• Chloe Bernard

Updated: Jul 6, 2021

I would rephrase with "what do you actually pay for when you hire a doula"? If you think doulas are crooks or they exploit the situation of vulnerable parents to be millionnaires, maybe I won’t convince you, but if you want to understand the costs behind a doula’s fees, please keep reading.


Behind the fees of doulas, whose basic birth packages cost on average between 1000-1500€ in Finland, are all the obvious fees that parents can witness and experience but also all the "behind the scenes" expenses.


The visible:

  • Time spent with parents during pregnancy Preparing for birth, acquiring all the necessary knowledge to make powerful informed decisions. Building a strong birth team: connecting physically and spiritually. Establishing trust. This is the main key to navigate confidently and empowered through the Birth waves.

  • Time spent during labour, birth and immediate postpartum. I’ve been to births that lasted between 5 and 31 hours. Doulas tend to stay after the birth, keep company if baby is taken to NICU, help establish breast/chestfeeding, wait for parents to get a room and settle.

  • Time spent in early postpartum (postpartum home visit, debrief, postpartum care, sealing ceremony…). A few days after birth, emotions and tears might rise to the surface: questions, pride, regrets, fears, sometimes anger, mixed feelings that are difficult to untangled alone. It is important to express all these emotions, for each parent. Articulating one's dark cloud-feelings can help dissipate them. Having the attention one deserves, feeling validated, brings strength and confidence that can go a long way. All the physical and symbolic postpartum work, can support the release of stuck memories and the healing of traumas, in addition of accelerating the body recovery. These postpartum visits facilitate the transition.

  • Communication with the family Keeping in touch, keeping that link alive brings comfort to parents. Knowing that they are not alone and that they can contact their doula in case of doubt or to share both their joys and fears, is a relief.

  • Different material and accessories (TENS unit, electrodes, birth and peanut ball, books, affirmation cards, ethically made rebozos (from Antama for example), essential oils, gua sha combs, massage tools, etc.) Some birth accessories are expensive, take room and only serve during pregnancy or birth. Renting/borrowing is a great concept: ecological, economical and space saving. To me, there's even an emotional aspect to it: imagine using the same rebozo that helped birthing many babies before yours. Can you feel the strength of all these beautiful people? Can you feel that they are all behind you supporting you? I do. I want to.

  • Plants and minerals Organic herbs (for steaming), calendula and other flowers, essential oils (aromatherapy, postpartum womb massage), optional gem stones, palo santo, ingredients for ceremonies (raw cacao and spices), etc. I, like other doulas, want to work with the best quality and fair-trade products.

  • Food and travel Doulas don't teleport yet. Doulas still need to eat. Labour can be long, very long and doulas need that fuel to shake your apple tree.

  • Certified education Anyone can call themselves "a doula". There is no license per se. However there are certifications. Certified birth doulas have attended a doula training, either an international training such as DONA or CAPPA, or a local training in Finland such as Doulakka, Doules or Doula Akatemia. That means that they have not only completed the program (in my case about 400 hours), studying the physiology of birth, the protocols in place, hands-on techniques, but they are also committed to follow a standard of practice, and respect a code of ethics.


The invisible:

  • On-call time During this time the doula stays in the region, ready to join you any time, often in the middle of the night. Doulas are commited. They can't overlap with other clients to optimise for your birth. They also team up with a back-up doula to ensure that if any unfortunate impediment might occur (disease, accident), you wouldn't be left on your own.

  • Time preparing, shopping and cooking Your doula tries to tailor to your needs as much as possible. Depending on your existing knowledges or your special needs, they will deliver the best solutions, references, studies and contacts for your specific situation. They also need time to shop according to your situation or diet, preferences or possible allergies. When doulas cook for you (especially for the postpartum) it requires time too.

  • Time researching and connecting People have different needs and wishes. They might want to see an osteopath, an acupuncturist, or look for prenatal yoga or ballet courses. Doulas will suggest you professionals in their network or will work to find the best fit for you.

  • Continuous education A doula is learning and acquiring new skills constantly through workshops, courses or conferences, whether online or in-person, to better serve clients.

  • Time spent reading books and evidence based literature It is necessary to know the basics of birth and postnatal care literature but also keep up-to-date with last publications on the matter and most importantly all the significant and unbiased studies made about different interventions, procedures and protocols as well as the on-going research.

  • Writing Blog posts, guides, hand-outs. This can take time to collect and organise ideas in a pretty way.

  • Time spent on networking Doulas meet other professionals: other doulas like them or complementary perinatal professionals (midwives, physiotherapists, lactation consultants...) so they can choose the best back-up doula for their client, suggest a doula who better fits their requirements (specialty, mother tongue), refer them to specialists they trust and finally build up a solid perinatal community.

  • Website designing/building and hosting costs Whether "homemade" or created by a professional designer, websites take time, money and often both.

  • Marketing (business cards, ads) That is useful for us to find you and you to find us. Our business cards look also really good on your fridge or inside your Ina May's guide to Birth as a book-mark.

  • Cost of doula/birth association membership(s), for example Suomen Doulat or Aktiivinen Synnytys

  • Taxes! VAT in Finland is 24% (kind of one quarter, yes, that's a lot)


When I think of the benefits of such an investment, I have in mind all the medical aspects: less chances of needing an intervention, more chances of breast/chestfeeding success (if such is the wish of the parent), less time spent in the hospital. Moreover, I think of the emotional aspects, the possibly enhanced bond with the baby, the self-confidence as parents, all the well-being that material can’t buy. To see the full evidence on birth doulas, check out Rebecca Dekker’s website and the article Evidence on: Doulas.

First-time parents often overspend in childcare articles, a UK study revealed. Companies compete to sell you "indispensable" or "must have" accessories. What does a baby really need? Loving and caring parents, milk (human or manufactured), warmth, a safe place to sleep, nappies (not so many if you practice Elimination Communication), something to carry them and stay close (arms, sling, baby carrier).

What do new parents need? Feeling supported, validated, encouraged, loved. They need to rest, eat, keep hydrated and smell the sweet scent of their baby. They don’t need to worry about the rest.


If you struggle financially, there are still ways to hire a doula. We’ll see this in my next blog article, 7 steps to afford a doula.


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  • Chloe Bernard

Last year, I made this little lexicon to help my clients navigate through their journey in a smoother way. When you are pregnant in Finland, you meet nurses, doctors and midwives who speak Finnish or Swedish. Most of them speak English but you might be confronted to some "lost in translation" moments. I've got your back!





Abortti / raskaudenkeskeytys

Abortion

Termination of the pregnancy. It can be medical (induced with drugs) or surgical.


Akupainanta

Acupressure

Alternative Chinese medicine similar to acupuncture but without needles.


Akupunktio

Acupuncture

Traditional Chinese medicine using the meridians of the body to balance and heal. Very thin needles are screwed in the skin at strategic points. It can be used during pregnancy to alleviate discomfort, pain or to facilitate labour.


Aquarakkulat

Sterile water injection (aqua blisters)

A non-medical pain tricker. Hot feeling that makes diversion. The sterile water is injected just under your skin, in your back or lower belly. You can ask for refills.


B-ryhmän streptokokki

GBS

Group B Streptococcus also known as Group B Strep Infection (GBS) is a type of bacterial infection that can be found in a pregnant woman's vagina or rectum. This bacteria is normally found in the vagina and/or rectum of about 25% of all healthy, adult women. Women who test positive for GBS are said to be colonised.


Ballonki

Foley balloon catheter

This is a tool used as a mechanical induction method. The balloon is inserted in the cervix, then it is inflated with a saline solution and left in place while being taped to the thigh to provide gentle traction. When the balloon falls down, that means the cervix has opened. During this process, contractions usually start and labour follows.


Doula

Doula

A professional who offers you information and unconditional (emotional and physical) support through pregnancy, birth and beyond. There are different types of doulas: birth doulas, yoga doulas, water doulas, bereavement doulas, death doulas, postpartum doulas. Some doulas are even specialised in adoption or surrogacy. Doulas are there to facilitate all types of transitions.


Emätin

Vagina

Magical organ with superpowers that some men fear. It is an elastic, muscular canal with a soft lining which connects the uterus to the outside world.


Epiduraali

Epidural

Injection of anaesthetic and/or analgesic in the epidural space.


Episiotomia / välilihan leikkaus

Episiotomy

A surgical cut made at the opening of the vagina during childbirth, to aid a difficult delivery or to enlarge the vaginal opening during a vacuum-assisted delivery. Traditionally, it used to be practised systematically to avoid tears. Since then, evidence based medicine has refuted the theory and tears, healing faster and better, are preferred to a surgical cut that can lead to further damages and challenge the mother’s quality of life.


Gua sha kampa

Gua sha comb

A traditional Chinese medicine massage tool that looks like a comb, a fish, an heart, made of jade, quartz, bone or wood. It is use to scrap or spoon the skin. A way to relax, release tensions, during pregnancy, birth and after.


Hieronta

Massage

One of the tools we have to relieve pain, relax, and stimulate oxytocin production.


Hypnoosi

Hypnosis

Self induced state of relaxation. Technique to enter and stay in a safe bubble. The mind-body fantastic relationship.


Häpyhuulet

Labia

Lips of the vulva.


Häpykieli / Klitoris

Clitoris

The female organ that focuses on pleasure only. Its full shape has recently been discovered.


Ilokaasu

Laughing gas

Nitrous oxide (nitrox) is used as a pain relief during labour. The birthing person inhales the gas through a mask. The gas formula is N2O.


Imetys

Breastfeeding/Chestfeeding

Gastronomic exchange of oxytocin. Soothes and reassures baby. Helps mummy/parent to get a restorative sleep, bond with their baby and so much more.


Imukuppi

Vacuum extractor

The vacuum device uses a soft cup that attaches to the baby’s head with suction and guides the baby’s expulsion through the birth canal.


Istukka

Placenta

The placenta (a type of cake, in Latin) is a temporary organ that connects the developing fetus via the umbilical cord to the uterine wall to allow nutrient uptake, thermo-regulation, waste elimination, and gas exchange via the mother's blood supply; to fight against internal infection; and to produce hormones which support pregnancy.


Joogamatto

Yoga mat

Thick mat with a grip which doesn’t damage the knee caps.


Jumppapallo

Birthing ball (gym ball)

It helps you dance your baby down, sitting. You can also hug it while your doula gently sifts your belly or shakes your apples with her rebozo.


Kaksoset

Twins

Two for the price of one birth. Twice more love and twice more everything.


Kalvojen pyörittely

Membranes sweeping (stripping)

Mechanical labour induction technique. A doctor or midwife will use a gloved hand to sweep the inside of the cervix in a circular motion.


Keisarinleikkaus / sektio

C-section / Belly birth

This is one of the possible entrances for babies into our world. This is a surgery which can be elective (elektiivinen keisarileikkaus), urgent (kiireellinen keisarileikkaus) or emergent (hätäkeisarileikkaus).


Keskenmeno

Miscarriage

When the pregnancy involuntarily stops.


Kivunlievitys

Pain relief

Tools, medical or non-medical, to alleviate the pain.


Kohdunkaula

Cervix

The womb’s turtle neck.


Kotisynnytys

Homebirth

Birth in your own very familiar nest. Your bed, your fridge, your shower, your smell and friendly bacteria.


Kyykky

Squatting

An art and a strategic position for pregnancy and birth. Relaxes the pelvic floor and strengthens the legs. And it doesn’t press your tail bone, making more room for baby’s exit.


Kätilö

Midwife

Midwives are medically trained to assist families during pregnancy and birth. They also deal with female reproductive health and menopause.


Lantionpohja

Pelvic floor

The layer of muscles that support the pelvic organs (uterus, bladder and bowels). It is often referred as a hammock.


Lapsivesi

Amniotic fluid

Protective water contained in the amniotic sac. Not pee. Not discharge. It is slightly shiny and smells sweet like an areola. Coincidence? I don’t think so.


Lääkäri

Doctor

You might meet one if you encounter challenges before or during the birth. If not, you’ll meet one at your post partum check up, about 6 weeks after birth.


Mikrobiomi

Microbiome

The microbiome is the genetic material of all the microbes (bacteria, fungi, protozoa and viruses) that live on the skin and inside the human body.


Nänni

Nipple

The female part of the breast that is too often censured on social media.


Nännien stimulointi

Nipple stimulation

When nipples are stimulated (with the person’s consent) the body might secrete oxytocin, which relaxes or excites the person and can help induce the start of labour if the conditions are present.


Napanuoran myöhäinen katkaisu

Delayed cord clamping

It’s when you wait for your baby’s umbilical cord to be empty of blood (and nutrients, ferritin, oxygen etc.) and stop pulsate, so your baby gets the maximum amount of goodness to thrive. (3-10mn).


Napanuora

Umbilical cord

The conduit connecting the placenta to the navel of the fetus or baby. Contains two arteries and one vein buried in Wharton’s jelly. The average length is 55cm but it can rarely be longer than 1m and in this case the midwife must bake a cake for her colleagues. That’s the tradition.


Närästys

Heartburn

Heartburn is a painful burning feeling in the chest or throat. It happens when stomach acid backs up into the oesophagus. During pregnancy, the hormone progesterone causes the valve to relax, which can increase the frequency of heartburns.


Oksitosiini

Oxytocin

The love hormone involved in love making but also labour progress, breastfeeding and bonding.


Pähkinäpallo

Peanut ball

This is peanut shaped ball created for pilates but used more and more during labour to mobilise the pelvis while lying down. Placed between the legs of the birthing person, the peanut ball can significantly shorten the length of the second phase of labour.


Peräaukko

Anus

The beginning of the end.


Peräpukama

Haemorrhoids

Haemorrhoids, also known as piles, are swellings containing enlarged blood vessels inside or around the rectum and anus. During pregnancy, piles (just like varicose veins) can occur because hormones make the veins relax. Fortunately, they retract once the baby is born.


Perätila

Breech

When your baby is ready to enter the world bum/feet/foot first.


Pre-eklampsia

Pre-eclampsia

Pre-eclampsia is a serious condition. Symptoms might be: high blood pressure, blurred vision, headaches, swelling.


Prostaglandiini

Prostaglandins

They are synthesised within the human foetal membranes (amnion and chorion) and decidua and act to ripen the cervix, change membrane structure and contract the myometrium (middle layer of the uterine wall).


Raskaus

Pregnancy

A pregnant woman's placenta produces hCG (human chorionic gonadotropin), also called the pregnancy hormone. If you're pregnant, an urine pregnancy test can detect this hormone in your urine from about 1 day after your first missed period.


Raskausdiabetes

Gestational diabetes

Too much sugar in the blood during pregnancy. The condition disappears after childbirth.


Rebozo

Rebozo

A beautiful shawl traditionally made in Mexico or Guatemala to carry merchandise and children. It is also a piece of fashion. Traditional midwives use the shawl to massage pregnant women and new mothers. They also use this tool to help the baby rotate and descend in the birth canal in an optimal position.


Repeytyminen

Tearing

When pressure and pushes lacerates the perineum, vulva or vagina. Some tears require stitches, others don’t. A tear heals faster than a straight cut (episiotomy) because it follows the fibres of your skin tissue.


Sikiökalvojen puhkaisu

Rupture of membranes

Rupture of membranes (ROM) or amniorrhexis is a term used during pregnancy to describe a rupture of the amniotic sac. Normally, it occurs spontaneously at full term during labour. Rarely, it doesn’t happen and the baby is born “en caul”. Rupture of the membranes is known colloquially as "breaking the water”. Membranes are sometimes artificially broken to kick start or accelerate labour.


Spinaali

Spinal

Single dose anaesthetic injection in the spinal fluid. Acts quickly in numbing the saddle area. The risks are hypotension, difficulty to push, severe itching, headache, medication crosses the baby bloodstream, challenged breastfeeding.


Supistus

Contractions

Oh, the c-word. Call them “surges” just like Ina May Gaskin does. Suddenly these waves are more pleasurable.


Synnytyksen käynnistys

Birth induction

When nature is assisted by the human’s touch.


Synnytys

Birth

A new beginning.


Synnytys laskettu aika

Due date

Are babies just like industrial pizzas? Let’s talk about an approximate due month, shall we?


Synnytysosasto

Delivery ward

This is the ward dedicated to birth.


Syntymärefleksi

Fetal ejection reflex (FER)

This is a natural process happening during an undisturbed birth. High levels of adrenaline can trigger the foetal ejection reflex. The surge triggers strong, rapid contractions which move the baby from the uterus and into the birth canal. The pressure of the baby in the vagina stimulates the Ferguson reflex, which is the uncontrollable expulsion of the baby, which happens when nerves in the pelvis are stimulated as the baby descends through the birth canal. This biofeedback sends messages to the brain to release even more oxytocin, resulting in two or three strong contractions. The baby is born quickly and easily without voluntary pushing from the mother. More about FER.


Testi

Test

Like in ovulation test, pregnancy test, amniotic fluid test, GBS+ test.


Tens-laite

Tens machine / Tens unit

Transcutaneous Electrical Nerve Stimulation. Electrodes are sticked on your skin and you press a button to deliver an electric shock. It feels like thousands needles. Another pain tricker that makes endorphins kick in.


Ultraääni

Ultrasound

Type of imagery that uses sound waves to produces pictures of the inside of the body. It helps dating the pregnancy and the child’s healthy development. In Finland there are 2 routine ultrasounds: the early pregnancy ultrasound scan, (week 10+0 – 13+6) and the structural ultrasound scan (week 19–21).


Vyöterapia

Reflexology

Similar to acupressure but specialised in hands and feet. Each spot is linked to an organ or system.


Äitiysloma

Maternity leave

In Finland, you get a maternity allowance for 105 working days minimum (4 months). After the maternity leave, there is the parental leave to share as you agree with the partner. More info on Kela’s website.

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  • Chloe Bernard

Last Summer, Sophie Messager had a message for all of us, explained in a 9 chapter-book called Why Postnatal Recovery Matters (Pinter & Martin).


"A doula is like a Sherpa. If you were going to climb Everest, you would take your partner, but you would also hire someone to help you navigate the mountain."

The author, Sophie Messager, is a birth and postpartum doula based in Cambridge, United Kingdom. This is how she describes the profession: "A doula is like a Sherpa. If you were going to climb Everest, you would take your partner, but you would also hire someone to help you navigate the mountain."


She starts her book by recalling ancient wisdom and traditional postpartum practices from all over the world. As a doula, I knew more about Chinese, Indonesian or Mexican traditions rather than European ones. It was refreshing, here, to learn a little bit more about old English postpartum rituals and recipes (such as the recipe of the Groaning cake). This gives me hope to rediscover and restore some old French or Celtic postnatal traditions, as long as they provide comfort and support the new parents.



Why Postnatal Recovery Matters
Cover by Blok Graphic, illustration by Lucy Davey

Sophie presents these four keys to a successful recovery:

  1. Rest: Extreme tiredness can be avoided if you have the right support.

  2. Food and drinks: Comforting and nourishing foods and drinks are necessary to repair damaged tissues and promote milk production.

  3. Social support: Loneliness is met by 80% of new mothers. First months can be monotonous and isolating. Adult interaction is essential.

  4. Body work: After a wonderful job, the rather amazing postpartum body needs nurturing (closing the bones, wrapping the hips, massaging...). This has been forgotten in Western countries. What else? Pelvic floor re-education is offered to all new mothers in France. Why isn't that a priority in other countries? Why does society focus on your mom bod, your stretch marks, your saggy breasts and expect you to bounce back in the twinkle of an eye?

So you read this list and you wonder, how is it possible? What are people going to think of me if I don't manage on my own? Isn't that a luxury? This is well explained and it is when the village intervenes.

There are all these limitative thoughts that prevent us from asking for support. There are also polite habits pushed on us. In some cases, there is no free support available: no family, no friends around. It is then suggested to hire professional help such as postpartum doulas, lactation consultants, cleaners, housekeepers etc.


On the other hand... This is ultra complicated for first time parents to set up boundaries, to limit visits in the hospital, to refuse to host well-meaning guests who bring (sometimes useless) token-gifts and want to pass the baby from hand to hand, expect to get served, offered refreshments and leave the dishes undone. The book gives tips on how to set up boundaries and ask for much needed help (laundry, dishes, cooking, walking the dog) in a diplomatic way.


We tend to forget about postpartum. It is often relegated as the prologue of birth, instead of being invested and recognised as the epilogue of a strong bond between a mother (a parent) and a child, a united family. This vulnerable time can affect (negatively or positively) the family for months, years, decades or even generations.


Sophie mentions how it is complicated to explain to a future mother/parent what they will need before they can even experience it.


There are heartfelt testimonials of women who went through postpartum (the good, but also the bad and the ugly) which will help future parents better visualise, feel and prepare what is coming.

These postpartum stories are filled with gratefulness, regrets, envy, hopes and wishes for an empowering postnatal experience, a better care for new mothers, new parents, in our countries, a real desire for a re-focus on the person who just gave birth.


New babies don't care about clothes and stuffed toys: what they need most are parents who feel strong enough to support them

As an ex-biologist and researcher, Sophie always shares studies, statistics and references to back up her findings.

One conclusion is shattering to me: According to a survey, new parents spend a lot of money on a new baby, splashing out an average of 1600£ on equipment alone and 10000£ on the first year (about 1783€ on equipment and 11143€ in total, on the first year). So much pressure from marketers that parents feel the urge to give in. 90% of parents admitted having overspent on baby equipment, with an average of 5567£ (6203€) wasted . Babies certainly don't need that much; a place to sleep, some clothes and nappies and a sling could be enough. Second-hands items are also great, for your budget and for the planet.

As Sophie writes it: "New babies don't care about clothes and stuffed toys: what they need most are parents who feel strong enough to support them."

I appreciate very much that Sophie adds a chapter dedicated to special circumstances and suggests adaptations or integrations to a postpartum plan. Solo-mums, NICU babies, complications at birth, still births, miscarriages or other pregnancy losses. She shares her own very personal and touching experience with miscarriages and invites the grieving hearts to a postpartum treatment. Why would you be treated differently? Your body and your soul went through the same journey as if your baby was alive. Keep warm, eat well, rest, wrap your pelvis and surround yourself with lovely people. You don't deserve any less.


Sophie's dear wish is to shift the mindset of many people who wrongly think that the sooner the new mother "bounces back", the better. They value independence as the ultimate asset, instead of appreciating interdependence or what collective effort brings to the game. She hopes, just as I do, that the more mothers experience a supported postpartum, the more it will become the norm.


Just like Michel Odent shares the view that a respected birth can change the society, Sophie Messager shares the view that a nurtured postpartum can also transform the world. That is powerful, and it is a power we all have.


I recommend this useful little guide for future parents (and their parents). It contains a precious bibliography, some nutritious and delicious recipes, contacts of different British associations, and lots of tips. 150 pages of wisdom that fits in your pocket and only costs about 10€. A good investment.

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