"My 9 to 5 Job Is Birth Work": A Case Study of Two Compensation Approaches for Community Doula Care.

Anu Manchikanti Gomez,Alli Cuentos,Jennet Arcara,Renee Mehra,Stephanie Arteaga,Cassondra J Marshall,Marna Armstead,Rachel G Logan,Andrea V Jackson

doi:10.3390/ijerph182010817

Abstract

With the increased policy emphasis on promoting doula care to advance birth equity in the United States, there is a vital need to identify sustainable and equitable approaches for compensation of community doulas, who serve clients experiencing the greatest barriers to optimal pregnancy-related outcomes. This case study explores two different approaches for compensating doulas (contractor versus hourly employment with benefits) utilized by SisterWeb San Francisco Community Doula Network in San Francisco, California. We conducted qualitative interviews with SisterWeb doulas in 2020 and 2021 and organizational leaders in 2020. Overall, leaders and doulas reported that the contractor approach, in which doulas were paid a flat fee per client, did not adequately compensate doulas, who regularly attend trainings and provide additional support for their clients (e.g., referrals to promote housing and food security). Additionally, this approach did not provide doulas with healthcare benefits, which was especially concerning during the COVID-19 pandemic. As hourly, benefited employees, doulas experienced a greater sense of financial security and wellbeing from receiving consistent pay, compensation for all time worked, and benefits such as health insurance and sick leave, allowing some to dedicate themselves to birth work. Our study suggests that efforts to promote community doula care must integrate structural solutions to provide appropriate compensation and benefits to doulas, simultaneously advancing birth equity and equitable labor conditions for community doulas.

Highlights

IntroductionAs health policy advocates and policymakers look toward doula care as an intervention to mitigate adverse maternal and infant health outcomes in the United States, examining the sustainability of providing this type of care has become crucial
SisterWeb leaders quickly realized that paying their doulas as independent contractors did not support their goal of providing sustainable employment for their community doulas, who work in cohorts, regularly attend trainings, and often provide additional support for their clients needing more intensive services beyond the scope of fee-based, private doula care models
This is in line with a 2019 report on community doula care models that outlined the many services community doulas provide beyond private doula care, including additional home visits, referrals to social services, engagement with community, and support over a longer period in the postpartum phase [6]

Summary

Introduction

As health policy advocates and policymakers look toward doula care as an intervention to mitigate adverse maternal and infant health outcomes in the United States, examining the sustainability of providing this type of care has become crucial. A doula is a nonclinical birth worker who provides physical, emotional, and informational support to a pregnant person during pregnancy, childbirth, and the postpartum period [1]. Doulas provide critical support for birthing people, working to ensure that their nonmedical needs are met by providing advocacy, advice, assistance, nonjudgmental support, and comfort [2,3]. Doulas help birthing people become informed about their care and birthing options and provide emotional reassurance throughout labor [3].

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