In the Western world, where the doula profession is gaining more ground, it is common to hear of doulas practicing for free, or nearly so, for expectant parents who cannot (or in some cases will not) budget the cost of hiring them at their full fees. It is encouraged often in online forums “Find a doula who is seeking certification, she’ll do it for free!” And, “Every woman deserves a doula, which is why I offer a sliding scale for low-income parents.” While it is certainly noble to volunteer one’s time, I do not believe free labour support is the answer to the problems our birth culture is facing.
The problem arises when doulas, who under most circumstances are self-employed, offers her services at a rate that is significantly discounted free, she is either able to afford the time and loss of income, thus making her independently wealthy, perhaps, and often known as a ‘hobby doula,’ a woman serving a community apart from her own. Or, she is giving her time and effort at the expense of her health, sanity, or her family’s income. This indeed is a noble act, but it cannot be sustained, and will lead to burnout, and an otherwise passionate and knowledgeable asset to the birth community being taken out of commission or losing her desire to continue this type of work. Furthermore, it has been shown in many anecdotes that expectant parents do not take free or student or discount doula as seriously as they do a full price doula, leading to contract disputes, missed calls for labour, parents doubting or ignoring the doula’s suggestions to their own detriment, and many other instances that lead to disappointment and frustration on all sides.
Doulas worldwide have begun to realize that despite having a passion and loving what we do, we still deserve and must be paid for our work, no matter how sacred or direly needed we are.
In my own case, the birth culture of Macau is a challenging scene for a doula. What I am counting on now is the demands of the expats to help change the culture. The English speakers are my target clients, as I do not yet speak Cantonese or Mandarin or even Portuguese (maybe next year!) The way I see myself making the biggest difference is creating and spreading ideals of what labour and birth can be, so that more women can begin to demand it from the hospitals. Rather than lowering or waiving my fees to make my services accessible to everyone, I will encourage change in the system from the inside out. Once women begin to feel more confident that their birth choices will be respected, they will stop fleeing the country to birth in Hong Kong or suffer in silence in Macau. Rather than saying “every woman deserves a doula” I’m thinking a little broader in my perspective with the idea that every birthing woman deserves options. I owe it to the women of Macau–those who cannot afford my fees, or whom I cannot serve because of a language barrier–to stay the course and see things change. I need to operate in such a way that will not only be sustainable to me, but to set the stage for any future doulas who choose to take up this work, but may not be able to take time away from their day jobs without sacrificing income. The pay needs to be able to draw new doulas to the profession. To quote the best comment I’ve seen so far on the subject:
If we keep insisting that the way to serve underserved populations is free and discount services, we close the door on people that are actually from that population being able to practice with their peers. We make it so that the only doulas are middle class women looking to save the poor as a hobby.
September Phillips–notjustnine.com
So how do we serve the underserved? To put it simply, educate, rally the community and address the people in power. In many communities this looks like a publicly funded or non-profit organization that provides working wages to doulas and free or nearly free services to qualified applicants. More on these topics in my next blog post.
macaubirthdoula.wordpress.com 