Back-up or share care?

Working as a doula needs to be financially viable and I’d like to see more doulas thinking about their doula work as a proper business.

I was shocked to learn from a survey I did last year that the majority of doulas have a turnover between £3,000-£6,000 per year. This is not going to be enough for most women to live on, let alone support a family and pay a mortgage and household bills. 
 
Many doulas work as both birth and postnatal doulas as well as other complimentary work, such as baby massage, pregnancy massage, placental encapsulation, Hypnobirthing and yoga to name but a few. There is also another way that you can take on more than one birth client a month and that is what this blog is about. You could ask another doula to be your back-up and another one to do a shared care with you. I realise that not every doula wants to have three clients booked a month but some need to and other feel that this is the only way to make a decent income.
 
Back-up doula

If you are going to use a back-up doula, it’s always best to let your potential clients know that you’re unable to cover their on-call period, because you have another client booked before they book you. It’s, therefore, imperative to be organised so that you know about all upcoming holidays, weekends away, weddings etc. so that you can enter them in your diary. When you have an enquiry, you can quickly look to see if the on-call will clash with something. Introducing a back-up doula after the client has booked you, unless it’s an emergency, is in my view not really fair. They booked you because you told them you were available and changing those parameters afterwards could be seen as unethical.
 
Generally speaking, a back-up doula should only be used if you need someone to cover the on-call period for a few days, but should definitely be less than a week. The continuity of care is what makes the services of a doula so unique and is also what is proven to make the big difference in birth outcomes. Asking someone to be your back-up doula for 2-3 weeks does not really feel right to me as it’s a very high likelihood that your back-up will be supporting at the birth whilst the client has spent time with you preparing beforehand. In a case like this, it might be better to offer a shared-care service to the client but I’ll move on to that in a minute.
 
A back-up doula should meet at least once with the clients or at the very least, have a conversation on the phone or FaceTime. You would agree to pay your back-up doula for the initial meeting, a daily rate for being on-call and if she supports at the birth, a fee for that. It’s important to agree these things beforehand, both for the back-up doula but also the doula that is using the back-up. The client should pay the doula they booked and the back-up doula would invoice the main doula for the final amount owed to her.
 
If you are a back-up doula, you should not take on any other work, unless you get a back-up yourself, if the on-call periods overlap. I’ve heard doulas tell their back-up doula that they can take on their own birth client too but imagine a situation when you need your back-up doula and she has gone to her client. What would you do in this situation?  

At the same time, if you promise to be another doula’s back-up, it is not right to let them down because you’ve got your own client. Remember, the doula that you’re backing up only took on that job because you promised you would be there as a back-up. At the end of the day, each doula will do what works for them but it’s worth bearing these things in mind.
 
In summary:
 

• Use a back-up doula for shorter periods of cover of the on-call period.
• Agree the cost beforehand.
• If you do take on your own client, consider the possibilities of a clash and what would happen in that scenario.

 
Shared care

A shared care would be something that would be offered to a potential client from the beginning. If you are already booked for a birth and you can see that the on-call period will overlap by more than one week, then this might be the best option. Basically, the client will get two doulas for the price of one.  
 
In a shared care, both doulas would go to the initial meeting so that the client will meet both of them from the start, before making up her mind to hire them. It’s important that the client is happy to have either one of the doulas at her birth. The antenatal sessions can be done together or split between the two doulas and the on-call period is also divided. Whoever is on-call when the client goes into labour will, of course, support her at the birth. However, in a shared care, you have the option of calling on the other doula if the birth goes on for a long time.  All of the details of when to call who and whether there might be a swap during the birth should be made clear beforehand. 
 
One of the doulas will invoice the client and then the two doulas will share the fee however they see fit. Some doulas might split it in half, others might divide the fee into three equal parts and each of the doulas get one third and the last third goes to the doula that supported at the birth.  
 
In summary:
 

• Shared care is offered before a client books you.
• Agree how you are going to split the fee.
• Make it clear that the client might have either doula and set-out who to call when in an easy and clear document.

 
So, as a birth doula, you could book your own client, which becomes your priority client, get a second client who you have a back-up doula for and a third client who is a shared care with another doula. Potentially meaning you can have 2.5 clients per month.  
 
There are, of course, plenty of combinations as you could offer a shared care service to more than one client and have different back-up arrangements with more than one doula. At the end of the day, you need to decide what is right for you and fits in with your life.
For some doulas, having more than one birth client per month might be stressful whilst for others, five birth clients per month is the norm.
 
Another idea might be to setup a doula collective with some of the local doulas that you feel have similar ideas and ethos to you. That way, you could take on clients and organise the on-call period between the doulas in the collective.
 
I’d love to hear what you do in your doula business and how that is working for you!