​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:

• non-refundable deposit due at contract-signing (half of total fee)
• remainder due at postpartum visit (other half of total fee; yes, due after the birth)
• if I am not at the birth (they fail to call me, precipitous labor, illness, etc.), no additional money is due, we are square with the deposit to cover our prenatal time together
• if after a missed birth they wish me to come to the hospital (precipitous situation), the fee remainder goes down by 1/2; again, due at our postpartum visit

 
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. 

Doula work is hard! Let's just get that out of the way! Planning life, working another job or going to school, taking care of family needs -- and knowing at any minute you could be called away to a birth -- that's stress!  Burn-out rates can be high for doulas, and if it doesn't send you away from the work permanently, it can leave you reeling in chaos and discontent while you try and regain your doula spirit. Find hope in these 13 ideas to keep yourself grounded and satisfied.

1. Be picky about what clients you accept. It is normal, in the beginning, to take every client that seeks out your services without thought to how you might work together. This can be draining, though. You have ideals, and while we know the mantra, "it's not my birth," it would be unrealistic to say you need nothing out of the experience simply because you are the hired help. If, for example, you feel useless sitting by your client while she gets an epidural at 2 centimeters, then it is okay to ask yourself: What would my ideal client look like? As doulas, it is rewarding for us to work alongside the client. That doesn't mean we stand in condemnation of the mother who wants an epidural as fast as she can get one, that simply means, be true to yourself and honor your feelings. During your interview, ask how she envisions her birth. If that is the information she shares ("I want an epidural as fast as I can get one"), there may be a doula that fits her better than you fit her. 

2. Find something else that fills your doula cup. I taught childbirth classes for a midwifery practice. I remember sitting across the desk from one of the midwives, having a breakdown, because suddenly my doula life felt like it was crushing me. I am grateful for her words: "If you keep going when you feel like this, you may lose your love for doula work -- it can be hard to come back from a burn-out. See if there is another way you can get those feelings -- like teaching -- and then come back to doula work when your heart feels ready." In the midst of this career crisis, I felt like a failure for wanting to just walk away. This was my passion! This is what I worked so hard for, and yet, I was ready to trash the whole thing in a time of severe stress. I am grateful for the wisdom of a sister birth worker and her words of love that day. There is no shame in stepping away for a while and rebuilding your faith and restoring your energy, so you can serve better in the future. 

3. Take on a partner. I remember exactly when my first burn-out occurred. I was at an especially long and difficult birth. I stepped out of the room in a moment of calm and called my very good friend, who is also a doula. "I hate this!" I cried. "I would leave right now, give them all their money back, if I never had to see them again!" I had been piling on more and more and more. I probably took this birth sooner after the birth of my own baby than I should have. The mother was not responding to any of us. The hospital put her on the clock. And nothing was working. I realized if I had a partner, I wouldn't bear the full weight of this -- I could call in support after so many hours awake and apart from my baby. My same friend and I agreed to begin working in a partnership. We didn't change our business names or websites, instead we just created an agreement between the two of us (we didn't know how long we would work like this). When a phone call came for either of us, we would explain we were working in a partnership with another experienced doula. We would attend all prenatals together, and then we generally had agreements about which client we would be on-call for (simply taking turns worked), barring another birth or life event coming up. We split the deposit, and then the doula who attended the birth kept the remainder of the fee (and she also did the postpartum visits). It was amazing! Unlike simply having a back-up, where I often feel I am spending money to keep her around "just in case" I need her (but I really try to never have to call her), with a partner it feels easier to share the births, and the guilt isn't there if I am not able to attend, because the clients know they will have support from one of us. 

4. Offer gratis service to someone. When you are paid for your services, it can be a nice break to find a mama who really could benefit from having a doula. Contact pregnancy crisis centers, womens' shelters, churches, OB/midwifery offices -- someone is bound to know a woman who could use birth support. This is a way to get back to the basics of why we became doulas in the first place -- to mother the mother so she can mother her baby -- and a mama struggling is in need of that scaffolding so she can be at her best for her baby.

5. Raise your fee. The flip of that is, it may be time to raise your own fee. Feeling undervalued can lead to resentment. When I first began working as a doula, I offered clients a sliding scale. This worked well for me, and I found that clients preferred to pay my top fee. Something I noticed: the clients more likely to pay the bottom end of my fee were, in my eyes, the ones who most could afford to -- double-income professionals, in owned-homes with brand-new cars in the garage. The clients who had noticeably less more often paid me from the top end. After two births in a row where I felt I was being taken advantage of, I raised my fee and kept it there -- no more sliding scale. 

6. You're stressed, so destress. In one of his lectures, Tal Ben Shahar shared "stress is not the problem, lack of recovery is." He offers a way to regain ourselves through three different ways of recovering:  micro=15 minutes of every hour, mezzo=good night's sleep, macro=vacation. Realistically this may not seem practical -- we can't often walk away for 15 minutes of every hour while at a birth. But we can find small moments, even if it is just going to the bathroom. Sharar also said, "To create, you need to (re)create." Find your recreation. Do what you can as you not only care for the clients, but also as you care for yourself. 

7. Work with a doula group. My third burn-out resulted in creating a doula group with 5 other women. It took a lot of time to put this together, is wasn't just a random grouping of doulas who decided to work together. We had to hammer out a lot of agreements and policies before we were ready to hang our shingle, but once things came together, this was an amazing way to work as a doula. In addition to sharing call by picking 4-5 days a month on each calendar (which clients were given so they knew who to call), we also held free mini-workshops every other week that were open to the public. Those lasted about 45 minutes, and then we excused our non-clients and paired up as doulas to work with our clients. This was a great way to attract clients, as well as devote specific time to our contracted families. Although I moved away, this doula circle is still up and running. 

8. Let go of someone else's experience. We all walk away from births where we think, "What just happened???" In your prenatals, mom sounded so sure she wanted her birth one way. She seemed confident in her ideals, you felt she had done her homework and had prepared herself to have the birth she talked about. Then at the hospital, it all comes undone! It can be easy as a doula to feel you failed -- you were going to help her achieve her perfect birth, then you watched as she continued to make choices that led her further and further away from that possibility. "I can't want it more than she wants it." I say that to myself a lot. This is her experience, and for whatever reason, it didn't stack up to her before-labor plans. IT IS NOT YOUR FAULT. In order to help the clients understand they have the control, you might phrase your statements with words like, "Choosing (intervention) can lead to (side effect); are you sure that is your decision?" It is not that you are blaming her, you are helping her see she has the liberty of choice. This is assumed, of course, after gentle reminders from you about alternatives, trying 3 more contractions, etc. It is a fine line between helping/advocating, and then staying silent and happily continuing to support her once she has veered from her birth plan. She makes her choices, and you continue to support her efforts. 

9. Say no. Just because you are a doula, that doesn't mean you have to answer every pregnant person's questions. Once in a while doulas get locked into conversations with women who act interested in hiring them -- the doula is hoping for a client, and the woman is hoping for free help. Decide how far you will get entangled in this before you let the woman know you would be happy to meet with her for an hourly fee (you are being her free research assistant!), or as her doula, but her requests are demanding more of your professional time than you are able to give her.

10. Set limits. As doulas we want to make ourselves available to our clients. While the average client may not need an excessive (or annoying!) amount of care, once in a while we encounter a client who is always in need of some advice, information, or help processing things. It's okay to set guidelines on when you are available and on what topics. I have a friend who is a breastfeeding counselor, and she let's families know they can call her "during daytime hours," meaning, when the sun is up. Communicate to your clients how best to contact you and regarding what topics, with the exception of when labor may be beginning. 

11. Refer, refer, refer. It is too easy to get pulled into wanting to be EVERYTHING for a family. We are only as capable as our professional skills and training deem us. For issues out of your scope as a doula, if you have no additional trainings or certifications, a client's issues are best supported by the professional made for the job. For breastfeeding problems, know your IBCLCs and LLL groups. If she is having mood disorder issues during or after pregnancy, find out who helps mamas in those situations. Who are the postpartum doulas in case she needs after-birth help in that way? As her doula you offer physical, emotional, and informational help related to labor and birth. Brush up on your local resources if she needs more so you can help her get the continued support she needs. 

12. Pay your back-up. When I began teaching childbirth classes twice a week, I knew I could not leave my group if I had a client in labor. This was a huge stress for me, even though it was only 4 hours a week that I was unavailable. I wasn't sure how I could take clients until I realized, with a solid back-up, I would have no worries. She could step into the doula role while I was at class and manage things until I returned. For this peace of mind, I would pay her half the deposit, and she would attend one prenatal with us, as well as be on-call for me. 

13. Find your support community. Doulas support families, but who supports doulas? Although like anything, a real-life group of fellow birth workers is ideal, that isn't always practical, so online groups are also an option. There is something that runs through our veins and our hearts, and it bonds us. There are some things it seems only other doulas can understand. Gathering together with others when you are feeling disappointed is a way to be buoyed up, and we all take our turns being the one lifted, as well as being the one doing the lifting. Turn to you doula sisters when your heart hurts and your mind is telling you you aren't making a difference.