Doula services
(Don Delfin Almonte/Upslash)
Geography
At least one doula serves clients in every county in Washington state, although a majority of doulas work in King, Pierce, and Snohomish counties.
About 54% of counties had less than five doulas who provide services in the area. Garfield and Wahkiakum counties had the least number of doulas available. Fifteen respondents also provide services to clients in Oregon and Idaho.
Number of doulas who offer services, per county in Washington state
Tribes/Tribal nations
Only a small percentage of respondents have provided services to tribes or tribal nations (14.36% of 186 respondents). Among doulas who did provide services, 63% served one, 14.8% worked with two, and 22.2% worked with three or more tribes or tribal nations.
Tribes or tribal nations which doulas provide services to include: Chehalis, Colville, Cowlitz, Hoh, Kalispel, Lummi, Muckleshoot, Nisqually, Nooksack, Port Gamble, Puyallup, Samish, Sauk-Suiattle, Skokomish, Snoqualmie, Spokane, Squaxin Island, Suquamish, Swinomish, Tulalip, Upper Skagit, and Yakama.
Training and certification
97% of 174 respondents received formal training to become a doula
41.1% of 175 respondents indicated that they are certified doulas, while 24.6% are working toward certification
The doulas who obtained certification at some point did so primarily through DONA International (57.1%) and PALS Doulas (16.7%)
Barriers to certification
Survey question: “Did you face, or are you currently facing, any barriers to obtaining certification?”
Of those who indicated that they were certified, had lapsed certification, or were pursuing certification, 41 respondents reported facing barriers while trying to obtain certification. Three dominant themes emerged:
Financial barriers
Time constraints associated with parenthood and other work
Finding clients who are willing to work with birth doulas as they pursue certification
“The time you have to take off to be on call to volunteer births was a huge barrier - it’s a service occupation that you can’t really have another job with (in my opinion).”
“The largest barrier to certification was finding clients as a new doula. In the end, I was required to not charge or severely undercharge for the first couple births, meaning I paid to complete a certification process I had already paid to be part of.”
Doula practice
(Sergiu Vălenaș/Upslash)
A majority of respondents work as solo doulas (73.6% of 201 respondents), but some are part of a shared partnership with other doulas (14.9%), work through a for-profit (12.4%) or nonprofit agency (14.4%), or volunteer (11.9%).
For 17% of 159 respondents, birth doula work is their sole source of individual income.
Almost 15% of respondents do not rely on their birth doula work as a source of income.
About 33% of respondents said 10% to 20% of their individual yearly income comes from their work as a birth doula.
During the two years prior to this survey, each birth doula served an average of 20 clients. On average, less than half of those clients used public assistance.
Doulas spent an average of 12.4 hours with each client during the prenatal period, 19.1 hours during labor and delivery, and 7.6 hours during the postpartum period.
Almost 47% of 164 respondents offer clients two prenatal visits, birth support, and two postpartum visits.
Number of visits per client, n = 164
17% offer three prenatal visits, birth support, and three postpartum visits.
Some respondents indicated that they offer more than three prenatal visits, and others reported offering more than three postpartum visits. Oftentimes, participants noted, the number of visits is dependent on the clients’ needs:
“I do unlimited prenatal support. There’s no way I can truly get to know someone and who they are in a 2 hour sit down. We clean their house. Go shopping. Get coffee. Go on walks. Doulas should be sisters. Not hired professionals.”
— Respondent 156
On average, respondents charge clients $913.70 per birth. Most clients pay the birth doula directly as an out-of-pocket expense, but 49.7% of 163 respondents said they are volunteers or work on a pro-bono basis.
Payment and low-income clients
To find ways to work with clients who cannot afford to pay a birth doula, respondents:
Accept payments in installments (71% of 162 respondents)
Use a sliding scale based on clients’ income (54.9%)
Offer free services (42%)
Use a “pay what you can” policy (38.9%)
Those who selected “other” work with low-income populations and are paid through organizations such as Open Arms Perinatal Services, Global Perinatal Services, and Swedish Hospital’s Doula Program.
National Provider Identifier (NPI)
29.1% of 172 respondents use an NPI for their birth doula work
54.7% do not have an NPI
16.3% do not know what an NPI is