Should Doulas Offer Free Services Is The Wrong Question

Aug 26, 2013 by

It seems every doula with a blog has weighed in on the “no free births” debate and every doula with an opinion has expressed it on Facebook.  The debate usually goes something like this:

“If you don’t charge, you demean my services.  You make doula work appear unprofessional or not worth paying for.  By giving away your services, people are less likely to pay me for mine.  They won’t value what we do.  And since our customers usually employ us only once or twice in their lifetime, they will tell other people a free doula is as good as an expensive one.  Third party payers will continue to refuse to reimburse us because they’ll say a consumer could get the same services for free or a professional is not required.”

Beneath this argument is a current of fear.  We want our profession to be recognized as legitimate.  As birth doulas, our actions are often invisible.  They are only missed when we aren’t there.  Our fear is if those we are welcoming into our professional ranks undermine our work – even if it is out of ignorance – how can we ever rise into a position of recognition and be seen as having a unique and valuable contribution to maternity care?  Will we ever be able to earn a living wage to support our families?

We have no control over how other doulas set their fees or how they feel the calling of doula support fits into their lives.  However we do have control over ourselves.  When we examine the root of our fear, we can take action to address those issues in other ways.  We need to establish the value of our own experience and contributions.  Some doula businesses have already done this with tiered pricing based on experience and credentials.  With each successive tier, more skills are added to the list.  Parents and payers can easily see what they are paying for.  Individual doulas have added a section on their own web site:  “What I know now after 20, 40, 100 births” or “What makes my services special”.

Instead of putting our efforts into controlling the newbies – and there are thousands of them every year – those of us who have survived past the first ten births need to make a LOUD statement about what we bring to the labor room.  There are fewer of us and we’re busier and more tired, but we have lasted.  We need to value ourselves first. 

My goal with this blog is to give you tools to do just that.  You need to go forth in your own community and state loudly and clearly, “I have something to offer that benefits everyone in the labor room.  It requires training, experience, and very few people can actually be an effective birth doula.”  We must support one another in this stage of our profession’s growth by actively promoting our value to families and to care providers.  Yup.  If you’re doing it right, you make a positive difference for nurses, midwives and physicians too.

It is up to us to use research and other evidence to create change.  After 27 years in this business, I have seen it grow incredibly.  For the first ten years, I didn’t even use the word “doula” to describe what I did.  This argument about “no free births!” is a part of our growing pains.  But we have to recognize it for what it is – a response to our fear.  Once we can name what we are really scared of, we can act to change those circumstances where we do have control.  I am eager to see what we will do next.


  1. Tami Sutton

    What should low income mothers do if they want a doula?

    • Amy Gilliland

      I know you’ve asked this question on a couple of other doula blogs today, Tami! 1. Find out if there is a program available in your community that matches low income mothers with doulas. 2. If not, figure out what you could afford to pay or barter for doula services. This might be obvious if you already have a small business, but if you don’t I have accepted weeding and gardening; child care when I was at another birth; and had a new fence made for my yard (labor was bartered). Another doula friend got her children’s first years scrapbooked – a project she dreaded, but her client loved to do. You will want to supply the barter BEFORE the birth. Not all doulas participate in a barter economy, like you, they need dollars to pay bills. But some will, especially if you have a respect for their work and role when you begin the conversation. 3. Contact a doula trainer in your area and ask her if she knows any new doulas who might accept a lower fee for the experience. I’d say about half of my doulas are ones I would recommend without a problem, and they are eager to learn. Yes, you won’t be getting the most experienced doula, but if there is an experienced one who can be called just in case, you’ll be okay. 4. Don’t accept less than a good match – someone you can trust and who makes you feel safe in your gut – simply because the doula is less expensive. Don’t compromise your birth for your care provider, or for your doula either. 5. You may wish to accept an alternating arrangement between two doulas who don’t yet have established businesses – you’ll get whoever is available when your labor starts, and they may need to ‘tag team’ if one of them has to go to their day job. This can enable them to keep their main moneymaking job and go to births when they are able to. Because of the uncertainty, they may charge less. Once again, the trainer in the area may know some past workshop participants who work this way or newer doulas who are just getting started. 6. Figure out what you can afford to pay – I said this in #2, but think about it honestly. I feel so much better when someone says, “We looked at our finances and the baby gifts we’ll be getting, and what we can set aside is $150. That’s a number we’re really comfortable with. Do you know a doula who would be willing to work within our budget or accept some barter on top of that?” If I know they’ve already considered their options, I’m wanting to help them even more. I hope this helps you Tami!!
      Also, you can find doula trainers by looking at their organization web sites. ICEA, DONA, CAPPA and BAI all have the trainer’s names and location of their workshops on their web sites. If there is an ICAN group or doula organization in your area, they may also be able to help you locate a doula.
      I hope this helps!

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