In researching and interviewing doulas to join your care team, you will encounter two specific practices of doulas: solo doulas and group practices. A solo doula is an individual who provides all the perinatal and birth support for their clients. Solo doulas can work independently or be associated with an agency. An agency serves as an umbrella organization, working to link clients to individual doulas.
A group doula practice brings together a team of doulas with a shared philosophy and approach to supporting clients. A group doula practice has shared responsibility of providing perinatal and birth support, which translates into better care. When doulas are supported and pool their resources and knowledge together, you benefit through high quality, consistent, professionally-catered care.
As a doula with 21 years of experience – the first 15 years as a solo doula before creating a group doula practice – I feel uniquely situated to talk about the differences between both practice models. Ultimately, a group doula model is sustainable for the doulas supporting our birthing community. There are five key reasons why I am so dedicated to a group doula model as a means to ensure the best care for birthing people, including the advantages of experience, availability and dependability, quality, price, and the promotion of health equity.
Solo v. Group: Experience
The most recent national survey of doulas reported a majority of doulas practice as solo doulas and these same doulas only attend, on average, nine births per year.
In contrast, the average DCBD doula – because of the group model – attends 36-48 births a year (3-4 births per month). Group practice doulas not only learn from the sheer volume of births they personally attend, but they also learn from one another. When one of our doulas is at a birth, they are in touch with their team and can ask for new ideas, coaching, or a different perspective.
The learning curve is steep and lonely for solo doulas without a mentor or colleagues to learn from. The growth curve for group practice doulas is accelerated because each doula learns from their own births and each doula on the team. They are learning skills in the first few months of practicing that it took me, as a solo doula, years to achieve.
In addition to what we learn in the birth room, our DCBD doulas also attend at least 24 hours of specialized skills training throughout the year. We build on our basic birth skills, including training to provide trauma-informed care, release fear and anxiety, and techniques to help your baby move into better positions for labor. Our doulas also participate in weekly case reviews and have access to peer mentoring from more senior doulas on the team. All of this additional collaborative learning is in addition to maintaining their formal doula certification requirements.
The benefits of training, mentorship, case review and collaboration that define group practice is passed onto our clients. As a result, DCBD has a documented track record of providing consistent, high quality care as evidenced by the hundreds of reviews on Yelp, Facebook or Google.
Solo v. Group: Availability & Dependability
All doulas promise to be available 24/7 for their clients. Solo doulas have a back up plan in place for when they can’t make this happen. What does that look like? First, solo doulas typically try to stagger their clients’ due dates, and then commit to being available for your birth during a specified window of time – usually during 37-42 weeks pregnancy. While staggering clients may help, birth and life are notoriously unpredictable. You may go into labor at 35 weeks, at the same time as someone else, or immediately after your doula has finished another birth. You may require labor support for multiple days. Your doula may be sick, get into a car accident, be unable to find childcare or need to care for a family member. Second, solo doulas prepare for these contingencies by working formally or informally with a “back-up doula”: a doula who would attend births on their behalf in case they are out of town, sick, or otherwise unable to support you at a birth. This “back-up doula” may not be someone you have met or spoken to and may not share the same experience or approach as your chosen doula. Solo doulas want to be there for their clients 24/7 and they work hard to make that happen, but the fact is, they are just one person.
How does a group doula practice ensure they are available for you 24/7? While birth and life are still unpredictable for group doula practices, a shared call-schedule and a team of doulas creates a built in system for dealing with contingencies. This stability and reassurance is passed onto you, our clients. You will always have a team of doulas ready to support your birth no matter when you go into labor. You will always have a doula ready to support you even if another client is in labor at the same time. When we are at your birth, we are focused on you and not on other clients. After 24 hours of in-person labor support, the team will send in a second well-rested doula ready to support you for the rest of your birth. For life emergencies, like if a doula is sick, gets into a car accident, or experiences a house fire, you know we have a deep bench of healthy and available doulas ready to step in. It’s the ultimate feeling of “we’ve got your back” because there’s a whole team of doulas to make sure that happens.
Solo v. Group: Quality
Being available 24/7 for clients is a significant responsibility. For a solo doula this means they are responsible for responding to a client while they are in the movie theater, swimming laps, watching their child perform, finishing a glass of wine, hosting a birthday party, or at your birth. They are literally always on – as in tuned in and attentive to their phone. The inability to take a break from work can be mentally, physically, and emotionally fatiguing. On top of that, solo-doulas still have to be available for other clients while they are supporting you at your birth or while they are recovering from another birth. The fatigue of continuous on-call responsibilities and the challenges of juggling timing and availability for solo-doulas, through no fault of their own, inevitably impact the quality of services provided. Doulas from a group practice, on the other hand, have the rest and support they need to do their job well. Work fatigue is not good for the health of any worker and leads to poor performance, including “slowed reaction time, reduced vigilance, reduced decision-making ability, poor judgment, distraction during complex tasks, and loss of awareness in critical situations.” A group doula practice designed to prevent workplace fatigue helps ensure that you get the best quality doula support available.
In addition, a group practice holds each other accountable to the highest standards of catered care. We review one another’s prenatal, birth, and postpartum notes, phone call conversations, and email correspondence to ensure both quality and customized service. Everything a group doula does reflects on the group practice and on each doula in the practice. The owner (that would be me) screens and vets each doula to make sure that only doulas who share common values and who are willing to adhere to shared practice standards are hired and remain on the team.
Finally, a group model provides an alternative path for course correction. If for some reason you aren’t happy with your service, you can talk to another doula on the team, the team supervisor, or the company owner to find a resolution. In contrast, a solo doula is not professionally accountable to anyone except their certifying organization. If you are not happy with services received by a solo doula, while you could confront the doula directly, this type of conversation can be challenging at best.
Solo v. Group: Price
Due to the challenges of availability, a solo doula may need to limit the number of clients they work with each month to help them meet the needs of each of their clients. With the need to accept fewer clients, solo doulas may need to charge a premium for their service with a fee of $1,800-$2,500 per client. Solo doulas also have to be protective of their time and resources (and by resources, I mean sleep). Solo doulas know they may not have time to sleep and recover between long births. As a result, they may try to limit how much time they spend with each client. To achieve this, it is common practice in the solo-doula world to charge clients an hourly rate after the first 12 hours of labor support. With a group practice we are able to charge a mid-market rate to provide a top-market service because we have a broader client base and a deeper bench of doulas to support multiple clients at once.
Solo v. Group: Health Equity
Solo doula services, with the premium price tag and workforce barriers related to availability, childcare, mentorship, and call schedules can exclude clients and birth workers from all but the most privileged communities. The national survey of doulas confirms that the majority of doulas practicing are middle-class, white women earning a secondary income. As more and more doulas are trying to figure out how to shift from a part-time to full-time professional career, especially from low-resourced communities and households where they are the primary income earner, solo doula work is not sustainable.
Currently doula services are largely excluded from most insurance provider benefits and most clients pay for doula services as a private fee-for-service. However, experts agree that the use of doulas could be one of the most powerful tools used to combat the maternal mortality crisis our country is facing. The Cochrane systematic reviews found that the benefits of doula support include a 39% reduction in the likelihood of cesarean birth, a 15% greater likelihood of a spontaneous vaginal birth, a 10% reduction in the use of pain medications, a shorter labor by an average of 41 minutes, and a 31% reduction in reporting negative birth experiences.
Other studies have found, as detailed by Ancient Song Doula Services and other community-based doula organizations, that perinatal community-based doula support is associated with lower rates of preterm and low birthweight births and postpartum depression and higher rates of breastfeeding initiation and duration. As a result, the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM), state in the Safe Prevention of the Primary Cesarean Delivery that continuous labor support by a doula is “one of the most effective tools to improve labor and delivery outcomes.”
There is no single solution to address maternal mortality – especially because food and housing security, the stress of systemic racism, iatrogenic medicine, a lack of culturally congruent care and more are all part of the problem. However, while we are working with our community to address one piece of the health equity puzzle – expanding public and private insurance benefits to cover doula support – we are also refining another piece of the health equity puzzle – creating a doula practice model that trains, supports, and helps to sustain an inclusive workforce.We know that solo doulas are passionate, skilled, hardworking, and might still be the right fit for you. However, we believe that collaborative care through an inclusive group doula practice is designed to more consistently provide the highest quality catered care for a more affordable price to a wider range of communities. We believe group care is the future of doula work, and invite you to learn more at one of our upcoming Meet the Doula Events!