Should You Offer Sliding Scale Pricing as a Doula?

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One of the most common questions new birth doulas ask me is: should I offer sliding scale pricing?

So many birth doula and postpartum doulas in our online doula training ask this early in the program. We always say, wait, we will get there because there is so much more to the answer to this question for new birth doulas.

Here’s the truth, there’s no one right answer. But there are some crucial things to consider before you decide.

Sliding scale pricing touches on money, equity, and values, so it’s deeply emotional. As doulas, we work in a system that is designed to exclude people. We see the gaps, we want to help, and the idea of saying no to someone who can’t afford our full rate can feel heartbreaking.

But here’s the hard truth: we cannot burn ourselves out in the name of accessibility. That’s not equity. And it’s not sustainable.

Let’s break this down, sweet birth doula.

Before we start, if you are not sure how to price your services, check this out here. It will really help you get clear on what to charge. 

The Origins of Sliding Scale

Sliding scale pricing didn’t appear out of nowhere. It comes from radical community care models in healthcare, therapy, and legal services; where people pay what they can afford, and those who can pay more help cover the cost for others.

When done well, with structure and community support, sliding scale can be powerful. Clinics that run on this model often rely on donations, fundraising, or a steady stream of higher-paying clients.

But here’s the thing: doulas usually don’t have that kind of infrastructure. Most of us are the infrastructure. Without balance, offering discounted care puts you at risk of financial instability and burnout.

So yes, sliding scale pricing can increase access. But it needs structure.

Why Doulas Feel Pressure to Discount

Let’s talk about the culture we’re swimming in.

Because doulas are overwhelmingly women, non-binary folks, and queer folks, and many of us are racialized, we get fed the message that our care work should be free or cheap. That we should do it “for the love of it.” That money somehow contaminates the sacredness of birth work. It doesn’t help that most of the weekend doula training options do nothing to heal or teach otherwise. If you want to check out why the weekend doula training model has to go, read this here. 

That belief that we should not charge for care work is not an accident. That’s patriarchy, capitalism, and white supremacy at play.

Research backs this up. A 2016 study in Gender, Work & Organization found that care workers in feminized professions were significantly underpaid compared to equally trained professionals in male-dominated fields. Racialized care workers were also more likely to provide unpaid labor because of systemic inequities.

And in our 2022 bebo mia survey, nearly 70% of doulas reported feeling guilty about charging full price, especially when serving marginalized clients.

That guilt? It’s not yours. It was planted there.

You can be anti-oppressive and charge for your services. You can support birthing people and pay your rent. The wage gap needs to be closed and we can be really conscious of this within our businesses. 

There is some good news with the fact insurance policies are now covering birth doula and postpartum doula care so more under-resourced folks are getting access to the care they deserve. 

Who Is Your Sliding Scale Actually Serving?

Here’s where many doulas get stuck. Sliding scale gets offered randomly, sometimes to a friend of a friend, or someone who says they can’t afford you… but then you show up to your prenatal and folks have two cars in the driveway. It feels oh, so bad. Trust us.

Bianca, the bebo mia founder, has shared her stories of people saying they cannot afford care and she did not want them to birth alone so she would offer sliding scare or reductions. 

But, when she got to their home, it would tell a different story. One client thanked her for doing her birth doula package at a reduced rate because they just put a new roof on the house and money is tight. The feeling she shared was one of such deep sadness and worthlessness. It made her feel like what she is doing doesn’t have as much value to them and she would feel shame because she was renting and struggling financially as a single parent and had undercut herself to folks that were choosing to not prioritize her services with their finances. 

This is where financial and care boundaries are critical for doulas to have!

Without a structure, you risk panic-discounting instead of running an intentional sliding scale model.

Here are a few ways to approach it:

• Create clear tiers (for example: $1500 / $1000 / $500, based on income or access).
• Set boundaries on how many reduced-fee clients you can take per month.
• Use a simple application or intake conversation. This isn’t about shaming, it’s about clarity.
• Share your sliding scale policy openly, not as a whispered exception.

Remember: saying yes out of panic is not community care. It’s a trauma response. And you’re not alone if you’ve been there.

Alternatives to Sliding Scale

Sliding scale is just one tool. There are other ways to make your work more accessible without sacrificing your sustainability:

• A “pay it forward” model, where past clients contribute to a community fund.
• Sponsorships or donor-backed care.
• Group offerings, like prenatal classes or postpartum circles.
• Digital education packs that provide accessible, lower-cost options.

You can be values-led and strategic at the same time.

Why Sustainability Matters

This part often gets left out of the conversation: if your work isn’t sustainable, you can’t keep doing it.

A 2023 report from the Birth Workers Alliance found that 43% of doulas couldn’t sustain their practice beyond year two. Over half cited undercharging and boundary issues as the main reason.

You deserve to stay in this work. 

Burnout is not a badge of honor.

You are allowed to charge. 

You are allowed to rest. 

You are allowed to thrive.

This is something that is commonly skipped in a weekend doula training which is why we wrote this open letter – check it out here.

So what do you do?

Firstly, grab this free tool that will help you navigate through deciding if offering a sliding scale is right for you and your business at this time.

(Note: by opting in you are consenting to receive emails about cool stuff, free events, and what is happening here at bebo mia.)

Sliding scale isn’t bad. It can be transformative. But it’s not the only path toward equity… and it’s not the right fit for every doula.

The real work is aligning your pricing and accessibility strategies with your values, your capacity, and your long-term sustainability.

If you’re ready to dig deeper into building a doula business that is anti-oppressive and sustainable, join our online doula training we call the Maternal Support Practitioner (MSP) training program. It’s full-spectrum, evidence-based, and comes with business tools to help you build a model that works for you and your community.