Sunday, April 02, 2006

My sliding scale

Last weekend a doula sister asked to get together on short notice. She was feeling a little stressed and unsure about whether she had established appropriate boundaries for her services, especially in the postpartum time.

Doulas have boundary challenges. The work we do is intimate and emotional. Clients sometimes become friends. Friends sometimes become clients. Births turn complicated. Our personal passion for birth becomes intertwined with making a living.

Since many of us work in complete or partial isolation, it is very difficult to know if one's own services approximate a norm. There are standards of practice, which DONA and other certifying organizations have. Those are helpful in certain instances. But when it comes to issues like what to charge clients, whether to count babysitting as postpartum care or a service meriting separate pay and at what point to call in a backup doula on long labors, there are no definite answers. I know there are e-mail groups and chat rooms for these things. But please feel free to post here if you have comments thoughts.

In the interest of openness, I thought I would share my fee scale. Doula fees vary a lot across the country, being highest on the coasts and in wealthy communities. Ann Arbor, where I practice, is a wealthy community. Yet like all wealthy communities, there are also unwealthy women here. My fee scale attempts to make services available to everyone at a level they can afford. It's not perfect, but I feel better about it than the flat $550 fee I used to charge.

I use a sliding scale based on household income. I don't ask for any documentation, but let women tell me where they fall.

<$35,000: no fee, just coverage of my babysitting expenses, if applicable, up to $50
$35,000-$50,000: $350
$50,000-$65,000: $550
$65,000-$85,000: $750
over $85,000: $950

I have only had a few clients in the $350 range and none at the extreme high and low range. Most are at the $550 or $750 level.

This includes a minimum of two prenatal and two postnatal visits (with an additional visit at no fee if the client or I feel it is necessary) and continuous support during labor, birth and the first couple hours postpartum.

I have heard a few other doulas in the area charge flat fees of $500 or $650, so I think I'm in the right range. On the other hand, I never want cost to prevent a woman who needs a doula from getting one. That, of course, is balanced against the significant investment, not only of my time, but of time away from family, emotional energy, sleep lost (and commensurate decreases in productivity at work and home).


Blogger I am a Milliner's Dream, a woman of many "hats"... said...

I've been thinking about fees, sliding and otherwise, and length of stay postpartum, etc...'ve got me thinking about another post.


2:35 PM  
Anonymous Anonymous said...

Since I'm working on my cert. still, I haven't actually been paid for my sevices yet.... BUT, what I do have is a fee range of $250 to $450, and I allow the client to select from within that what they feel able to pay.

A recent client who is a Mary Kay dealer gave me $250 worth of products she knows I use/would use, since she didn't have the cash available.

I don't use a salary scale, because how much someone makes isn't always an indicator of how much they have available for something extra like a doula.

We'll see how that works out once I start having paying clients....`

3:39 PM  
Blogger I am a Milliner's Dream, a woman of many "hats"... said...

A recent (and previous) client paid me my retainer fee--which I passed in toto to my back up doula for being on call--either to teach my childbirth class or to go to the birth if I was at another birth. I had two previous clients both due and both wanted me...which is nice...but... when they paid me they included they paid $100. above my usual fee--so with the previous $100. retainer fee they "tipped" me $200.



10:08 PM  
Anonymous Ahavah said...

You're so right about boundary issues. I know I really have that problem.

My first clients were all 'volunteer' births, although I do have a Gifting clause in my contract. Gifting is something I picked up from my Reiki Master - it just keeps the cycle of giving and receiving open. I ask that clients who receive volunteer services gift my either giving money to me, the local doula organization or another organization that supports birthing families, or by donating old baby clothes or even their time to like-minded organizations. So far each client has paid me personally, which works out nicely, but I feel other local gifting is just as valid.

I have a flat rate now, because with two kids I can't afford free births anymore. My rate is about the median of the local range. I offer a sliding scale, but I just ask the parents to pay what they are able, preferrably a minimum of $100: $50 on signing and $50 by on-call date.

1:31 AM  
Blogger doulicia said...

very interesting. Thanks for all the thoughts and comments. I know the doula fees vary, but I didn't know how widely.

I like the "gifting" idea. Perhaps I'll try to incorporate that somehow.

2:26 PM  
Blogger Babylove said...

I find this site after signing up for DONA training in my city. I am really excited about the opertunity of being a Doula it will work in nicely with my career as a counselor at a Pregnancy Care Center and Parent Educator.

The post I have read thus far have been really helpful. Being I do have a full time job I am concerned on how to handle clients who need me while I am working. I hope after the training I can network with other doulas to help when I can't be there.

Thanks for the post and hope to read more.

8:52 PM  
Anonymous Bellabirth said...

I happened upon your site while "googling" for sliding scale fees. I happen to be a doula but I didn't even specify that I was a doula, and 'ta-dah' up popped this doula blog! Thanks for sharing your fees! It's really helpful!

4:39 PM  
Blogger Just Another Jenny said...

Hi, I am planning to take part in a tranining this weekend.

I am curious to know, now that time has passed, whether or not your sliding fee schedule is still working for you. Has your price fluctuated during this time? Or -- have you moved away from sliding scale all together? Just curious.

I receive acupuncture treament at a community acupuncture clinic which offers services on a sliding scale. Their business model seems to work very well, so I was thinking that it might be a great idea to try to bring the idea of affordable care over to doula work. I see other have tried it, so I'm just looking for more input.


12:58 PM  

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