I was inspired to write this blog by the Queen herself, fellow doula, Victoria Wilson. Owner of Mother Well Doula, located in central Kentucky. I’ve attended Victoria’s webinars & watched so many of her videos on YouTube. She has been a pivotal piece in my birthwork journey. She shared her presentation at the recent DONA Summit & inspired me to explore the topic of What’s a Doula’s Worth? I fell down the deepest rabbit hole researching almost everything.
You done messed up, A. A. Ron!
Last year, after I hopped on the NYS Medicaid doula benefit rollout, shortly after, my business went into the red. I didn’t expect denials or supporting families for free. I feel bad mentioning this because it’s not my client’s fault, when they see the reimbursement rates they are floored. Meetings with my financial advisor feels like Parent-Teacher Conferences, not the good ones. My financial advisor has (deservingly) climbed the ranks in his career. He’s a VP now. He wears those tight-fitting pants & shiny shoes. I was contemplating shutting my business down. He will be contacting me soon & my stomach hurts.
During our last meeting, he asked for an hourly breakdown of my income, my business expenses, etc. He’s still trying to help me find a way & I pray he never reads my comment about his pants. Victoria & my advisor led me to this space for a reason. After I compiled this info, I started writing this blog.
The cost of birth support in New York
In New York City, birth doulas typically charge between $2,000-$3,000 per client, but after business expenses, taxes & 65-95 hours of work, most take home around $1,300-$1,400, or about $14-$21 an hour. Here’s a breakdown of what that looks like & how it compares to the current New York State Medicaid doula reimbursement rate.
doula Services breakdown
People often see a doula’s fee & picture someone showing up for birth, not realizing everything that happens before & after. At times, hospitals treat us like we just met our clients. Birth doula support includes months of preparation (dependent on when our client signs on with us), education, emotional support & on-call commitment. Expectant families have started working with me as early as 9 weeks into their pregnancy. Each case is different, but the reality remains that many expectant families in New York face significant health disparities. Many doulas support families through high-risk, medically complex pregnancies & postpartum recoveries.
There are many doula agencies & organizations across New York City that birth doulas work with. There are also independent community-based doulas who are solo business owners that fund everything themselves. We’ll walk through what independent doulas in NYC typically charge, the costs behind running a business in NY & what the New York Medicaid reimbursement rate brings to the table.
When families understand what’s behind our fee, they see the value of our services. At least that’s what we hope for.
Standard NYC birth doula package typically includes:
Prenatal Visits: 2-3 sessions, each 1-3 hours
On-Call Period: 24/7 availability from 37 weeks until birth (approx 4 weeks on-call)
Labor & Birth Support: 10-20 hours (sometimes 30+)
Postpartum Visits: 1-2 sessions, each 1-3 hours
Between Visits: unlimited text, email & phone support, approximately 3-5 hours total, based on the individual needs of each family.
That is a (potential) total of approximately 35–50 hours of direct client care
This is based on the average approximate range that birthworkers have shared. The range many vary based on the doula’s personal practice.
Behind The Scenes
Running a solo doula business means we’re the bookkeeper, marketer, content creator, scheduler, social-media manager, admin, customer-service rep, tech support, graphic designer, photographer, self-therapist, chile I’m tired just typing this out. This is the life of an entrepreneur. The work doesn’t stop when we leave a client’s home or leave their birth space. There’s prep, lots of education, follow-up & multiple interactions that no one ever sees.
Behind-the-Scenes Work
Approx. Hours per Client (avg)
Client onboarding, forms & contracts 2-3 hrs
Intake calls, check-ins, DMs, texts 2-4 hrs
Research, resource creation, referrals 2 hrs
Between-visit communication (text, email, phone) 3-5 hrs
Travel to/from prenatal, birth, postpartum visits 10 hrs
Documentation, charting, billing 2 hrs
Marketing & social media content 5-10 hrs (min. weekly)
Continuing education & research 3-5 hrs
Networking & community outreach 2-3 hrs
Debriefing, receiving mentorship/perspective from other birth professionals 1-2 hrs
That is a total of approximately 30-45 hours per client cycle
Adding it all together, NYC doulas can spend 65-95 hours per client in direct care & admin work, while on-call 24/7 for (potentially) multiple families at one time.
What It Costs to Run a Doula Business in NYC
Operations & Admin
Website + domain + hosting $40-$80/mo
Scheduling + contract software $25-$60/mo
Professional email/accounting tools $25-$50/mo
Payment processing 3-3.5 % per transaction (includes all associated fees)
Marketing & Outreach
Canva Pro, social ads, flyers, community events $50-$100/mo
Branding + SEO updates $300-$600/yr (dependent on business)
Professional Costs
Liability insurance $350-$500/yr
Continuing education/recertification $500-$900/yr (CEUs are required for many of us)
Directory listings/memberships $100-$250/yr
Client Expenses
Supplies (PPE, snacks/meals during labor, comfort tools, birth bag supplies) $150-$300/client
Transportation (gas, tolls, parking, MTA) $40-$150/client
Taxes & Self-Employment
Self-employment + state/federal tax 30%
Health care, retirement & sick time are self-funded.
This reflects the expenses of a birth doula without children under the age of 18. I don’t want to incorrectly add any data to this breakdown, it has been some time since I had littles :(
Expenses Per Client:
Direct expenses: $300
Operational costs: $150-$200
Payment processing fees: $75
Plus, small fluctuations/padding (parking, extra supplies, etc.): $25
Low End Total of Expenses: $550
What Does That Mean in Numbers?
Example-Private Client
Client fee: $2,500 (avg)
Expenses: -$550
Taxable income: $1,950
Taxes (30%): -$585
Net Take-Home: $1,365
Hourly Rate $14-$21/hr
With a $2,500 fee, NYC doulas may take home about $1,300-$1,400 per client, roughly $14-$21 an hour for specialized, on-call, emotionally intensive work.
NYS Medicaid Reimbursement, Doula Benefit
The Medicaid Doula Benefit was an important historic first step toward equity & access, but it still doesn’t cover the actual time, energy & expenses of birthwork in New York City.
The answer isn’t to do away with the doula Medicaid benefit, but to make sure future reimbursement reflects a thriveable wage. Anything else will be unacceptable. Future doulas deserve better than what is currently in place.
A thriveable wage refers to a wage that allows employees to not only meet their basic living needs but also to thrive personally and professionally. It is often seen as a higher minimum wage that accounts for additional expenses such as travel, hobbies, and family support, beyond just covering basic necessities. For example, some companies set a thriving wage around $67,000/year, with automatic annual raises, ensuring that employees can afford to live comfortably and pursue their interests. This concept emphasizes the importance of financial security in addition to basic survival, promoting overall well-being and productivity (Less Annoying Business)
According to the New York State Department of Health & eMedNY, the current fee schedule for NYS Medicaid reimbursement for doula services is:
Up to $1,500 per client in New York City
Up to $1,350 per client outside NYC (Upstate, Long Island)
This reimbursement rate covers 8 visits that can be used for prenatal/postpartum support. Labor/delivery is covered & billed separately from the 8 visits. The full $1,500 rate only applies when all eight visits & labor support are completed. If fewer visits are used, payment/reimbursement is lower.
Private vs Medicaid Reimbursement
Hours Worked 65-95
Private Client Average Fee $2,500
NYC Medicaid Rate up to $1,500
Avg. Expenses per Client $550
Subtotal (after expenses)
Private Client $1,950 (-30% in taxes-$585)
NYC Medicaid Rate $950 (-30% in taxes-$285)
Net Take-Home Pay
Private Client $1,365
NYC Medicaid $665
Hourly Rate
Private Client approx $14-$21/hr
NYC Medicaid approx $7-$10/hr
For NYS Medicaid doulas that work outside of NYC, the reimbursement for doula services is $1,350 instead of $1,500, the take-home drops to approx. $560, about $6-$9 per hour.
The gap in reimbursement that currently exists often forces community-based doulas to choose between serving Medicaid families & financial survival. Expanding access without supporting sustainability isn’t equity, even if it’s highlighted as advancement. This leads to birthwork becoming a revolving door profession. Handing this over to future doulas doesn’t feel right, at all.
Medicaid reimburses up to eight perinatal visits plus one labor/delivery encounter, the rest of the work that makes doula care possible, on-call time, travel, communication & admin remains unfunded (does not meet criteria for billing/payment) under the NYS Medicaid benefit.
There is no deposit associated with Medicaid reimbursement (like what exists for private pay clients), doulas begin care without any upfront payment, sometimes working for weeks or months before meeting criteria to bill for an encounter & receive payment. If claims are denied, the doula absorbs the loss entirely.
Our Most Sacred CurrencY: Time
Doulas may also invest in:
Community building: advocacy, showing up for local families, networking & community events
Professional development: staying up to date on current evidence-based practices
Continued debriefing: processing births, loss & systemic challenges
Client care outside the room: texting, phone calls, referrals, checking in long after contracts end
Doulas Have Admitted To:
Not having savings, retirement contributions, time for their families, adequate rest & healthcare
Burnout
Inadequate time off due to fear of not being able to make ends meet
Being on public assistance
Experiencing mental health crises due to traumatic experiences
Limited emotional support
Being excluded from their client’s care team in the hospital setting
Being excluded from major decisions regarding their work
Being treated disrespectfully in the hospital setting
Working two or more jobs to meet the income requirements of their household
Taking on more clients to balance income
Disruption of their family dynamics, missing family events, challenges within their marriage/relationships
Pouring all earnings back into their business, not being paid a salary for years
Thriveable Wages for nyc doulas
Thriveable wages for all doulas across the world. Thriveable compensation for our expertise, presence & care makes birth safer & more supported. Compensation that allows us to continue reducing maternal health disparities worldwide. The hours, emotional labor & financial investment are the same whether a client pays privately or through Medicaid. The difference is what the doula earns & whether it’s sustainable to keep offering that care long-term.
When our services are underpriced, when reimbursement rates are set low, we devalue the physical, emotional & financial energy it takes to sustain this calling in an expensive (as hell), inequitable, unjust system.
When a doula is paid a thriveable wage, they’re not just being paid for their time, it’s an investment in their livelihood, their learning, their rest & their ability to keep showing up for the next family. And vacations. We deserve vacations, too.
Please join me for part 2-Supporting Independent Community Based Doulas…
Disclaimer
These figures represent average NYC doula pricing & expenses based on independent birthworker data, NYS DOH policy & current Medicaid rates (2025).
Actual costs vary by boro, experience & business size but this breakdown reflects the economic reality for many independent doulas working in New York.