When living in Chico, California, and starting as a doula, I did not enter this work with a professionally-created business plan clutched in-hand – I walked in with my heart open and extended, ready to help families. The focus on business in the doula world has been huge in the last few years, and I absolutely see the value in that. When I started as a doula, there simply were not resources past the doula trainings we took. I did as many others did – made things up as I went along. With freedom and (eventually) experience, I made changes as needed to better fit how I wanted to do business. I have known all along that I do things differently than many other doulas, and I am perfectly content in that. In order for me to stay sane, happy, and sustainable as a doula, my business beliefs and practices have to match me. Take, for example, payment.
It is the norm for doulas to be paid-in-full before a baby is born – often by 36 weeks. The agreement generally is, if you have not paid your doula before your birth, she does not consider herself on call for you. I deviated from this years ago after seeing an uncomfortable situation with a doula friend and her client.
Anne was called to labor with a client at home. The client had not yet paid the second half of Anne’s fee, but Anne made the choice to attend her client. After a night spent working through contractions, labor stopped. Anne left to wait for her client to share when labor began again. But Anne’s client never called, and soon Anne learned the baby had been born. Expecting to be paid, Anne contacted her client to make arrangements. The client, though, expected that since she didn’t have direct doula support for the birth, nothing was owed. For weeks and months I saw this play out, and I felt bad for Anne. The amount of time and energy she put into trying to collect payment was painful to watch. I understood Anne’s side of things, and yet I could imagine a situation where her client felt good about birthing without a doula.
Anne never was paid.
I have since moved from Chico to serve the areas of Visalia and Bakersfield, yet my belief hasn’t changed: my true heart of this birth business lies in wanting families to have what is right for them – even if that means they change their minds about me. I cannot stress this enough! Thoughts come to me: what if a family finds that fee-remainder would be more important to them than doula support? What if I miss a birth? What if they are laboring confidently and a doula’s presence doesn’t fit the flow of their birth? What if a planned cesarean birth is needed and they feel well-enough supported? I wanted my clients to have an “out,” to be free not to call me, without worry of penalty.
My contract expectations are as follows:
There it is – all in place should a family find it useful.
This structure is worrisome to many doulas I have shared it with. What about being on-call and then suddenly having your time wasted by not attending the birth? Unless I block my calendar out for specific dates (and as my husband is a teacher, I block out some time in the summer), I am on-call a lot. When weighing this as an option for families (against my inconvenience), I want families to win.
Ultimately this has been more of a non-issue: I am getting close to 200 births as a solo doula, and I changed my contract to reflect this option around birth 30; in all of that time, I have never had a family NOT call me, and I have never had a family NOT pay me. So why keep it in my contract at all, if it isn’t going to be used? Because I believe birth is a time when your choices shape your outcome – and who is on your birth team should always be one of your choices.
I have a son who was born with an aortic stenosis. This means his aortic valve is narrower than it should be. He just turned 14 and up until his cardiology appointment last month, there has never been an issue.
Before we found ourselves back in the office, we had been rescheduled twice, so I was already feeling on-edge. Walking into the waiting room, there was not one place to sit. This added to my feelings of annoyance. When we finally met with the doctor, I was relieved, until after placing the transducer on my son’s chest his first question was, “Have you had a growth spurt recently?” Not what you want to hear when your child has a heart defect.
The most recent reason we had been rescheduled was our doctor had a spider bite on his leg that needed treatment. I rolled my eyes when the receptionist shared this with us (good thing it was over the phone). I thought it sounded like an interesting excuse – who has to go to the hospital for a spider bite? But another part of me wondered: Why is she telling me this? Is that my business?
At this bad-news-appointment, we were told medication would be needed to lower my son’s blood pressure – not because it was high, but because the rate of flow through the narrowing could cause damage to the area where the blood comes through, like spraying a pressure washer constantly at one spot on your house. We were also asked if we had other children, and if they had ever been assessed by a cardiologist? We have 4 sons total, and no one has ever told us this before – that was jarring. The doctor was adamant my husband and I be checked, as well. Our heart-son’s health is monitored fiercely because there is a known issue – but if this were genetic, any of us could have an issue and not know. That was frightening.
We were the last appointment of the day and the office was shutting down. As the doctor was performing the echocardiogram, he kept sharing details of his spider bite, occasionally shaking his leg or letting out a sigh or “ouch” here and there – it was obvious he was not feeling well. He also said he couldn’t wait to get out of there that day and change the dressing.
So here’s us: bombarded with overwhelming information.
And here’s our doctor: trying to help us while being distracted with his own issue.
I left that day feeling sad, scared, and unsure about all his recommendations. Knowing we didn’t have his full attention added to my stress and confusion. I questioned our relationship with this professional, and again to my mind came: Why is his issue my business?
So how does this relate to doula work? Let me share another story.
A number of years back I had a couple I loved, and I think they loved me. We were so excited to work together. A week before they were due, my grandma passed away and the funeral was in another state. Of course I was going to attend – in the grand scheme of things, my grandma’s funeral is going to be more important to my health and memories than the birth of a client’s baby. So I let my client know my plans.
It was an emotional phone call, because she was one of the first people I told. I did cry when I let her know I was going out of town, and of course I would provide a back-up for her. I felt good about everything. I was gone for 5 days, and just as we hit the California state line again, I knew I would be home by nightfall and things would return to normal! I could still be there for her birth.
I was unprepared for the phone call I got within an hour of that feeling. It was my client. She said she didn’t want there to be any bad feelings at the birth, and they had decided to proceed without a doula. I felt confused because I knew I didn’t have any bad feelings – had I been clueless to their feelings?
The next day we talked it out more. I felt I had made it back and things would proceed as planned. But what I didn’t realize was, my business had become her emotional baggage, as she worried about my loss and whether I would be back in time for her birth.
At the time I remember thinking, “No one cares about me.” Meaning, clients don’t offer the same emotional support and empathy that doulas do. Our lives don’t get the same priority as the pregnant families we serve. It was an acutely painful realization made worse by the loss of my grandmother and exhausted nature of the trip.
Of course, I was wrong. That’s how it should be when I am being contracted to provide a service. And once I was mature enough to realize it, I decided I wanted my clients to feel like I don’t have a life. Never again would I burden a client with my personal business. I want them to realize, when it comes to their expectations of me, there is nothing more important (even at the most inconvenient times), than their call of: “we need you.”
I have heard from many women over the years, words and situations that haunt them, where a professional’s business was made the mom’s business (which is really bad for business).
-A mom was waiting for her midwife to come for a postpartum home visit. The midwife told the mom she couldn’t find childcare for her little boy, so she would need to reschedule. The mom experienced a pretty traumatic birth, and she was eager for this visit and the need for someone to look over her baby again. She was so worried she took her baby to the ER just to have someone tell her the baby was safe and healthy (which she was).
-A mom who wanted a TOLAC (trial of labor after cesarean) ended up with a repeat cesarean birth. It was very emotional, everything leading up to this and ultimately, having an unexpected surgical birth with an unexpected provider. Toward the end of the birth, the doctor said, “Can someone take over for me? I have to get to my granddaughter’s piano recital.”
-A mom who experienced terrible postpartum anxiety and depression who was desperate for support. She sought out a therapist recommended to her by a friend. Once there, sharing her story in an uneasy fashion, with tears, and memories, and guilt, the therapist let this be an opening to share her own struggles with depression after her brother’s suicide. Suddenly "a little postpartum depression" felt minimal compared to this professional’s loss.
We pay professionals for a service. They should be taking care of us. When the tables turn and we are suddenly made aware of their personal lives, it can stir up feelings of empathy and sympathy. It can make us feel like we should be the caretakers now – we need to look out for this person and not bother them with our trivial matters. “I don’t want to load too much on her, because she has struggles of her own.”
But then, what are you paying that person for again?
Professionals need to leave their personal business out of their professional lives.
That’s not to say clients are rude or uncaring – they aren’t. And the focus still needs to be on them. What can we do when something comes up?
As a doula serving Bakersfield and Visalia, California, I strive to build families up and let them know I will be there for them, come hell or high water. I also contract personally with a back-up doula who attends prenatals with us, thus laying a foundation of support in the small chance I am unable to attend a birth (it rarely, rarely happens, and the cost of paying for a back-up’s time is absolutely worth my peace of mind). It shows a family: I am committed to you, and sometimes things come up; if that happens, here is my trusted back-up so you won’t be alone in this journey.
Ultimately, I believe me making my business your business is bad, overall, for business!
♥ four young boys and a boy dog (offspring)