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You are not allowed to not allow me

When talking to families in interviews or prenatal visits or in my childbirth education classes, I can’t stress enough how important it is to choose your care provider wisely. This amazing article on Pathways for Family Wellness (a site well worth checking out) does a great deal to emphasize some of the red flags you should be aware of when meeting with potential doctors and midwives and how to empower yourself with appropriate questions to weed out those that might not be a good fit. 

I know in my prenatal sessions and classes, couples tend to get anxious waiting for me to FINALLY get around to the things they thought they were coming in for–What does labor look like? How do I know when to go to the hospital? What are the tools for having a “natural” birth?–as I spend the entire first pregnancy consultation or the first two hours of my first prenatal session talking about your birth team. 

I have to remind them that all the squats and yoga breathing and mantras in the world aren’t going to make an impact if you have a care provider who doesn’t believe birth is an event not necessarily full of management and intervention and doesn’t really seem committed to helping you have an unmedicated birth. 

One of the ways you can figure out if they are going to be harmful or helpful to your goals of a physiologically appropriate birth is by paying attention to language like “We don’t allow” or “I don’t do that.” If you’ve done your research and know you want to have a water birth, why would you stick with a care provider who says something like, “Oh some doctors/midwives do that, but I don’t.” or “We don’t allow births in the tub here.”? It’s amazing how often I hear pregnant folks say something to that extent and either don’t know that they can switch providers, or know that they have other options, or for whatever reason just don’t think it’s going to be a big deal in labor. IT IS A BIG DEAL! And though having a doula can be enormously helpful in advocating for your wishes in birth, we can’t make decisions for you or fire a nurse a doctor or a midwife for you, and so there’s only so much we can do in the end. 

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Sadly, we in the United States have grown accustomed to poor medical care, a lack of true informed consent, and being told that we can’t possibly know much about our bodies. With most women hearing horrible stories of near-death births left and right, they’ve grown to think that they must also have this kind of traumatic birth, so it doesn’t matter if they “like” their provider much, as long as they’re there to rescue you and baby. It’s precisely this culture of fear and misinformation and lack of choice and trust in care providers that is driving the rising maternal mortality rate in this country (we are the only country–developed or otherwise–which boasts a rising rate). 

So, it does matter who your provider is and where you choose to give birth. If you are currently seeing a provider who uses language that takes away choice and support, SWITCH! Even if they have a nice smile and good bedside manner, if they’re not on your team, fire them. Now and not when you are fighting them in labor. That’s not fair. If you are early on in your pregnancy interview a bunch of different providers. Seriously. How much time did you spend picking out a stroller or car seat? Spend 10 times that amount talking to care providers and staff at the place where you choose to give birth and don’t stop till you’re sure in your gut that you’ve found the best fit. Take a month to do it. Make them sit down with you for an hour and answer all of your questions. 

If they don’t want to give you their cesarean rate, but avoiding a cesarean is your biggest concern in pregnancy, keep hounding them or leave and never look back. 

You are 100% entitled to having the birth you want. There’s no being “selfish” or “smug” or “bossy” or “difficult” in asking for care that is supported by evidence and is kind and supportive. Choosing an appropriate care provider who gives you options, supports your choices, and practices according to informed consent is also not just for parents hoping to not use pain medication in labor. This isn’t you not being particularly nice to a waiter somewhere, this is arguably the most important day of your life and what happens in labor has long lasting effects for you, for baby, and for your family. It’s not about being a “smug hippie” or trying to win an award for best mom, this is about you taking control of a very normal, natural process that shouldn’t leave you battered, scarred, and needing therapy. 

Do not allow them to tell you you’re not allowed. 

If you want more information like this, sign up for a pregnancy consultation package or hourly conversation. That first investment can save you stress, time, money, and help you connect to a care provider in line with your wishes and needs in pregnancy and beyond.

Pregnancy Challenge Week #2 -- Save for a Doula

I’m starting a series of challenges to expectant parents to encourage them to take small steps toward better care, more informed decision making, and a smoother transition into parenthood.

Over the next few weeks, I’ll be posting on action item in this vein, with some information for why and some resources for how. I imagine the challenges will be steeper for some families than others. I also imagine that it will vary person-to-person which action items are more difficult than the others. Some families, too, I imagine won’t face a ton of barriers, but just needed some guidance on the fact that these things are available.

What’s on the docket for Week 2?


I challenge any expectant family to start budgeting for a doula.

budgeting for a doula


So I might need to start with answering What is a doula?

A doula is a secondary support person trained in non-clinical support in the childbearing year and sometimes beyond.

Doulas are not primary caregivers, so they work in tandem with midwives, doctors, nurses, midwife assistants/apprentices, lactation consultants, etc. Most often you will hire a doula independently, though some birth centers and hospitals have on-staff doulas you can or are required to choose from. Most doulas work primarily in a hospital setting, but can join you for an intended home or birth center birth, as well.

Evidence shows that the one of the best ways to reduce the number of unnecessary interventions, improve maternal and infant birth outcomes, reduce disparities in care and outcomes, and create more satisfying birth and postpartum experiences is to have continuity of care that includes continuous labor support. Most families are very surprised somewhat late in their pregnancies to discover that they aren’t going to get that from their primary care providers in a hospital setting (and this includes hospital-based midwives who work on a shift schedule), hospital staff, or pediatricians. This is where doulas have come in and where the evidence shows that they can help families have better birthing experiences -- both in emotional wellbeing and in reducing unnecessary medical interventions. Following the first publications of these findings, one author famously said, “If ‘doula’ was a drug, it’d be unethical not to use it.”


Most birth doula packages include 2-4 appointments prenatally to discuss your individual pregnancy and desires for birth as well as common coping practices, community resources, advice on having good communication with your primary care providers and other staff and loved ones that might be present at birth, your options in pregnancy and birth, the typical stages of labor, and some newborn advice. They are on call for you 24/7 for a window typically two weeks prior and two weeks following your guess date (it is a total guess when your baby will arrive, btw). They are available for phone, text, and email support throughout your contract. They will set a plan of communication around the early stages of labor to be your primary point person for what’s going on in your individual birthing situation. They join you when you are in active labor and need additional support and help you stay at home longer if birthing at the hospital help with the communication around when to call your midwives if you are birthing at home or a birth center. A doula will then go with you/stay with you at your intended place of birth till baby has arrived and for a short while after to help talk about baby feeding, what to expect in the first few days, and to check in on how you’re settling in after birth. Most doulas include 1-2 follow visits in your home in the first two weeks following birth to cover a wide range of topics on healing, feeding, newborn care, and other items of need.

Postpartum doulas focus primarily on care for parents and infants in the first 2-4 months after birth. Some birth doulas are also postpartum doulas and are available for extended care packages through the childbearing year. However, it is possible to hire an additional or exclusively work with a postpartum doula, too. They typically work either daytime shifts of 3-5 hours a few days a week or overnight shifts that shouldn’t be longer than 8 hours each. Though it may seem amazing to hire a postpartum doula for around the clock care, most families feel very well educated and supported with having a trained, thoughtful person come in to check on them 2-3 days or nights per week. Ideally, you are working with them on a tapered system where there is denser coverage in the beginning that fades to maybe one day or night shift a week to help you transition into caring for baby on your own once you have a rhythm established.


The cost of a doula varies based on what’s typical in your community, what their packages include, and their level of experience. It is possible to work with a doula who works on trade, sliding scale, or on a volunteer basis, though I encourage you to explore the value of the time, effort, and resources this person is putting in to being your support person in this immensely intense time in your life. Having said that, if you are really wanting to work with a doula and it isn’t in your budget, there can be lots of avenues for finding a fantastic doula that can fit your economic needs. Many doulas will be more than happy to reach out to their community to find you a good fit or to connect you with an organization that offers volunteer support.

Even in high income areas, the upper reaches of birth doula fees are typically under $3,000 for full care and the national average is around $1,500. Postpartum care, especially overnight care, can run into the tens of thousands of dollars over the course of several months. The highest fees don’t always reflect the level of support you’re getting or denote who might be your best fit, so it’s worth researching a wide number of doulas and asking even the higher fee doulas if they’re willing to work within your budget or have a strong recommendation for someone who can.

For this challenge, I want you to imagine setting aside at least $2,000 for doula support if you can. According to Fortune, folks spend an average of $1,300 on Amazon per person per year. Individuals in the US spend about $1,500 each on vacations per year. The average cost of a wedding is almost $26,000, which is also an enormously important day for many, but also just a single day and doesn’t carry quite the same lasting benefits and risks as having a positive birth experience...I mean, even the cost of the cake on average is $500. What would it mean to put that towards several hours of personalized postpartum doula care?

You can make up these costs in a lot of different ways. I have an earlier post on how postpartum preparation can help save you a ton of money you can put towards doula care I’d encourage you to take a peak at, but the gist of it is

BUY LESS BABY STUFF

Can I challenge you to try this : Every time you are about to purchase something for baby, can you either do without it (the answer is almost certainly yes) and put that same amount into a savings fund for a doula? Or can you put a matching amount in that savings fund? Many useless baby items will run you about $35 a pop and will likely wind up in the Goodwill pile where $35 is about the hourly rate of many postpartum doulas. That $120 countertop sterilizer machine…? Guess what, there’s no sound evidence on sterilizing bottles and a lot of good evidence on why not to so there’s $120 closer to your birth doula fund. There is no gadget out there that can replace having quality labor support or someone helping you to navigate the tricky first months with a newborn.

Friends, family, and co-workers are often very very excited to help you greet your little one and want to show you. This often leads to them purchasing a ton of stuff, and it’s up to you to direct them into another option, if you really want support around having a doula. Don’t be shy about talking about your process of hiring a doula, trying to reach your budget goals, and that if you’d prefer it, that you’d rather have some money to put toward doula support over another book or pile of onesies.

What about expensive gender reveal or baby showers? Can you have a celebration with friends around this that isn’t full of cheap decorations you’re just going to throw away? Have it be a potluck with fun games around baby names and the like and ask your guests to chip in to your doula fund in lieu of obligatory baby gifts you might not ever use. You can ask your doula to attend, even, and talk to your guests about how beneficial their support might be to you in the long run. If it doesn’t feel too tacky, you can put out a box/jar/whatever with the label “doula fund” and even if you just get a few bucks, you’re a few bucks closer to $2,000.

Or, if you don’t feel like making a ton of swaps to your plans for celebrating before baby arrives, can you just set a goal of how much money you’ll set aside per week till you hit your doula fee goal? If you have a partner, you can ask them to do the same and set up a mutual savings spot and even make it kinda fun somehow. Maybe get an old school piggy bank and smash it when you’re ready to hire your doula!?

Did you go out for a regular giant fancy coffee drink or regular cocktail that you’re abstaining from in pregnancy? You could calculate how much that cost you per week and put that money directly into a fund for your doula, who will be your new self care and indulgence guru.

Have you ever found yourself saying something like “I’d pay $X for a nap right now?” Well, put a number on that, start setting aside a few naps worth, and think about the beneficial rest your postpartum doula will help you take once baby’s here and think about paying them to help you achieve that when you need it most.


If $2,000 is an unrealistic goal for you or is much more than you need based on fees in your community, just pick a different amount and save away!

To read a bit more about the true cost of a doula, you can check out my article on the cost breakdown here.

If you want more information on how to find, save for, and hire a doula, you can set up a 1hr phone consultation or sign up for one of my full pregnancy and/or postpartum consultation packages where I’ll talk to you about doulas, how to save money in this process, and much more.

If you participate in these #pregnancychallenge ideas and want to share, please comment below, send me an email, or tag us @Rosewoodrepro on instagram and let us know how you are doing! Happy saving!

Pregnancy Challenge Week #1 -- Choosing a care provider

I’m starting a series of challenges to expectant parents to encourage them to take small steps toward better care, more informed decision making, and a smoother transition into parenthood.

Over the next few weeks, I’ll be posting on action item in this vein, with some information for why and some resources for how. I imagine the challenges will be steeper for some families than others. I also imagine that it will vary person-to-person which action items are more difficult than the others. Some families, too, I imagine won’t face a ton of barriers, but just needed some guidance on the fact that these things are available.

So let’s start with the challenge for Week 1:


I challenge any pregnant person, at any stage in their pregnancy, to go out and interview 4 primary care providers in their area.


While this might seem most beneficial for families earlier on in their pregnancy journey, if you are not feeling 100% supported, informed, and comfortable in your care, it is not too late to look around. Truly, most of my birth clients wind up hiring a doula in their late second or third trimesters because they thought they were going to get more education and support in pregnancy at some point from their providers and realize fairly far along that they need to outsource.

It doesn’t have to be that way. Don’t accept sub-par care for ANY REASON.

If you are not digging the approach your primary care provider is offering, or you know that the person you are seeing for primary care in pregnancy will not be the one working with you in birth to make decisions, why would you expect them to suddenly jive with you come your day of birth?

how to choose a care provider in pregnancy

Do you want to be pressured into decisions you don’t agree with when you are having a baby? Do you want to have to come in expecting to fight off things you don’t agree with? Do you want to continue care when you are skeptical of where advice is coming from? Do you want to feel like you are paying a TON of money to still feel lost after months of working with someone through your pregnancy? Do you already feel like you’re having to give up a lot of your parenting desires to appease your provider’s thoughts around your care? Do you think your visits are long enough? Do you feel exhausted from having to outsource a lot of your education to get the support you need?

The communication you are getting through pregnancy is a dress rehearsal for the big day with that provider/practice/place of birth. You don’t need to wade through care that feels inadequate and hope for the best. A doula can only do so much to help you in this circumstance, too. It really matters who is guiding you in the clinical components of pregnancy and who will be there to help make major medical decisions with you in birth.


So here’s is what I propose -- Spend 1-2 hours a week for two weeks in interview with 4 additional providers and/or go on a birth center or hospital tour or open house or to a meet the midwife event.  


I read an article recently that said that on average, we watch about 550 hours of Netflix per year. We spend an average of 53 minutes on Instagram per day and 2.5 hours scrolling on our phones total through each day on average. I’m challenging you to spend 2 full hours A WEEK for two weeks face to face with the provider who is going to be your primary point person for one of the most intense and important experiences of your life.

Except we do…that ACOJ study makes it really clear. Doc’s make decisions based on “opinion” not science.

Except we do…that ACOJ study makes it really clear. Doc’s make decisions based on “opinion” not science.

I want to encourage you to pick 4 providers who offer something different than the care you are currently receiving -- a midwife with hospital privileges, a family practice doctor with hospital privileges within your network who can transition into your baby’s primary pediatric care provider, an independent homebirth midwife team or two, or going to a free standing birth center’s open house tour.

I promise you that this won’t be a waste of time, even if you feel these providers or locations feel like a stretch for you for whatever reason. You are not bothering them, this is part of your job. If you switch providers, they won’t be hurt or care, it’s part of their job to work with new people all the time. They are there to answer your questions and address common concerns/dispel myths about their care. You will feel fairly certain in these hours that you have seen what other care looks like and if you choose not to switch, you can feel confident you made the right choice for your family. If you have been questioning your care, you have started a foundation toward understanding that something different exists and how to access it. There is a very clear and palpable difference in the styles and types of care each different type of provider can offer. It’s worth the investigation.

The Harvard School of Public Medicine did a large survey a few years back and discovered that most families choose the place they’re going to give birth (the hospital where they’ll give birth for 99% of American women) because it was the closest one to them. This is not necessarily the best fit for most families. They also found in the same research project that it was clear that the setting and provider made the most difference in whether or not a birth ended in a cesarean surgery, not risk status or how the labor progressed. This is due in large part to litigation-based care and not evidence based care, doctor opinion, and the lack of continuity of care with shift-based primary and birth care, and lack of continuous labor support in hospital settings. With that in mind, isn’t it worth spending 4-8 hours investigating your options?


Here are some questions to take to these interviews :

  • What is your training and background?

  • How many years have you been practicing?

  • What is your philosophy on pregnancy and birth support?

  • How do you approach clinical testing and exam options? Do you perform those all yourself?

  • If I hire you, how likely will it be that you will attend my birth?

  • Where are you able to support me in birth (home, birth center, hospital)?

  • What is your personal cesarean rate/rate of the place you attend births/transfer rate (for out of hospital midwife practices)?

  • How often do you attend unmedicated vaginal births?*

  • How long do your prenatal sessions typically last? What topics do they cover?

  • Do you offer centering programs or childbirth prep classes in your practice?

  • Do you encourage working with doulas?

  • How much communication can I have directly with you in pregnancy and labor via phone/text/email?

  • How many pregnant persons do you support in a month?

  • What does your follow up care look like?

  • Are you available around my due date?

  • What is your rate and do you accept insurance/sliding scale?


You should be looking for more than just a pleasant bedside manner. Many families say to me that they stuck with their provider because they felt unsure of how to switch and anyway, their provider was “nice.” Since an ACOJ paper pointed out that ⅔ of standard OBGYN practices were based in low-tier or opinion based evidence, I’d say it’s a good idea to look beyond proximity to your home and how nicely your provider might be telling you inaccurate information.

And I don’t mean to pick on doctors alone -- You might find your dream clinician by switching to a new practice or different hospital. Not all midwives are identical and it might take interviewing a few to find a fit you feel comfortable working with. Home birth might be off the table for you in your mind, but you hadn’t thought to check out the free standing** birth center in your area.

Hiring a doula earlier on in your pregnancy journey can help a lot with this. Doulas are interacting with primary providers and individual birth centers and hospitals often and can give you a pretty broad starting point for some providers who might prove to be a good fit. They can also help affirm your decisions, ease your anxieties about switching, and help you sort out some of the ins and outs of the insurance issues.

This is also a big part of my pregnancy consultations services and I can do in person or virtual consults on this topic exclusively if you’re needing further resources for how to choose a provider that’s right for you. In ten years of this work in many different states, a few other countries, in hospitals and out, I can tell you that who you have by your side in pregnancy, birth, and postpartum makes an ENORMOUS impact on your safety and satisfaction with the experience, completely independent of the outcome. You need a provider in line with your wishes in birth and parenting. I’m here to help you find them.


If you’ve accepted this challenge and want to share your story, please feel free to comment below, send me an email, or touch base with me on Instagram @Rosewoodrepro. Happy hunting!


*If that is something you are hoping for it is important to ask this that specifically. Many doctors are trained to use “natural” birth to mean “vaginal” birth, regardless of medical management leading up to that outcome. You might want to also ask for more specific information on how many inductions they oversee a month/year, how often they use vacuums or forceps in births, how often they support parents not wanting medical pain management, if they “labor sit” or spend non-management time during birth in the on call room, their thoughts on “post-dates” inductions, what they consider to be a “high risk” pregnancy, if they treat pregnancies in persons over 35 years old as “high risk,” etc.

**A note on the language around “birth centers,” many hospitals are now calling their maternity floors “birth centers” and maybe having a nurse midwife or two on staff, but this is very very different than a free standing birth center with independent, case-load midwives, something many families don’t realize till they do the hospital tour late in the third trimester and realize it’s not a separate unit from the standard hospital birth care and are disappointed.




Call Your Girlfriend -- I'm Doing Virtual Consults!

Here to tell you about my phone and video consultation services!

Okay okay okay, truth be told, I HATE talking on the phone. I don’t even like FaceTime chats except to see my baby nephew so this has been a stretch for me. BUT I loving it.

image via  Mere Street

image via Mere Street

I was asked to start doing phone consultations by a former client who is building a network of experts to reach Chinese families around the globe who are trying to find more holistic parenting resources. It started as short video workshops (that was challenging enough for me as a rambler) and merged into phone consultations for small groups of parents interested in holistic sleep education. That lead to phone consultations for doula contract writing, prenatal education with families outside my services areas, and more. It’s inspired me to keep going.


I’m going to start offering almost all of my services virtually from now on -- Well Woman Consultations, Pregnancy Consultations, Postpartum Prep Consultations, Sleep Support Consultations, and Doula Contract Writing Consultations and Classes.


Here’s what each might look like :

Well woman consultations :

After you reach out about wanting to work with me to find a more tailor-fit approach to your hormonal and reproductive health care, I’ll send you one of my whopping 10 page intake forms to fill out and send back to me. You can sign up for 1+ hour of support over the phone or video, we’ll pick a day and time, and that’ll be when we can go over your needs and wishes for care.


After we chat, I’ll do a bit of research and reach out to my network for good recommendations in your area and send you a detailed email with everything you need. If you want to keep working with me, we can do so in the same manner on and hour-to-hour basis or you can jump into one of my annual or 6-month packages for further support.

We’ll cover everything from nutrition to seeking a primary care provider to navigating tricky hormonal issues to birth control options, and more.

I’m very dedicated to working with young persons and their parents/guardians to help them navigate the transition from pediatric into reproductive/gynecological health care that’s supportive, inclusive, expansive, respectful of the enormity of these age transformations, and doesn’t scare them out of routine care. We can work as a team and have private sessions so everyone feels comfortable and connected in this process. Privacy, compassion, and empowerment are the keys here and I’d love to be a guide for you and/or your child in this process.


Pregnancy consultations :

These can work the same as my in-person package options where you can sign up for a 2 hour consult at any point in pregnancy or the full 10 month support package. After you let me know what might work best for you (and if you start with the 2 hours and want to jump into a larger package, that fee will just be transferred over), I’ll send you a detailed intake form so you can let me know about your pregnancy journey so far and fill me in on what I might be able to help you with going forward.

For some families, you’re just looking for extra information on a specific topic like choosing a care provider, GBS testing, nutrition, finding a doula, home or birth center birth vs hospital birth options, how to find and interpret high quality research and information, information on comfort measures in birth, or other singular topics.

Other families want to get the support they would traditionally get from an independent midwife (minus the clinical testing) that they aren’t able to access for any reason and want to have me fill in a lot of the huge gaps left in our maternal care system.

With ten years of experience supporting pregnant persons in all sorts of ways (childbirth educator, doula, midwifery student, infant care specialist, researcher, doula trainer) and in many different states, countries, and settings, I’m here for all of it! If you feel like my style is the best fit for you, or you feel like you’re not finding what you need in your area at this time, let me help you virtually!


Postpartum Consultations :

Feeling like you’re not getting the resources on what to expect once baby is home? Feeling like you’re getting a lot of conflicting information or information too focused on risk and fear and opinion? Wanting an infant and mama/birthing person healing crash course done on your own time and with your specific family’s needs in mind? Let’s set up a call or video to go over what you need to know. This also can be done as a one-time 2 hour session or as part of the broader packages.

Unlike traditional newborn basics or breastfeeding classes now widely offered, these consultations don’t follow a standard system. Instead, they are focused on the concerns you have individually and specific to what you feel you’re not getting. We can set these up before baby arrives (ideally) or up to 4 months after baby is here. This can be a truly awesome baby shower gift!

I offer discounts for group consultations, so if you have a few friends or a parent’s group of expectant/new folks due around your same time (minimum 4 participants), the price is dropped to $20 per participant per hour.


Sleep Consultations :

Wanting some basics in infant sleep expectations? Not sure you want to sleep train or what sleep training even entails? Wanting a holistic and personalized approach to discussing sleep difficulties without fear or judgement? Need a point person on standby for those crazy weeks of transitioning sleep schedules? That’s me!

Lack of sleep is one of the number one challenges parents face in the first few months with a new babe. There is no way to make this obstacle disappear -- it’s part of the process, sorry to tell you. However, so much of the sleep training information floating around is not routed in good science or good practice and often leaves families feeling more stressed and tired. This often leads to them either ditching their goals for compassionate sleep adjustment sooner than they’d like, or makes them feel like giving up even trying to get babe to sleep on their own. There is a middle path, friends!

For better or worse, this middle ground takes a lot of extra support, guidance, and respect for nuance. Rosewood consultations aim for realistic, quality information-driven, and non judgemental discussions around safe, healthy, and lengthier sleep options. This isn’t a promise of X hours or a leave your baby to scream bullet point plan, no-sir no-thanks.

There is an option to have a 2 hour basic rundown of common sleep issues and information you can access while still pregnant, or you can reach out to me once baby is here and you feel you need more advice, either as a 2 hour consult or as part of a larger package based on your needs. This can also be a group virtual class at the $20 per person per hour rate (for at least 4 registered participants).


Doula Contract Consultations :

Let’s face it, most doula trainings leave you totally in the dark about how to write a contract that really protects you or supports your individual practice.

With a one-on-one contract consultation and edit, we can work together to go over the basics of contract writing (I send you my full how-to booklet once you register), using your contract to set up healthy and cooperative expectations for yourself and your clients, how long to keep a contract, what goes in your contract vs on your website or handouts, myth-busting scary legal language and legal fears, and how this practice can evolve and grow and be a benefit to your wider doula community.

Individual virtual edits are 2 hours of prep on my end going over your material as-is, 2 hours of virtual meeting time, and 2 email follow ups built in with the option of adding more at a low hourly rate.

Virtual group classes can be done at an hourly rate of $100 per hour for any size group. I’ve loved talking to doula groups and collectives around the country about how to use this exercise together to create better contracts and support one another in this often difficult work.  


Want to bring me to your group or training organization in person? I’d love that! We can chatrates and options, so please reach out.

Rates for virtual consults are the same as in person consultations at this time and can be found on my Services and Doula pages. As always, sliding scale and some trades are options to keep this type of support accessible in many areas.

If you are part of a parent’s network or group and think I’d be a good fit for one of your gatherings, please reach out! I love discussing specific topics families want more information on like holistic sleep advice, environmental parenting, choosing a care provider, finding a doula, and more.

If you are a doula group and want me to speak (virtually or if possible in person) about one of my specific focus areas, LET’S CHAT! I do it all the time and love meeting and teaching doulas from all over.




Why do doulas cost so much?

Money is always a tricky subject, especially when working within a profession in the "healing arts." For many birth workers, this profession is seen as a "calling" as much as it is a job. Add to that the fact of these caretaker roles being traditionally held by women, being seen as "fringe" or outdated, and still sometimes viewed as a luxury item despite mounting evidence otherwise, and with no set national standardization for the profession a leaving a host of intricate and competing economic influences driving the fees for these services in every direction.

When I first started out as a doula, I was living in a community where bartering was the norm. In many ways, I really enjoyed that concept. There was always communal food, carpooling, couchsurfing, skill sharing, etc., and I learned a lot in my nine months there. On the other hand, I was making about $500 a month for a job I was way over qualified for and could barely pay my bills.

I was twenty-two, fairly fresh out of college and trying, desperately, to grow my doula business. I spent hours upon hours learning how the internet worked (funny, as I almost failed my web building class in college), calling every doula and “alternative” practitioner in town, forming study groups, forming community groups, volunteering at childbirth ed classes, and scrounging for clients, all with zero pay.

I was burnt out and exhausted before I even went to my first birth.

That first birth was wonderful. A home water birth with two midwives and my doula mentor. I did it on a trade and was happy to do so. I’m grateful for that experience and didn’t sweat not being paid.

After that first birth, I attended my next four births on a volunteer basis, too. What’s more, I had to travel 40 minutes to the hospital to attend them. Because it was through a volunteer program, I also had to drive up to the hospital numerous times for orientations and shots and the like, and often went in on night shifts only to leave after 12 hours without having attended a single birth.

Now, I’m not trying to complain or sound ungrateful, I got a lot out of each and every birth. Instead, what I’m trying to highlight is that this is not uncommon for a new doula. Not only do we have to invest several hundred, sometimes thousands of dollars to even start training to be a doula, but we are expected to attend several births for free. In my case, It was almost a year after my training till I got paid for my first birth. I was given only $350 for hours of travel, three prenatal visits, one month on-call, supporting the labor first at home then at the hospital, and two postpartum visits.

I moved out of that community after less than a year because I could not hack it on that rate. I traveled (by bike) south to San Francisco with the woman who was becoming my doula business partner, Jasmiene. We figured that if we could split the cost of owning a small business (and doulas are small business owners), and the time trying to acquire new clients, that we’d have a better chance of turning a profit and not getting burnt out.

The price tag for doulas in Olympia, WA was $300-450. In San Francisco and the surrounding area at the time I moved here and wrote this (around 2010) it was $800-1,500. Even with the increase in the cost of living, the rate at which doulas were being hired, how organized they were as a group, and how many opportunities there were to continue our education for a smaller fee made this move seem like a wise decision. We tenuously increased our rates to $800, but after just two births, we realized we were grossly underselling ourselves…plus we could barely pay rent on one birth a month. Eventually, we were up to $1,000 per birth and $25/hr postpartum ($30/hr for all night care). 

Now, $1,000 for a doula might seem totally ludicrous to some (and currently, it’s on the low end of the fee spectrum for doulas in the Bay Area), but I want to break it down into what the doula is putting into her services and what you are getting out of it:

Doulas are business owners:

  • In most cases, doulas are interviewing for new clients constantly. That means they are driving to you, either to your home or to a cafe, and spending money (on drinks and food and gas) and time to get about 1 out of 3-4 interviews ending in a hire. At one point in my career, Jasmiene and I were going to 2 or more interviews every week and shared no more than 6 clients in our practice at any time. More commonly, we had half that.

  • Advertising alone is an incredible financial burden and it’s often hit or miss. Printing business cards, pamphlets, flyers, advertising online, in newspapers, and keeping up a personal website really adds up. In the Bay Area, we were spending about 15% of each fee for these costs alone. If we took a hit one month or couldn’t take on more clients for some reason, those costs still existed. IT IS A BUSINESS.

  • Printing other materials is just as expensive. We always came to our prenatal visits with a wealth of information as well as necessary documents to fill out so we could be the best support persons possible. Contracts, hand outs, birth plans, favorite articles, readings specific to each pregnancy, etc. We weren’t employees of an office with a big, efficient printer, either. Every other month, we would go to the office supply store and buy several hundred dollars worth of printing materials ourselves. We also regularly had to go to a print shop to get things done more professionally and that cost really added up, despite having to do that maybe once every three months.

  • Despite having the same needs as many other small business owners and freelancers, since doulas are still considered to be working in a "fringe" field, it is rare that we would qualify for small business loans, adjustment programs, grants or scholarships for continuing education, tax credits, and other perks offered to small businesses in this country.

Doulas require continuing education:

  • Most parents are concerned about our credentials. Not only is it expensive to get and keep up with our certifications, most families are looking for women who are constantly continuing their birth education. These classes aren’t cheap. There are workshops starting at around $35 for a one-day session and they go up to $5,000 for courses offering a specific credential. This can often cause a catch-22 situation where it’s not always the “best” doulas (or the “best” doula FOR YOU) who is able to advance herself and her business, but rather the ones that can afford it and will thus generate more business and be able to get more clients.

  • Doulas often gather in collectives to help learn from one another and support one another. This takes up an extraordinary amount of time. Like it or not, time is money. We’re not paid hourly for the work we do outside of our interactions with clients and we’re not on a salary. Same for the amount of time we spend reading research articles, books, blogs, and discussing / debating this information with one another. If our collectives don't put money aside for subscriptions to various journals (and most can't afford to do it), those become out of pocket expenses, too.

What are you getting out off all those behind-the-scenes expenses anyway:

  • Doulas make themselves available for you. They cater their business to your birth. They are often the only ones there specifically for you and not for some outside agenda of profit, public health number, political pressures, hubris, etc.

  • Unless you are planning to work with a home birth midwife (and even then it’s not 100%), you will not get to choose the people who surround you in birth. How often have you heard of a friend telling you that she, of course, had the one doctor in the practice she’s never met before for her birth? You won’t meet the nurses before you deliver. You may be in labor during shift changes and wind up with eight different nurses and doctors before it’s time for baby to make her debut. The one constant you can have is a doula. Unless the birth goes on exceedingly long or the doula has to send in a backup for another dire reason, you will have that doula for the entirety of your labor. It makes an enormous difference in women’s views of their births to have a steady champion devoted to them and them alone during labor. We might be the only constant for you once baby is home, too.

  • Too few women understand how alone they will be in labor. Especially if you are in the hospital, you will only see your care providers for brief spurts of time to do this or that check in, routine intervention, etc., and then for the last few minutes of pushing. This can be daunting for women, and sometimes even more stressful for their partners, who will be made to be their only support persons in labor. I have come to labors when I felt it was too early because the woman and/or her partner really felt they needed me there. Sometimes, that’s meant having me sleep on the couch and occasionally popping up to tell them to relax and go back to sleep, that we’ve got a long way to go, and so on...but it often means giving up more than 24 hours of my life to make sure my clients are feeling safe and supported. Goodbye plans for grocery shopping. Goodbye friend’s birthday party. For doulas with children it can mean missing ballet recitals and art shows and more, but so it goes. We're hunkering down for the night because that’s our job as your doula, to be there for you and your partner when no one else can.

  • All that education and community building is what makes us your birth gurus in pregnancy and labor. Attendance at childbirth education classes is steadily declining, unfortunately. I can’t tell you how many times I’ve had prenatal visits run over 5 hours because parents felt totally unprepared. I don’t charge more for when these visits bleed out from 2.5 hours to 5 hours, either, just like we’re not paid more if a birth goes for 52 hours instead of 18. In so many cases, the sad truth is that your doula is the only person telling you some of this critical information. We will be the only people who will explain informed refusal, newborn procedures, and if that particular doctor is all too quick with a scapel. You are paying for the wisdom we are constantly trying to expand upon.

  • We are on call for you 24/7 for an entire month around your guess date. Being on call sucks. Ask any doula, midwife, or doctor and they’ll tell you the same thing: It’s the hardest part of the job. 99% of the time, it isn’t possible to be a doula and have a second job. With our $1,000+ price tag, after removing business costs and the rate for just the birth ($400 we figured), we were making a little less than $10 each on call day for each client. Now, you can’t take on too many clients with an on call schedule, either, so it was rare we’d have much overlap in pay during those on call weeks. How often do you live on $10 a day? Currently, that’s less than three gallons of gas, which is about how much I use for each prenatal and postpartum visit or interview. I bike as often as possible to avoid that, but it’s not always possible and relying on a bike for transportation has made clients of mine uncomfortable in the past. Doulas in most communities typically need to have cars to be on call, which is another huge cost.

  • We are there for you when baby comes home, too. We offer the same sort of tailored to you, one on one, in home care for birth person, baby, and family after the birth. That idea of seamless support we give in labor works the same magic during the postpartum period. You know us. You trust us. We were with you for one of the most monumental experiences in your life. That helps when it comes down to figuring out the myriad of details of being a new parent. We may be the only ones that notice marked changes in your mood and can stave off worsening postpartum mood disorders. We may be the only ones supporting your choices for feeding, sleeping, pacifiering, diapering, etc. Our community resources extend into the postpartum support community as well. We are often experts on breastfeeding and infant massage. We do your laundry. We hold your baby so you can shower or go for a walk. We talk you out of late night deep dives down the black holes of mommy blogs and their false alarms.

  • Studies show that this support reduces the need for all sorts of interventions, which in the end not only makes the experience more enjoyable and empowering for most laboring folks, but actually saves you money. Insurance doesn’t fully cover each and every intervention, so it can add up. Not to mention the rates of re-hospitalizations decrease with doula support. The average cost of a week in the NICU is $40,000. Makes $2,000 for the whole package seem like a bargain, no?

The sad truth is that our obstetrical care system does not fully support pregnant people and their families. We have recently dipped from 50th place in the world for maternal mortalities to 60th. Making the investment of hiring a doula does not form a magical protective shield around you in birth, but the studies point to numerous benefits to having this continuous support in pregnancy and early parenting. It is worth the investment in time and money to consider hiring a doula that suits your needs.

Here are some ways you can afford to hire a doula:

  1. Ask for part of the fee covered through baby shower gifts. Truthfully, you DO NOT NEED THAT MUCH BABY STUFF! If someone was going to spend $50 on baby clothes, that could easily go toward your doula fund instead.

  2. Ask your doula if they accept payment plans or work on a sliding scale but please keep in mind everything that she is putting in in order to be a great advocate for you and your baby.

  3. See if there are programs at your hospital, birth center, midwife practice, or community center that can help either connect you to a doula who works on a reduced budget, or one who’s fees are covered by a program or foundation. There are programs for young parents, homeless folks, recent immigrants, veterans, those without insurance, those with lower insurance coverage, high risk parents, and more in many communities, but it takes a bit of effort to find sometimes. Some church programs might have connections to these centering and doula groups, too.

  4. Consider hiring a newer doula. The studies show that working with any person who is there just for you, providing continuous support and encouragement in labor increases safety and satisfaction in the birth process. There are many benefits to working with a doula who has been practicing for a long time, but if they are out of your price range, you could potentially still get a lot out of hiring a recently trained doula for a fraction of the fee.

  5. Call your insurance agency and see if they will cover your doula costs. This may take calling and asking for several people at different times. It’s all about finding the person with the magic code, asking for specific details for what information you need to have laid out on your claim, and following through. Some doulas are well versed in how to write up their invoices to maximize coverage. If you have Medicaid in some states/cities, there is now growing insurance coverage, so it’s worth asking.

  6. Some midwives and birth centers offer discounts for working with doulas. Every so often, a doula will match that discount (I do!). That can save you upwards of $1000.

  7. Start putting aside money early in pregnancy for support like doulas, lactation consultants, acupuncturists, postpartum care, etc. Resist the urge to spend that money on needless things from Amazon Prime and think about the investment you are making into a smoother transition into new parenting.

I hope you found this rundown helpful in explaining the costs and benefits of working with a doula. If you want more advice around this decision, check out my site : www.rosewoodconsult.com