2. Experience: While I never ever want a woman to go without a doula for cost reasons alone, I have to consider that prices, more than anything else, are set by experience. Many brand new doulas just out of training are willing to volunteer their time in exchange for evaluation paper they can use for DONA certification. Other new doulas charge a nominal fee that helps to pay for their costs. As a doula gains experience, and in some cases becomes certified, she raises her prices, because it really isn't fair to undercut new doulas or they will never ever get any clients. If you could pay $300 for a doula with 6 births of experience or 22 births of experience, you would probably choose the more experienced doula, at least to interview. (This is not discounting that most doula/client matches are based on connection, but just that people often choose who they want to interview based on price and experience, and then choose the best fit from the small handful of doulas they met in person)
3. On-call childcare: This is a huge one, you don't ever want to have the phone ring at 7:30 a.m. and realize you have no one to ready to watch your kids and no way for them to get to school. I am very lucky to have a wonderful friend and neighbor who always answers her door, even if she is bleary-eyed and in her pajamas. I pay her per child, per hour, as well as a set fee just to be on call, even if I end up not needing her.
4. Lifestyle alterations: For myself, being on-call means sacrifices that are often unseen. I often cannot drink alcohol or take any sleeping or cold medication for weeks or months at a time. I miss family events, such as my niece's ballet recital, because I cannot travel to Olympia for the day. Even small vacations must be scheduled months in advanced and require me to take six weeks off of work because of the unpredictable nature of when babies may arrive.
5. Missed work with no notice: In addition to doula work, I also nanny for a 3 year old girl four days a week. If I get called to a birth, not only do I miss my wages for that day (or several days!) but the girl's mother also has to have back-up on-call childcare available for her daughter as well. I'm lucky she is a very understanding boss or I wouldn't be able to do the work that I do.
So now you can see there are many things the fee is covering that don't seem as obvious as "Well, my labor was 6 hours long, so that's $100 an hour, which is way too much!"
The reason that doulas do not even want to charge by the hour, or offer discounts to those who deliver quickly, or early, is because for every woman who has her baby in 3 hours at 36 weeks and didn't get both of her prenatals in, there is another woman who doesn't deliver until 42 weeks and calls for support 40 hours before her baby is born. I never ever ever want a laboring woman to be thinking, "I'd better have this baby soon, I can't afford any more hours of doula care." So for the doula, it balances out.
If prenatals are missed because of early delivery, more postpartum care will always be offered. The mother can decline this care of course, but it does not reduce the fee.
If a family is financially struggling, they are welcome and encouraged to work out a payment plan or barter system before the baby is born. If no plan is in place, the full base fee is due at the post-partum appointment. It's pretty much everyone's dream to get paid to do what they love to do, but it is still a business and a livelihood. It comes down to the fact that without the fee, I wouldn't be able to afford to do this.