It happens. Not often, but it happens.
And if you are considering becoming a birth doula or you are newly certified and building your practice, this is one of those scenarios worth thinking through before you are woken up with back to back texts:
“I think I’m in labor!”
The good news is that this situation, while stressful, is completely manageable when you have the right systems in place. And the systems are not complex (phew), they just require a little planning before anyone goes into labor.
First, how does this even happen?
Most birth doulas take between two and five clients per month with due dates spread across a four week window. Statistically the chances of two clients going into labor at exactly the same time are low. But low is not zero.
Babies notoriously do not consult your calendar… it would be really convenient if they did though! Two clients with due dates three weeks apart can both go into labor on the same Tuesday night. A client at 37 weeks can labor the same weekend as a client at 41 weeks.
And it is more common than most new doulas expect. A 2021 survey of over 1,200 birth doulas found that 38% had to call in their backup at least once in the past year. That is more than one in three. This doesn’t mean that the doula failed at some step of the booking calendar… It is just birth.
And this is exactly why having a solid backup system is not optional.
The backup doula is the solution. Period!
If you take nothing else from this blog, take this: The backup doula relationship is not a nice-to-have. It is the entire infrastructure that makes birth doula work sustainable and ethical.
Every doula should have a backup before they take their first client. This definitely should not be vague. You know, “I’ll call someone if I need to” understanding. It needs to be an actual person with an actual agreement, in writing, who knows your clients, who your clients know, and who can step in without it being stressful for anyone.
When two clients go into labor simultaneously, the backup doula attends one birth while you attend the other. That is the system in its entirety. Simple in concept and only works if you have done the relationship building before the moment arrives.
We talk about what you need in place before you take your first client here.
What makes a great backup doula
Your backup doula is a reflection of your business.
They are not a clone of you but they do represent your ethics and your professionalism. Here is what to look for:
- Someone whose values align with yours, including around inclusivity, anti-oppression, and trauma-informed care.
- Someone who is trained and experienced at the same level or higher. Weekend trainings really don’t cut it, y’all. (read why!)
- Someone who can communicate clearly especially under stress.
- And someone you would genuinely trust to care for your client as if they were their own.
Do not list someone you barely know and hope for the best. Hope is not a strategy. Build the relationship before you need it.
How do you decide who gets you and who gets the backup?
Ok, this feels slightly akin to a popularity contest, we know. It feels uncomfortable… and it is worth having an answer before you are in the moment trying to make it.
Most doulas use a ‘first to call’ system.
Whoever contacts you first when labor begins is the client you go to. Your backup goes to the second client. This is simple, fair, and removes any awkward judgment call about whose birth matters more. Spoiler: they both matter equally, which is exactly why the system needs to be decided in advance rather than in real time.
Some doulas factor in stage of labor. If one client is early labor and one is active, you might go to the more progressed birth and send your backup to the early one with a plan to reassess. This requires more judgment and more communication and only works if your backup is someone you trust completely and your clients both already have a relationship with them. This means you may be able to attend both with your backup offering phone support or early hands on support to the birthing person still early in their labor.
Bianca adds that sometimes you may have a more complex file that needs your specialty that would be prioritized over your other client in labor. For example, if you have a client that has PTSD from sexual trauma and you have been working with them and building trust over their entire pregnancy, you might prioritize them over your other client. Or if one was a single parent (by choice or circumstance), you may go to them and send your backup to the other client.
There is a lot of room for nuance here… because we are dealing with humans and really complicated and vulnerable events, like labor and birth.
Whatever system you choose, it needs to be in your contract.
What goes in the contract
Your contract should clearly state that in the rare event of two simultaneous labors, your backup doula will be called in for one client. It should name or describe the backup. It should explain that clients will have the opportunity to meet the backup during the prenatal period. And it should outline what happens afterward in terms of the postpartum check in and debrief.
If you want done for you contracts that cover all of this, we have a contract bundle built specifically for doulas that is thorough, values-aligned, and covers the backup clause and everything else your business needs here.
Clear is kind.
This is one of those situations where clarity before the fact prevents a lot of pain and stress in the moment.
Making sure clients know and trust your backup
When your backup attends a birth it should not feel like a stranger showing up. Your clients need to feel safe, taken care of and prepared to have NOT you at their birth.
There are a few ways to handle this depending on your model.
If you use a two doula model, you and your backup each do one of the prenatal appointments so the client has a genuine relationship with both of you before labor begins.
If your backup is only stepping in for a specific planned period, like a wedding or concert, you let your clients know as soon as possible. Something like: “Between 7 and 10pm on this date I will not be available. My backup will be on call. Text me as well as them. Once I am back on call, if my backup is with you, I will trade out unless you are settled and prefer to stay in their care.”
At minimum, a short email intro with a photo and bio goes a long way. It shows them that they are in good hands with you and that there are contingency plans for their care… meaning, they will never be alone in their journey. You want them to see you have planned for their care.
The goal is that if your backup walks through the birth room door, your client knows enough about your backup and what to expect to feel supported. Labor is not the time to build trust from scratch.
How to talk to clients about the backup before they need it
One of the reasons doulas hesitate to bring this up is they worry it makes them seem unreliable. It is in fact the opposite. Clients appreciate transparency and they respond well when it is presented confidently and proactively.
Try something like: “Because birth is unpredictable, I always work with a trusted backup doula. They will only step in if something truly unavoidable comes up and you will have a chance to meet them beforehand. This is actually standard practice for doulas and it means you always have skilled support no matter what.”
Most clients feel reassured by this. What makes clients nervous and anxious is finding out about the backup plan for the first time when they are in labor.
How to be an excellent backup doula yourself
This part matters just as much as finding awesome back up birth doulas for your practice.
If you agree to be someone’s backup, be clear on your availability and your fees before you agree to anything. Have your own intake questions ready in case you are called in. Review the client’s birth preferences and support notes ahead of time. Ask the primary doula what is most important to this client emotionally. And treat the client with the same care, confidentiality, and warmth you would offer your own.
When the birth is over you need to be available for the debrief with the clients. Let the primary doula re-establish care for the postpartum visits and follow up services unless you have agreed otherwise. You stepped in beautifully. Now step out gracefully.
And do not undermine the primary doula while you are there. Be clear with the client: “I am here as part of your team. I will be supporting you with the same care and values [name] would.”
Pay your backup fairly and promptly
Super important business alert! Your backup is also on call. Their time has value. Do not build your sustainable doula practice on another doula’s free labor.
Have a clear written agreement that covers what they get paid and how. A flat on call rate plus a per hour fee after a certain number of hours works well and protects both parties from burnout or resentment. Some doulas use a percentage of their rate. Others have a regular mutual swap arrangement where it evens out over time. Whatever model you choose, get it in writing and follow through promptly.
The agreement should also cover who collects payment from the client, whether prenatal or postpartum visits are included in the backup’s role, and whether there are different rates for holidays or last minute calls.
The founder of bebo mia inc, Bianca pays her backup just for being available! They are holding a spot when they agree to support your clients if you are unable to do so.
The legal side for backup doulas
If you are stepping in as a backup, make sure you have your own liability insurance in place. Have a signed mutual agreement with the primary doula outlining scope and payment. And depending on your jurisdiction and the situation, consider whether the client needs to sign a consent form or contract addendum acknowledging your involvement.
Protect yourself. This is your livelihood.
Avoid the scramble text method
When your doula certification is too short (like a weekend), these are some of the parts that get skipped… You don’t want to have your clients say they are in labor while you are with another family. We never want you to ever send a last minute text at 3am saying “Hey, are you available?!” to a doula pal of yours. It is not sustainable and it is not fair to the person on the other end.
Build a small circle of two or three backups with clear calendar check ins once a month. Take turns being the default. Know who is holding a window for you and when. Respect everyone’s boundaries and communicate when your on-call windows start and end so nobody is caught off guard.
Backup is not just for birth
This is something a lot of doulas do not think about until they are in a bind.
If you do postpartum visits, lactation support, fertility doula work, CBE classes, or loss support, your clients need to know what happens if you are sick or unavailable for those services too. The same principles apply. Have someone in place. Introduce them. Have a written agreement. Make sure your contract covers it.
Your clients are counting on you across all of it, not just the birth.
The shared care model for your doula business
One of the most elegant solutions to the simultaneous birth problem is building a shared care model into your practice from the start rather than treating backup as an emergency measure.
In shared care you and a doula partner share a client roster. You both attend prenatals. You split on call hours. Clients know and trust both of you from the beginning. When two births overlap neither client experiences a last minute swap because they have always known both doulas equally.
This model also takes a significant amount of on call stress off both doulas because you are never the only person holding the responsibility. We talk about how this model works in practice here.
The birth doula on-call reality
Two births at once is stressful. There is no version of it that is not a little bit stressful. You will worry about the client you are not with. Your backup will do the same. Both of you will do your best and that is what matters.
The families you serve deserve skilled, present, caring support regardless of what else is happening in your calendar that night. The backup system, the contracts, the prenatal introductions, the shared care models, all of it exists to make sure that is exactly what they get.
This work is a team sport even when it does not always feel like one. Ugh, we have all felt that loneliness of the private doula practice.
Having a great backup is not about planning to fail. It is about community care. Doulas are human. Human things happen. You deserve to have someone in your corner just as much as your client does.
If you want training that covers all of this including the business side, the contracts, the backup relationships, and how to build a sustainable practice from the ground up, our full spectrum doula training runs every March and September.
Already certified and feel like the business side was missing? The cert transfer program is here.
And if you want done for you contracts that already have the backup clause built in, grab the contract bundle here.
Email us anytime at [email protected] or book a free doula career strategy session. We love this conversation.
FREE ONLINE MINI-COURSE
BLISS IN BUSINESS RETREAT
Your future is created by what you do today — that's why we created a completely FREE mindset mini-course to help doulas and birth workers find bliss in their business!