your Doula to make the equivalent of a $40,000 per year salary,(well under the standard cost of living in NYC) a Doula needs to make $1,666.66~ per birth. Of course a reasonably salary in NYC where the average cost of living includes the median rent of $2500-$3000 per month, you can see how this would affect the cost of an experienced Doula.
Because we charge a one-time global fee that is all inclusive (prenatal, postnatal, phone calls, emails/texts, labor, travel, back-up fees and not including taxes and mandatory health insurance costs due to the new law) the reality of our fees is that with factoring in on call hours (24/7) from week 38-42 our hourly fee comes down to $3.25-$4.26.
At NYC Doula Service, we have always worked hard to maintain affordable rates to all our clients since we opened our doors. Currently our Doula fees range from $1750-$2300.
NYC Doula Service truly offers experienced Doulas at affordable rates. Contact us to book your experienced Doula today. 917-617-7905.
This video is about the advertising industry. You get the idea. ;)
Hodnett, Lowe, Hannah, et al, studied the capacity of nurses to achieve similar decreases in cesarean rates when trained by a professional Doula and given one-on-one care with laboring and birthing women. 6,915 women participated in a randomized controlled trial during a two-year period from 1999 to 2001. Women were randomly assigned to receive usual care or continuous labor support by a specially trained nurse. The primary outcome measured was cesarean birth rate. Other outcomes included intrapartum events and maternal/neonatal morbidity both immediately postpartum and in the first six to eight postpartum weeks. There were no significant differences between the two groups in the measured outcomes including cesarean birth rate. The mothers with continuous labor support did state a preference for that care in the future. These researchers concluded that in hospitals characterized by high rates of routine interventions, continuous labor support by nurses did not achieve the same outcomes as seen in research of continuous labor support by Doulas.
In 2014 The University of Minnesota concluded that Doula support is both financially and medically beneficial!
The research was conducted at the School of Public Health at the University of Minnesota.
“Our findings showed Doula support during labor and birth, not the desire for Doula support, is associated with 80 percent lower odds of non-indicated cesarean in comparison to non-supported births.”
“In previous studies, it is unclear if good outcomes happen because of Doula support or rather the particular types of women wanting Doulas and having a preference for ‘natural’ childbirth. The survey we used asked women if they wanted Doula support but didn’t have it, so we were able to account for this,” said Katy Kozhimannil, Ph.D., M.P.A., lead author and assistant professor in the School of Public Health."
This study showed that the difference in cost between a vaginal birth vs a cesarean section is $10,000. Therefore they concluded that: “Even setting aside other crucially important emotional, psychosocial, and longer-term benefits of Doula-supported care, the financial rationale is compelling.”
In July of 2013 Cochrane reported the following:
"Continuous support in labour increased the chance of a spontaneous vaginal birth, had no harm, and women were more satisfied."
The review of studies included 23 trials (22 providing data), from 16 countries, involving more than 15,000 women in a wide range of settings and circumstances. Continuous support from a person who is present solely to provide support, is not a member of the woman's social network, is experienced in providing labour support, and has at least a modest amount of training, appears to be most beneficial. In comparison with having no companion during labour, support from a chosen family member or friend appears to increase women's satisfaction with their childbearing experience.
The only explanations we have been able to come up with when discussing this topic among ourselves is that lack of experience across the board leads a newer Doula to set a fee that does not cover her own expenses. Many of those lower fee Doulas realize after one or two births the cost reality when they cannot pay their own rent. When deciding on the right Doula for you, it is important to take into consideration how the fee the Doula charges will affect her ability to support herself because this WILL affect how she supports you. If she is worried about how she will be paying her bills and back up, she cannot be fully focused on you. If she did not factor this in, what else did she not think about? Experienced Doulas fees ensure that we are providing the service you desire and deserve.
Do you really want to cut corners on something as important as the birth of your child?
Most people put huge amounts of money away to pay for wedding hall receptions and photographers for their weddings and we suggest that you do the same for your pregnancy by saving for the services of a Labor Doula the moment you learn you are pregnant or even before. This way you will never feel that you cannot afford an experienced Doula to help you through your pregnancy and labor and delivery. $100/week saved for 23 weeks covers the cost of our most experienced Doula.
"I have a decade of stories I could tell, but haven’t, because if I do, I know I will lose my job. Have you ever had a patient come in after having had her membranes swept, but not knowing that the doctor was going to do it? Have you ever told a normal laboring woman that she can’t eat anything, or get out of bed, or go to the bathroom? Have you ever witnessed a person in hard labor sign her birth consents in the middle of her transition contractions? Have you ever done a vaginal exam on a woman who looks like she doesn’t want one? Have you ever handed the physician the Amni-hook to break a woman’s water, without explaining all the risks nor asking her consent? Have you ever left a woman on a monitor indefinitely because it was just easier for you?"
"Have you ever watched the physician grab the scissors and cut while the mother was pushing so she wouldn’t notice? Have you ever heard a nurse tell a woman to be quiet- to stop yelling? Have you ever attended a cesarean where a mother is anxious and yells out that she can feel it, and you see everyone in the room roll their eyes in disbelief? Have you ever started an induction on someone who has absolutely no idea why they are being induced? Have you ever sat around the nurses’ station and made fun of a birth plan? Have you ever stamped a cesarean chart for a patient just because she had a birth plan? Have you stood and watched the physician who reaches into the uterus of all his unmedicated mothers after they give birth, just to make sure there was no placenta left behind? Have you ever heard parents being told that they technically can refuse any treatment- but do they really want their baby to die? Have you known a physician who diagnosed failure to progress, when really, we all know it was because they had to get ready for their Super Bowl party? Have you ever strapped a woman’s arms down to restrain her from moving in cesarean?" (read full article)
DONA Certified Professional Doula since 2007
Doulas are trained non-medical support. Quite a few studies have been conducted over the years to determine the efficacy of Doula support. Cochrane Report is a global independent network of researchers, professionals, patients, carers, and people interested in health.
Cochrane has 37,000 contributors from more than 130 countries working together to produce credible, accessible health information that is free from commercial sponsorship and other conflicts of interest. Many of their contributors are world leaders in their fields - medicine, health policy, research methodology, or consumer advocacy - and our groups are situated in some of the world's most respected academic and medical institutions.
Their work is recognized as representing an international gold standard for high quality, trusted information.