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Birth Ended in C-Section and Client doesn't want to pay half....

post #1 of 35
Thread Starter 
I would like some guidance in this area if anyone has any. I don't know if I was unreasonable here or if my client was.

My philosophy is that the client pays the doula no matter what happens with the birth as long as the doula has done her job.

This client paid half the fee on the first prenatal visit. We had one prenatal and she started having some difficulties with babies heart rate but that went on for a month or so. They were not sure whether she would need a c-section or not. We were in touch. I offered to move prenatal visits up "just in case" but she never acted on that.

She was admitted to the hospital for a "shaky" nst and never called me. Then she had a c-section and didn't call. But out of luck I guess I called her a moment before she went in when her husband informed me that she was going in for surgery. So I went to the hospital. I was out at her house that night for an appointment and no one called to cancel even though they knew several hours ahead of time that c-section was needed. Husband told me I didn't need to come but I came to give MOm support in case she needed it. I stayed for a few hours. I also had made a previous hospital visit where I stayed for a few hours when she had been admitted another time and I massaged her feet and hands and gave informative advice and emotional support after a scary moment.

I told her to call if she needed breastfeeding support. She had a small baby that was in the nursery for several hours after birth and her sister let me know only to stay a few minutes because my client was tired. I stayed a couple hours anyway day of birth but left because I felt maybe I was overstepping my invitation.

I never got a call from her, left a message, no call. Finally I e-mailed and tried to work in in a nice way that I wasn't sure if anything was wrong since I hadn't been kept informed or involved.

Without going into much detail she finally contacted me and told me she really only hired me for the support during a vaginal birth and didn't want me for emotional support and therefore didn't call. And the lack of communication the day of the c-section was more that she forgot about our appointment as well or she would've called to cancel. She didn't call after the birth because she was anemic.

So I understand mostly why she didn't call. I think she just had a very limited view of what the doula does. And said she thought half the money was MORE THAN ENOUGH for what I did.

I don't really think I agree with that. I've had super easy clients that only have a couple prenatals and a 3 hour quick labor and only really want one postpartum and they still pay me and think it was worth every penny. I always OFFER three prenatals and three postpartums. And offered her the same. I've had other clients have c-sections and pay. I've had people hire me that WANT epidurals but just need someone for emotional support and they pay me.

In the end I told her I didn't want her to come off with a negative experience from her doula and told her to pay if she saw fit but not to worry about it. And I don't believe I will see any more money.

And truly if she had offered me the other half I was only going to take half of it since we technically only had one prenatal. (Even though I saw her two more times in the hospital). So I was willing to work with her on it. But she just couldn't understand why I would want any more money.

What do you think? Sorry so long.
post #2 of 35
Thread Starter 
Oh, and just to ad, I get along well with this client. Even with the money issue we had a great talk about the birth and every thing else....
post #3 of 35
What is written in your contract?
post #4 of 35
Do you have some sort of contract, so your clients know that payment is expected no matter the outcome of the birth? If not, it might be a good idea, so this doesn't happen again
post #5 of 35
It's a hard call. I think that if a client has not paid me in full by week 37 or made a specific alternate arrangement, they are not my client. I think sometimes people hide thier indecisiveness in the circumstances of their pregnancy. If she had been 100% wanting a doula, she would have paid or asked for a different arrangement. It's a difficult call when you don't want to seem like a bill collector. With an unsure client, at some point you have to stop "chasing" the birth and let them be the one to contact you. I'm not saying you did anything wrong. You put supporting the mom ahead of your money concerns. Bravo to you for that. She was inconsiderate of your time by not being up front with you about her expectations. Will you get more money from her? Very doubtful.

Do you use a contract? I do and in it I specifically address what I expect of clients that wind up scheduling a section. I also address emergency sections and what happens if labor starts and they don't call me in time. I think it's best for everyone to be very up front about what you expect from your clients and what you are willing to give them in return.
post #6 of 35
Quote:
Originally Posted by DoulaAlicia View Post

She was admitted to the hospital for a "shaky" nst and never called me. Then she had a c-section and didn't call. But out of luck I guess I called her a moment before she went in when her husband informed me that she was going in for surgery. So I went to the hospital. ......

Husband told me I didn't need to come but I came to give MOm support in case she needed it. I stayed for a few hours.

She had a small baby that was in the nursery for several hours after birth and her sister let me know only to stay a few minutes because my client was tired. I stayed a couple hours anyway day of birth but left because I felt maybe I was overstepping my invitation.


And truly if she had offered me the other half I was only going to take half of it since we technically only had one prenatal. (Even though I saw her two more times in the hospital). So I was willing to work with her on it. But she just couldn't understand why I would want any more money.

What do you think? Sorry so long.
I think you did overstep. It doesn't sound, from the orange bits above, that you were ever invited. The husband and the sister tried to give you clues that your services were not wanted.

I think Babes in arms has some great advice. I don't know how clear you were with your contract. It seems like you "chased the birth".
post #7 of 35
I agree, I think it would have been better left alone.

This is what I have in my contract: I take a deposit that equals about 1/3 of my fee at our first visit (after an initial meet). I have written in therea, that if I miss the birth, either because they don't call me, or because labor goes too fast, if they still wish for me to come to the hospital, I charge $100, payable before I leave the hospital, for the additional support (then we do not exchange the original fee-remainder, the 2/3rds). If they feel they are okay and don't want additional support, then we call it good, I do one postpartum, and that's it.

I have never had that happen, though. If it does, we all know where I stand.

Generally, I get the deposit. After the birth, at the first postpartum visit, I get the remainder of the fee.

Live and learn. The reason my contract has evolved is as these things arise, I see I didn't make concessions for them in my contract, so then I change them. This particular change, about missing a birth, came about after a couple doula friends were getting stood up. They then had to try and hound the money out of these families, and the families weren't going to pay -- the doula wasn't with them (whether because the familiy changed their minds about calling or the birth went fast) so they didn't feel they should have to pay her.

Another change I made was, I didn't have it stated the initial deposit was non-refindable, and I had a client move. I felt compelled to give her half the deposit back, but we had had two prenatals. Now the deposit is totally non-refundable.
post #8 of 35
Thread Starter 
First, my contract does state that they pay no matter outcome and if they don't call they still pay. She told me over the phone she would pay me if I really wanted her to. But she said she didn't believe she should. I just told her that I wanted her experience to be positive and therefore it was completely up to her and non payment was o.k. and I would not have any hard feelings over that.

I do require half the money on the first prenatal and half on the 3rd prenatal so my clients are all paid up before the birth. But we did not get to her 3rd prenatal. Her baby was born at 36 weeks.

As far as overstepping......this is why I did those "orange things". When I called the husband he was literally running into the c-section room while talking to me. I called right at that time. And he could barely think. I said, "Should I come down" and he said, "No because you will miss it, I'm going in now". My thought on this was that the husband didn't understand the emotional comfort and breastfeeding assistance I would offer afterward. And that she would want that. Also I wanted to fulfill my contract if any questions did arise.

Second the sister did say to only stay a minute (and I wasn't sure if that was HER saying that or my client asking her to say that) but my client appeared to be enjoying me there and talked to me alot about what happened and was really hashing her story, her fears, etc....and I talked to her about breastfeeding of which she didn't know much and I was surprised. So I really coached her about that while I was there. She really seemed to be benefiting from my company. I wasn't just lurking...And as soon as she appeared to be tired and the conversation died down I said I would go even though I wanted to stay longer so I could actually assist with breastfeeding when baby came back from nursery. So I don't know that was actually overstepping or "chasing the birth".
post #9 of 35
Quote:
She told me over the phone she would pay me if I really wanted her to. But she said she didn't believe she should. I just told her that I wanted her experience to be positive and therefore it was completely up to her and non payment was o.k. and I would not have any hard feelings over that.
IMO, you deserve payment. You (likely) cleared your schedule, considered yourself on-call, kept your cellphone glued to you... she chose not to call you. She's giving you clear signs that she doesn't want your services now, but she signed a contract.
post #10 of 35
[QUOTE=DoulaAlicia;10768601]First, my contract does state that they pay no matter outcome and if they don't call they still pay. She told me over the phone she would pay me if I really wanted her to. But she said she didn't believe she should. I just told her that I wanted her experience to be positive and therefore it was completely up to her and non payment was o.k. and I would not have any hard feelings over that.


No you are being taken advantage of. You have a contract that states what the details for payment are. She knows she signed it but still believes she should not have to pay? Why? Did she not sign it? I think you are rolling over when you should not. Doulas deserve to be paid. You were available to her whether she accessed that or not. You took her as a client and that meant you would take one less other client. In other words, your contract with her means you were unavailable to take other clients. We do hard work and are on call 24/7. I suppose if she had planned a homebirth and had to transport she would then believe she did not owe the midwife? In the future, I would not say "its okay if you don't want to pay me", but since you did I guess you will have to live with it. In the future I would say "I am sorry you feel that way, but I did make myself available to you 24/7. I honored the contract and I expect you to do the same." And if they didn't I would take them to small claims court, which in my area costs $50 to file and since my fee is $700 - makes it worth it to me.

I will say this same thing happened to me once, but it was my fault because although she had the contract and kept saying she was putting it in the mail, I never received it. Did five prenatal visits (she was on full bedrest and couldn't take a childbirth class so I went to her) and three post partums for her baby in the NICU. Then she didn't pay me because "you didn't make the emergency cesarean" (literally a NST to stat cesarean where she was on the table when her partner called me - it would have been over before I even got to the hospital parking lot). Now I tell clients that I will not be available until I have a signed contract and go over the "you chose not to call me or it was impossible for me to make it or you choose a cesarean at the last minute" clauses very carefully at one of our initial meetings. That birth cost me a lot in babysitting fees for all the visits I did with her and I got literally nothing for it.
post #11 of 35
Thread Starter 
[QUOTE=homewithtwinsmama;10769824]
Quote:
Originally Posted by DoulaAlicia View Post
First, my contract does state that they pay no matter outcome and if they don't call they still pay. She told me over the phone she would pay me if I really wanted her to. But she said she didn't believe she should. I just told her that I wanted her experience to be positive and therefore it was completely up to her and non payment was o.k. and I would not have any hard feelings over that.


No you are being taken advantage of. You have a contract that states what the details for payment are. She knows she signed it but still believes she should not have to pay? Why? Did she not sign it? I think you are rolling over when you should not. Doulas deserve to be paid. You were available to her whether she accessed that or not. You took her as a client and that meant you would take one less other client. In other words, your contract with her means you were unavailable to take other clients. We do hard work and are on call 24/7. I suppose if she had planned a homebirth and had to transport she would then believe she did not owe the midwife? In the future, I would not say "its okay if you don't want to pay me", but since you did I guess you will have to live with it. In the future I would say "I am sorry you feel that way, but I did make myself available to you 24/7. I honored the contract and I expect you to do the same." And if they didn't I would take them to small claims court, which in my area costs $50 to file and since my fee is $700 - makes it worth it to me.

I will say this same thing happened to me once, but it was my fault because although she had the contract and kept saying she was putting it in the mail, I never received it. Did five prenatal visits (she was on full bedrest and couldn't take a childbirth class so I went to her) and three post partums for her baby in the NICU. Then she didn't pay me because "you didn't make the emergency cesarean" (literally a NST to stat cesarean where she was on the table when her partner called me - it would have been over before I even got to the hospital parking lot). Now I tell clients that I will not be available until I have a signed contract and go over the "you chose not to call me or it was impossible for me to make it or you choose a cesarean at the last minute" clauses very carefully at one of our initial meetings. That birth cost me a lot in babysitting fees for all the visits I did with her and I got literally nothing for it.
This is sort of how I felt but didn't want to come off as being selfish in some way. Other "business" people would GET THEIR MONEY but as a doula I don't know if it is my obligation to be overly understanding. I actually did reject a client due 9 days prior to her....I lost $450 for that. That is my fee. Then ofcourse I lost $225 for the money she didn't pay me. Since I only take two to three clients a month that is much of my possible income for the month. And my family needs it. Her family on the other hand spends $600 a night on hotel rooms in Chicago.
post #12 of 35
One way that you can avoid this conflict in the future is by walking your clients through your contract and talking about the hows and whys behind each of the items.

Here is how I talk about my fees. My doula contract says that 50% of the fee is due at the first prenatal and the balance at 37 weeks. If a client cancels before 37 weeks then they get no refund of the deposit, but don't owe the balance either. After 37 weeks, there are no refunds.

Here is how I present it to clients: "I just wanted to talk to you about the payment and refund policy. I ask that payment be made in full by 37 weeks. Occasionally something happens after that point that affects how I might help you, like a scheduled c-section or an unusually fast birth, or another change in plans. I don't give refunds after that point because essentially what you are paying for when you hire me is for me to block out 1/3 of my month in on-call time. It is impossible for me to find another client at that point to replace you if you decide not to use my services. This may sound crazy, but I limit the number of clients I take per month so that if someone has a long, long birth or needs lots of help postpartum I can be with them. I have only run into this situation a couple of times, like with a scheduled c-section for breech, and most of the time I can find another way to provide support for you, but there will be no refunds."

Hope this helps.
post #13 of 35
Quote:
Originally Posted by DoulaAlicia View Post
First, my contract does state that they pay no matter outcome and if they don't call they still pay. She told me over the phone she would pay me if I really wanted her to. But she said she didn't believe she should. I just told her that I wanted her experience to be positive and therefore it was completely up to her and non payment was o.k. and I would not have any hard feelings over that.
Alicia,
This type of situation happens once in a blue moon. I hate when it happens and i always feel taken advantage of. But i like to believe it creates good will. That must be worth something to you!
The client absolutely was wrong and did not abide by the contract. You were very generous towards her by not wanting her to feel her birth tarnished. I think you did the right thing not to argue with her. Next time you can say how you were on call 24/7 and refused other clients for her due date. However I would not go to small claims court.

Really what else could you have done? Sometimes the good will towards client and not allowing it to turn into an extended hot conversation is the best path.

Nickle and dimming a doula should be a deadly sin! It is really a national tragedy how women who provide services get "Nickel and Dimed"

That is why unions can be so beneficial to many workers.
post #14 of 35
One other thing -- the point at which I ask for payment and the deadline for either receiving a refund or being able to cancel services without owing further payment is the same. I ask for payment before 37 weeks and that is the point where clients can cancel as well. So I wouldn't find myself in the situation you did where someone cancelled and then had not paid me yet. Makes it a lot cleaner/easier.

If someone did not want to pay me for their birth because of a change in circumstances, I would offer them the possibility of postpartum support at an hourly rate. And then if they didn't want that, I would let it go. I might give them a congratulatory phone call afterwards, but otherwise I would not continue trying to work with them.
post #15 of 35
[QUOTE=DoulaAlicia;10771190]
Quote:
Originally Posted by homewithtwinsmama View Post

This is sort of how I felt but didn't want to come off as being selfish in some way. Other "business" people would GET THEIR MONEY but as a doula I don't know if it is my obligation to be overly understanding. I actually did reject a client due 9 days prior to her....I lost $450 for that. That is my fee. Then ofcourse I lost $225 for the money she didn't pay me. Since I only take two to three clients a month that is much of my possible income for the month. And my family needs it. Her family on the other hand spends $600 a night on hotel rooms in Chicago.
Unfortunately you gave her an out so this time I think you need to eat the cost.
post #16 of 35
Several people have mentioned the 37 week mark for the second payment. We do something similar, collecting the deposit (half of fee) when hired and the balance at the 2nd of 2 prenatals. I do this at least by 38 weeks, but in practice usually do that visit and get that 2nd payment by 36 weeks.

Our contract says that if the couple fails to contact the doula for the birth, we keep the whole fee. However, we have made a couple of amendments to this over time.
I consider the "prebirth" fee to be $250 of my total of $700. That is for prenatals and being "oncall" from 38-42 weeks.
So if someone has an emergency *prior* to 38 weeks, I don't think I was on call for that client. I didn't have to make special plans, carry my cell phone, etc for her, and around here I can probably snag a last minute client in that month; we get a lot of last minute calls, or I can tell other doulas I'm suddenly available.

I feel like a woman who has a birth emergency, as this woman did, with a cesarean and a baby in th NICU, really did not use my services. You didn't do all your prenatals, were not on call since she was only 36 weeks, and didn't have to attend the birth. This doesn't seem like a breach of contract to me. I would keep only the deposit in this case.

I have offered postpartum services in these situations (c-sections without labor and for which the couple didn't choose to use me for emotional support) if someone desired it, but otherwise wouldn't charge them for more than the original hiring and one prenatal.

mb
post #17 of 35
Quote:
Originally Posted by DoulaAlicia View Post
And truly if she had offered me the other half I was only going to take half of it since we technically only had one prenatal.
So really, the complaint is that you wanted the opportunity to refuse the balance as a goodwill gesture but since she didn't pay the full fee you are now considering her in breach of contract? What do you plan to do? :
post #18 of 35
Whether or not you overstepped or chased the birth, she had accepted you as her doula, and you had accepted her as your client. There was a contracts that was also mutually accepted.

She broke that contract.

I make sure to explain why I get paid even if she doesn't call, or if she gets a section. She is reserving a block of my time wherein I am on call 24 hours a day. I am thus unable to take on any other clients for that time period. I'm not saying you didn't explain this...but I am very clear as to this aspect (all aspects, really) of the contract. I probably spend a good 30 min going through the contract.

You wouldn't be in the wrong taking her to small claims court. Would I personally do that? No. But it's an option for you.

Kris, it sounds to me like the OP's issue is partly the prinicipal rather than the finances. Doulas (and babysitters, and midwives, and other female dominated, female/family centered vocations) have a habit of being crapped on financially. We're expected to reduce rates all the time for single mothers, poor mothers, or at the very least offer a payment plan. Don't get me wrong-I've done births for free, and probably will in the future. But try telling your CPA that instead of the $150 he charges for your taxes, you can only pay $80. Or tell your mechanic that even though he's fixing your car now, you can only pay him $50 a month for 6 months.
post #19 of 35
Thread Starter 
Quote:
Originally Posted by Midwife Kris View Post
So really, the complaint is that you wanted the opportunity to refuse the balance as a goodwill gesture but since she didn't pay the full fee you are now considering her in breach of contract? What do you plan to do? :
I was not going to refuse the entire balance of $225. I was thinking of taking half the balance which would've been $112 or so. And that was just to stay in her good graces and have her be happy with me as a doula but not because I thought she didn't owe it to me. What will I do? Probably nothing. I would love to write her a long letter and explain to her some of these things justifying myself. Not even for the sake of getting paid but for the sake of her realization. But I'm sure that would be to no benefit in the end. She would likely still not get me at all and then I would be more frustrated. I tried to tell her over the phone about those things but she just kept saying that I didn't "do the work" so the fee wasn't justified. So she wasn't even trying to understand I gave up $450 just to serve her.

After hearing these posts I think my big mistake was the contract. Even though it says these things in it I do not spend time with clients running through it line by line and I SHOULD!! So, what I'm going to do is firm up my wording a bit, making it VERY clear and then discuss it in detail with people on our first visit.

And yes, it is a bit frustrating that we are expected to give breaks, make exceptions, etc......but the guy at the jewelry store that just DESTROYED my dead grandmothers favorite bracelet that she gave to me is telling me that is just the way he did it and sorry I don't like it......where is my new bracelet since mine is destroyed? And where is the payment for my suffering that my airloom (sp?) is gone? It seems the world is a tough place....Being in business for myself I need to decide how tough I want to be.

Thanks for the advice ladies. You've helped alot!
post #20 of 35
I also ask for full payment by 38 weeks. (Half at the time your decided to hire me, half by 38 weeks). I spell out the refund policy and such. If this had happened to me, I would be frustrated, but I would just take a deep breath and let it go. Not much you can do and being nagry only hurts you at this point.

Sorry.
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