Thursday, June 6, 2013

Doulas Working in Pairs: A New Business Model

by Ananda Lowe

The future of the doula movement -- that is, a sustainable doula movement -- will be one in which doulas work in pairs, rather than attempting to serve their clients as Superwoman by working in solo practice. 

I was first exposed to a community that successfully adopted this model when I visited the San Francisco Bay Area, where numerous doulas work in pairs and the local clientele has come to embrace this.  In other regions, I have noticed that doulas express both excitement and hesitation about working in partnerships.  Many doulas long for the support of working with a partner, while wondering anxiously if families will only accept a solo doula who promises to always be available. 

When the modern doula movement first emerged in the 1970s and 80s, those original doulas did not anticipate that someday other doulas would seek this out as a full-time career.  In earlier years, a solo doula could work part-time, and this would be (emotionally) sustainable for her.  But today, the higher demand for doulas, not to mention the stress of working in a medical climate that has resulted in higher cesarean rates, also means a higher emotional burden and higher rates of burnout for doulas.  Just because the doula movement began with a solo practice model, does not mean it cannot evolve.

As the next generation of doulas shapes its business practices, I am very much in favor of these new partnerships.  Partnerships take work to find the right match and work harmoniously, and sometimes need to end due to disagreements, or life circumstances such as one business partner having a baby.  Clear communication with clients needs to be emphasized, so that all parties are in agreement and share all relevant information.  But I believe the benefits can outweigh the possible disadvantages.  I have collected the input of doulas around the U.S. who are working in pairs, and I would like to share the business agreements they have constructed between themselves.

Sample Partnership Agreements

  • In my arrangement with my doula partner, when a client hires me I become the primary contact person for that client.  The client pays me $1500, and then I pay my doula partner a $175 retainer.  I attend two prenatals and two postpartum visits, and my doula partner attends one prenatal.  Both of us doulas plan to attend the birth in 12-hour shifts.  In the event that my doula partner attends part of the birth, she would receive $325 as a birth fee (plus the retainer).  If I was completely unavailable and my partner attended the entire birth, she would receive $650 plus the retainer.  In the past I have not always clarified the financial agreement with other backup partners ahead of time!  This creates confusion and I have now learned that division of fees must be discussed in advance.
  • Charging a fee of $1200, my doula partner and I both attend the prenatals for which we each keep $200, then whichever of us ends up attending the birth will get the balance of $800.  For other backup doulas, I offer $100 for the first hour (for the backup doula to get out of bed or leave whatever she may be doing and get to my client) then $35 per hour until I can get there myself and/or $500 to attend the entire birth.
  • I pay my backup doula $25-$50 to attend a prenatal depending upon location and length of time.  Not every doula client needs or wants to meet my backup.  I don’t pay a retainer fee to my backup doula.   I pay my backup doula 60-65% of my doula fee if she needs to attend the entire birth.  While it has been very rare in 10 years, a couple times I paid a backup doula to come to the birth for 1-5 hours and taken a nap in my car (or taken an exam, or gone home and taken a shower, or even just have her come and stay to give us all fresh energy) then returned to my client.  I paid the backup doula $25-$50 per hour for covering for me during that time, again depending upon location, distance traveled, etc.
  • My fees are $600, so $300 is what I receive from the client for the last payment (birth fee).  Payment to my backup is dependent on how long they work.  If they work almost half the birth, I pay half of $300, if they work 1/4, I pay a quarter of $300.  If they work the whole birth I give them $300.
  • I worked on a co-doula basis for a few births. We each kept track of the number of hours spent with the client and then divided the fee accordingly. So, for the $1,000 fee, if she was present for 3 hours and I was present for 7 (just to keep it simple, although it was never that little time spent!) we split the fee 30/70.  We both attended the prenatal visit and then whoever attended the birth did the postpartum visits. 
  • Doulas who are good friends may work their backup in a more casual way (because they seldom actually do get called in) and have a fee exchange but with looser arrangement. Even then a prearranged division helps everyone to know what they are exchanging for what compensation. When beginning backup arrangements with in a new association it is too easy for each doula to have a different view of what is expected when timing in a labor varies from the expected.
  • I've worked with back up doulas or co-doulas quite a bit in the past (it's the only way I've been able to be successful!).  I charge $750 per birth.  I keep the $50 retainer plus the first half of the payment (which is due by the 37th week) - $350 - since I'm the primary doula, am on call, and have met with the client for 1-2 prenatal meetings. If my back up doula attends the birth I give her the second half of the fee - $350. If she is only there for part of the time then that amount drops and we discuss it afterwards.  However, we more often than not just take each other's kids so we can attend the birth with our own clients. Then there are no worries about money needing to be paid.
  • I have a reliable back up doula that I have worked with for the last five years.  While it has yet to occur, if she attends a birth for me then she receives $400 of the $550 I charge for a birth, the other $150 is my retainer fee which I keep for all the "legwork" I would have already done with the client.
  • I have a few backups that would use for barter for other services I do, like massage therapy for them and their husband.
  • When I have worked with other doulas I do not pay them anything unless they attend the birth - then they get half the fee.  If not then money would be going back and forth all the time.  I would speak by phone with the client if I were going to do back-up.  In the situation where I was at a birth - got a call from another client so my back-up went, then I joined them at a later time, then we would have to work out how much that was worth to me - probably still half the birth fee because it would be such an unusual situation and this person did bail me out.  The two times that did happen with me we both stayed for the birth and it was GREAT!
  • I have worked as a back-up for another doula and the arrangement was 50% of the fee if I attended the birth.  I have been thinking about and discussing the idea of a stipend for backup doulas because I feel it is only right to pay her or be paid something for being on call for weeks at a time. That, to me is definitely worth a percentage of the fee even if the back-up isn't called for the birth. I have been thinking 10% is a reasonable amount – peace of mind and not a hardship for the doula who has the client, yet a respectable amount for the backup to show appreciation for the significant commitment on her part.
  • I have about 10 doulas' phone numbers in my phone, and if a situation arises where I need backup, I start calling people in the order of which I think the backup would be a good fit for the particular client. When I call, I give a summary of the stats of the mom, where she is birthing, how likely it is I will be able to come eventually, and how much I can pay. Then the potential backup doula can decide whether or not she wants to do it. If she does, I alert my client about who is coming and assure her that if I am able, I will come as soon as I can, and if she doesn't, I call another doula until I find someone who is available.

  • I work in partnership with another doula and the arrangement is keeping us both sane!  It takes the pressure off of us, especially her as she has young children and is in school.  When a client contacts us, we both go to the interview and the prenatal. We have an on-call schedule, and the client will call the one who is on call for that day. We (the doulas) stay in close contact with each other, and sometimes we cover each other even if it's not our day. It has also happened that we had to call each other in, when a birth was extremely long, and both stayed. The doula that goes to the birth gets 70% of the fee and the other gets 30%. We also go the postpartum visit together. If we both attend the birth, we do a 50/50 split.  We have also used back-up doulas when one of us is away and we usually split 50/50.
  • My agreement with the doula who backs me up most regularly is that she receives $50 for each hour she's at the birth, up to the full remainder of my fee (less the retainer, which I keep for prenatal/postnatal services).  One thing I did last year that I liked was that the back-up received a $50 retainer to be on-call over the winter holidays.
  • I had a rocking partnership arrangement for about six months before she moved away. We offered two packages - one was a traditional arrangement where the client would hire one and the other would serve as backup. The collaborative arrangement meant the client would have us both at their prenatal visits, and then whoever was on call (or both of us) would attend the birth. The clients loved this arrangement and it allowed for us both to have a life.  I was able to go away on my anniversary and have a little wine and not feel a big guilty because I knew my doula partner was on call that night and the client was covered.  Now I pay back up doulas 50% of the fee if I call them.
  • My doula partner and and I split the fee 50/50.  We charge $1000 (one prenatal) or $1150 (two prenatals), and provide 1 post-partum follow-up. We alternate who attends the birth – she attends one, then me, her, then me.  We tried splitting the weeks of the on-call period, and she got nailed. Client after client was born on her watch -- which if you're splitting the fees is tough.  We pay our backup $100 for being on call if one of us goes away, and then another $500 (so $600 if there's a birth) for attending the entire birth. If she goes to part of a birth, we pay her $40/hr.


  1. I have a similar partnership with one of my back up doulas but it seems it is difficult at times to get a doula to charge her worth!!! I appreciate your blog and look forward to more....we are on the same page

    Dale Kaplan
    Coola Doula 410-608-7009

  2. In Central Florida we have a 'Doula on Demand' program where doula members enter their availability on the calendar and women that need a last minute doula, or a doula that needs a last minute back up, can find someone prepared to arrive within the hour. You can see the site at:

  3. I have been in two different doula partnerships, both with very dear and trusted good friends.

    In the first we each had our own solo practices and we were each others' back-ups as doulas and childcare. We both had 2 children under 7 at the time, and being successful as a doula meant we needed absolute, middle-of-the-night coverage for our children, and this made it possible. We did not pay each other but we traded back and forth. I only had to back her up once as a doula (when she had a client go 13 days over and was already scheduled for an out of state vacation), and she didn't have to back me up as a doula; this arrangement was more often to provide childcare for each other. Then she moved away :(.

    About 6 years later I entered into another partnership. We were total doula partners this time. Potential clients would come from her solo practice days or my solo practice days, and we would explain our new practice and how it worked -- it is of absolute importance that potential clients understand they can't enter into this really, really hoping they are going to get a specific doula -- they need to be okay with the idea it could be either of us. Of our fee, the deposit was split evenly between us, then the doula who attended the birth got the remainder, simple as that. We did all prenatals together, and the doula who attended the birth did the postpartum visit. Between the two of us we decided who was primary and thus more likely to attend the birth (in a manner of taking turns, whose turn it was, but we didn't frame it like that to clients). Once that was decided, we gave info to our clients for who to call first, etc. If the secondary had to step in we would take the total of the remainder of the fee and divide it up by hours, paying each doula her share according to how many hours she was there. In some situations couples wanted both of us there, and if we were agreeable (schedule being the biggest factor) we would just split the whole fee, and enjoy our time together at a birth! We worried clients wouldn't like this arrangement, opting instead for a solo doula. We thrived, and were even able to raise our fees (being the highest-paid doulas in our area, and the only ones working in tandem). Then I moved away :(.

    After many burn-out cycles, I kept envisioning a larger partnership, and as such I was heavily involved in creating a doula circle. The advantage to the client is a reduced fee and group structure where they get to meet with other pregnant families (and of course always a fresh doula), and the advantage to the doula was, a more livable life and less burn-out! Here is more info about that:

    It is hard to work alone as a doula, but the biggest factor that must hold true when entering into a partnership is, you have to absolutely trust the other doula(s) implicitly. You cannot be in a relationship with someone who is either rogue, very different from you, doesn't follow your standards of practice or code of ethics, etc. And sometimes that can be hard to find.

  4. Having done both a partnership and a solo doula practice, I find that they each have their own stresses. In a partnership, trying to coordinate times to both go to the prenatal visits can be overwhelming, and being away from my family for double the prenatal visits is taxing on my children. But feeling more comfortable to take time off and to call in my partner for a long birth was beautiful as well!

  5. I have a very reliable backup and if we have to attend others birth, we get $100.00 of the basic fee. I have never had to use her for any of my births or me for any of her births. My real desire is to have a doula in training to follow my whole process with my clients from the initial meeting through the postpartum interview. However for me, it takes a special client to be dependent on a doula in training, if I am not available. However, I have never missed a birth, nor required relief due to long labors. I think to have a DIT with you at a birth, she can learn from my years of experience and can actually help with comfort measures, creating a rhythm and visualization. I have approached this with some couples that I think would be open to this tandem operation, but they eventually chose my backup and not the DIT plan. I think to do this, your second doula needs have a common birth philosophy and you must keep her abreast of your clients needs and progress. I am not against this philosophy, but I think the client should have the final say about who she wants as her backup or tandem doulas at their birth. It is probably the responsibility of the main doula to sell the advantages of a second doula and ensure the client meet the second doula either in person or in a phone interview.