Childbirth Companion

By: Stephanie Hayes, CD(DONA), Childbirth Educator

I have been musing for some time on how to present the value of a doula to a society that enjoys many benefits of a free health care system. While much of the dilemma relates to misconceptions of a doula’s role and the lack of awareness of the proven benefits of continuous labour support, paying out of one’s own pocket for care not covered by government programs is a huge drawback to many parents. Over the years, we have seen cutbacks to many areas of health care. Still, a number of these additional costs are often covered through third party insurance which helps to relieve some pocketbooks.

Many professionals are feeling underpaid and undervalued and endeavouring to gain public support for their needs. Some are age-old professions feeling the stress of the economy. Others are a mix of old and new alternative health care options struggling to obtain equality and acceptance among society and their peers. Doula care, while a relatively new profession, provides an age-old service to the maternity world. Still, we are not government-funded and rarely covered by third party insurance. DONA International (www.dona.org) has been successful in implementing third party coverage of doulas in the United States. While this is still rare within Canada, doula clients are encouraged to approach their own insurance companies regarding coverage of doula care and childbirth education.

Studies have shown that the continuous care provided by a doula to a labouring woman reduces the need for many costly procedures and interventions which, in turn, could aid in reducing health care costs significantly. Yet we remain a highly overlooked profession on the obstetrical scene. The option and benefits of a doula are not readily passed between medical care providers and pregnant women. As a result, many remain unaware of this availability to them. Those who do learn of doulas often find the cost factor a drawback. It is not that doulas are actually expensive. Rather that there is a lack of understanding of what they actually do and how much time and energy they invest into each client. That understanding tends to come with the experience. When parents go through hours of labour with their doula (not to mention the hours of prenatal preparation, postpartum care, and breastfeeding support, plus phone and email conversations and traveling), they come away with different perspective on the dollar-value of a doula.

Most doulas have chosen this profession because they have a passion for assisting women in having the best birth experience possible. I, personally, chose this line of work because of the lack I felt in my own births for continuous emotional support, physical comfort, and information. Two of my five babies did not survive pregnancy, and two were born prematurely due to complications. My middle pregnancy and birth remained uncomplicated and relatively intervention-free. Out of these experiences was born the desire to assist other women as they embark on their own journey to motherhood, to help them achieve a positive experience regardless of the type of birth they may have. I see this as an opportunity God has given me to minister other women and their families.

So, what does a doula actually offer that sets her role apart from other birth professionals? Perhaps I should clarify that a doula is not a clinical care provider. While she possesses knowledge and education regarding the process of birth, medical pain management, and many other procedures and interventions common to modern birth, medical practice is not a part of the care that she provides. Instead her focus is on assisting women to discover and obtain information that can aid them in making informed choices during pregnancy and birth. She meets with them, often in the comfort of their own home, to help them prepare for childbirth. She is a constant presence for them throughout labour, a familiar face that doesn’t change with shifts and call schedules, and an advocate for their wishes. During this time she continues to provide reassurance, encouragement, and physical comfort through numerous natural techniques. She offers breastfeeding education and assistance, and follows up with visits after the baby’s birth. In the hours that a doula spends with parents over the weeks and months of pregnancy, a connection is made that provides comfort and reassurance to them when labour begins.

Doulas realize that there are many different factors that come into play when connecting with women in need of labour support. There are those who, while realizing how valuable doula care is to them, truly cannot find it financially feasible. Others may have special needs or circumstances which are not easily served by just any doula. It is important for a woman to be matched to a doula with whom she feels comfortable and well-suited. Regardless of the situation, a doula endeavours to ensure that every woman who wants a doula can have one. This is often challenging, but it is why many doulas volunteer or offer another financial solution.

Doula fees are as varied as the doulas themselves and the areas that they serve. Rural Canadian doulas are near the bottom of the scale compared to their urban or American counterparts. While a new city doula may start out by charging $500, even experienced doulas in the Muskoka region, where I currently live, rarely exceed that for a complete birth package. At this rate, if I devote 30 hours to a client for her birth, prenatal & postpartum visits, phone/email communication, and office work (research, writing the birth story, etc), then after traveling, and other expenses, I may be lucky to clear the minimum wage. This is being generous. Doulas usually begin care early in labour and can often spend more than 15 hours at her client’s birth. Some may offer more prenatal or postpartum care. Others must pay for childcare for their own young families while they are attending a birth. Regardless of the diversity, doulas are committed to caring for their clients and often go to great lengths to ensure that they receive the support that every woman deserves during birth.

If you would like another perspective on the value of a doula, I’d encourage you to read this blog from one of our American counterparts. (http://www.bigbellyservices.com/doula%20fees%20detail.htm) I found her perspective quite insightful. Hiring a doula could be one of the best investments you make. The more clients who are able and willing to pay a realistic fee are also giving back to their community by enabling her to provide care to those who are less privileged. As Dr. John Kennell said, “If a doula were a drug, it would unethical not to use it.” Let’s change the face of maternity care. Value the doula!