Tuesday, August 10, 2010

The Business of Being a Doula

Doula work is so intimate and personal that talk of money can seem distasteful and awkward. We don't do this work for the money, we do it because we love to support women through one of life's most defining experiences. However, being a doula involves heavy investments of time, emotion and money. Most of us working in Seoul have small children, so while we are meeting with women prenatally or supporting them at a birth, we are paying for babysitting for our own children. There are also travel and food expenses associated with doula work. In the beginning, most doulas jump in without consideration to the business aspect. Fees are very low to gain experience. Contracts aren't written or aren't signed until long after the work has begun.

And then...

You get burned.

This was a fiery summer in Seoul doula-land with several of us involved in some disappointing situations. Doula work, like business arrangements involving family, must be very clean and clear in the business aspects to avoid problems like the ones we experienced.

One "client" I asked to commit to us by a certain date because if I took her as a client I would have to rearrange my summer travel. Since she did not live in Seoul, we allowed her to wait until the prenatal to give the contract and deposit. She was supposed to call to tell me the time of her appointment and we would meet before or after, but she never did. I called her but they were leaving the appointment so I prepared some e-mails and we planned to meet the next week. J, my partner for that birth, and I met and discussed this client at length. We mailed materials to her and sent elaborate e-mails and prepped for the prenatal. She was hard to get a hold of and I had started to suspect she didn't want to use us but didn't know how to tell us. The prenatal never happened because she went into labor and did not call us. She said it "happened so fast there was no time" and then proceeded to tell me her 12 hour birth story. I instruct all my clients to call as soon as they "think" the might be in labor so I can make arrangements. I knew she was not telling the truth and that they had decided not to call us or decided to wait and see if they really needed us before calling. I could also tell that she did not think she owed us any money, though in our view she had committed to the deposit at least. I just wanted to get my stuff back which took three trips and was annoying, but I did get back. I just congratulated her and let her get away with it. My doula partner J, gracefully confronted her. It didn't go over well, but not horrible either. It did confirm our suspicions about what was going on with the situation.

I should have had her sign the contract and pay the deposit before I started working for her. She didn't understand the work we put in and the expenses I had. I did send her an e-mail backing up J after she talked to her. The client did not respond.

Another doula had a client cancel her services on the client's due date. The client hadn't officially signed the contract or paid the deposit and did not think that she owed anything. She had verbally committed, though and the doula considered the paperwork to be just a formality. Apparently, the parents had other ideas.

What parents need to understand is that when they hire a doula, the doula makes a big commitment to them. Doulas don't travel as much. They are on-call. If you hire a doula, but do not call her for your birth or cancel her services on your due date, you need to understand that she did not take another client because of her commitment to you. She did not take a vacation because of her commitment to you. You owe her the deposit at least.

There was another situation that was just muddy because expectations were not the same and not made clear. "We'll figure it out later" or "whatever you think I'm worth" is not good business practice. It is not good relationship practice as well because it you are setting yourself up for disappointment.

With the new doula business venture that Rachel and I are starting together, we are trying to keep the business aspect clean and clear. The first interview is just about doulas in general and what a doula can do for a family at a birth. Personalized consultations or recommendations will only be given after the contract is signed and the deposit has been paid. Why? Because they take a lot of time. Because they are part of the services that you are paying for. Because they can make the 1 hour interview meeting turn into a several hour event, an event that we are not getting paid for, but that we are paying for babysitting to attend.

With our clients going forward, we will go over the contract line-by-line at the contract signing and deposit payment so that everyone understands the expectations. I think that most people have good intentions, but when expectations don't match, someone will be disappointed.


Kathleen said...

Any thoughts about having sold and committed to a doula package that included massages at a reduced rate due to them being in a package but not all massages received by birthtime. Doula did two prenatal bisits and any leftover massages could still be used after delivery. Then doila called to naturally infuce labor (9 hours of time) but didnt work with clients wantin to go to bed. They had an induction at hospital schedule day after clients mom was to arrive. Still had doula come to hosoital induction. Doula stayed as requested but with great difficulty massagi around machines, baby monitor and ivs, then when mom wanted epi she sent doula home and the balance due from signed contract has yet to bckntractione paid even though it was due at 38 weeks. Baby ended up a section cuz of posterior presentation. Induction and all was at 39.5 weeks. Doula was informed of baby's name and invited back for a visit but I will wait until she has been home a day or two. At this point I, the doula, will not be doing any more massages until i am paid the remainder of the contract. I am wondering why she didnt oay since she knew it was due at 38 weeks. I have fulfilled my partnof the contract except for a couple massages. I was also asked to attend a childbirth ed class at hospital which was not in contract. I am obviously a bit peeved at this point. I realize mom having had to take off work early may have limited her funds but that isnt really my problem and it was oerfectly clear that massages could be done after the birth. Now i plan to say no to any further massages unless i am paid the remainder of contract. Even tho a c was performed that wasnt on my part and I feel I should certainly be paid. What do you think?

Mama Seoul said...

Hi Kathleen,

I am sorry that you had a difficult experience. Money is tough in birth work because it is a personal relationship and doulas have a lot of love and passion.

When you are arranging the postpartum visit, remind them that the balance is due. Act as if they are going to pay and planning to pay. Hopefully, they are and have just been busy with baby and recovery.

When you go to the postpartum visit, greet them, admire baby and then request the payment. Do it kindly and clearly. No need to be defensive or threaten to withhold services if you don't get paid. No need to say,"I'm really sorry to have to ask, blah, blah blah." Just simply say,"I need to collect the payment."

If they balk, you can explain to them that the doula fee was due before the birth and doula services do not guarantee any particular outcome. Some births are fast and easy and some are long and challenging, but the fee is the same. It is for support and for being on-call.

If they refuse to pay or say that they don't care about the postpartum massages, you might have to eat this one. Live and learn.

In the future, have payment due by 36 weeks (or a payment plan in place that is very clear). Change your contract to say that it includes "up to however many massages". Clearly state that if mom gives birth early, that the other massages can be done postpartum if she wishes, but there are no partial refunds. They are taking a slot on your calendar.

Send reminders when payment is due. In this case when you went over to help things along, you could have asked for the money. Waiting for the client to offer is not good for business.

Also, many doulas like to tout the studies that say doulas reduce c/s rates. Clients can interpret this as a guarantee that c/s will be avoided. You need to be very clear in your communications that you are not guaranteeing a particular outcome and that you are NOT advocating for the client against the doctor/hospital. You HELP them advocate for themselves.

I spend a lot of time in my childbirth classes and with clients talking about the importance of consumer choice. Different providers have different philosophies around birth and care and that the choice of care provider is the #1 choice they can make that significantly effects the outcome of their birth. It is more important than hiring a doula and more important than taking any class. Though, a thoroughly prepared mom can do well with an unsupportive provider, it is much more challenging and if they are any alternatives, she would be better off switching.

The Birth Plan is for the Pregnancy, not the Birth. They need to discus their preferences with their care providers in advance. If they don't line up there is time to negotiate, compromise or change care providers. Your life as a doula will be much easier if you can convey this message. Even if people don't switch, their expectations are realistic and clear.