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A Labor of Love that Can’t Pay the Rent: 

A Call to Action for a Living Wage for Doulas

Today, you can make a short phone call that can lead to long-term positive change. The Minnesota House and Senate are considering bills HF 2846/SF 2923 to increase doula reimbursement rates for Medical Assistance to up to $2,000 per client. Increasing reimbursement for doula care will lead us closer to a living wage for doulas – and open the doors for more pregnant people to receive the guidance and crafted personal support that leads to better birth outcomes. Contacting your representatives in Minnesota to express your concern will help move legislative action forward.

Living wage for doulas

Right now a doula billing Minnesota Medicaid for their services to pregnant people can earn up to $770 (that’s $488 for the labor and delivery, and $47 for each prenatal and postpartum visit up to 6 total). To make just $30,000 per year before taxes, health insurance or any business expenses, a doula would need to serve 40 clients – just over 3 clients a month. Full time doulas typically cannot serve more than 36 clients a year. 

Here’s why: 

What do doulas do?

Throughout the prenatal period, the doula will have 2-3 visits with the client and countless texts and phone calls to navigate pregnancy decisions and pre-labor planning. They provide recommendations for resources like books and blogs – and help determine when another professional, like a chiropractor or physical therapist, can be helpful.

When a pregnant person moves closer to birthing, a doula answers calls and texts throughout the night and day to help the pregnant person understand the signs in their body and eventually to cope with early labor. They are available to help decide when it’s time to head to the birthing location or call the homebirth midwife. They provide continuous physical and emotional support throughout labor and birth. After the baby is born, the doula supports the client in the first few hours to promote bonding, supports initial chestfeeding and ensures that the client has what they need. Only then can they head home for some rest – or to their next client, family or other jobs.

Postpartum, the doula will pay two or more visits to a client to ensure that they are nourished, recovering from the birth, and that they have support. The doula ensures that breastfeeding is in place and that the client has access to healthcare services they may need (such as a mental health therapist or lactation consultant). 

This work is constant;  a full time doula is essentially on call 24/7 every day of the year, as the doula must be ready, around the clock, starting at 37 weeks for each client. 

The low compensation for work with clients enrolled in Medical Assistance makes the profession a labor of love that is incredibly demanding on time, family and financial resources. The end result is that fewer people become doulas and fewer birthing people have access to doulas as part of their perinatal journey.

Impacts of increased rates on access to doula care

The fundamental premise of good public health is to invest in prevention. Investing in doula care means lower healthcare costs overall, as doulas can help lower medical and surgical interventions. Doulas can also help increase rates of breast or chestfeeding, which in turn leads to better health for birthing people and their babies. Healthier families means lower healthcare costs for infection, hospitalization, or complications.

Paying a living wage to doulas can positively impact health disparities. Birthing Black, Indigenous and People of Color are more likely to die from pregnancy-related complications. They are also more likely to see their newborns die before their first birthday. 

Doulas give voice to their clients and advocate for their needs. Their care and concern representing each client as an individual narrows these gaps, and having a doula with lived experience as a BIPOC individual is even more powerful. BIPOC doulas and other diverse doulas are needed, but they cannot make a living on the current wages. 

Each infant or maternal sickness or death represents a person and a family struck by mostly preventable tragedy. The ripple effects carry throughout our state.

Call to action 

I urge you to call or email your legislators today. You can find who represents you here. A phone call is most impactful.

If you need inspiration or a structure for a letter to your senator or congressperson, you can take a look at this letter. It’s a collaborative support letter from insurance agencies, public health departments, nonprofits, and a whole spectrum of healthcare providers and organizations. Then add your personal message. Maybe it’s about your own labor and delivery. Maybe it’s about a friend’s experience. Maybe it’s about the data. Just make it your own, and reach out to your senator or congressperson today.

Written by Zomi Bloom