Sliding Scale FAQs
The most common question I get from new clients is “How exactly does this pricing thing work?” It’s a fair question. We live in a capitalist society that teaches us that services are about transactions and that the value of a thing is determined by its price. This post is my attempt to answer why I work on a sliding scale, what I mean when I ask folks to name their own price, and some thoughts about trust and vulnerability.
To start, I want to note that this work is not a full-time job for me and therefore not my only source of income, which definitely shapes how I think about my pricing. Additionally, as a white birth worker, I acknowledge that I am far less likely to be expected to work for free compared to my colleagues who are Black, Indigenous, and other people of color. The idea that I can often assume I will receive compensation for my work and not be expected to provide free care for my community is undeniably grounded in whiteness. I am presenting this not as the ultimate guide to sliding scales or suggest that everyone can or should offer sliding scale services. This is simply my experience and my reasoning in this moment.
Take what is useful, adapt what is salvageable.
Why offer a sliding scale?
The first answer is really concrete: I believe that everyone deserves support regardless of ability to pay. Offering a sliding scale is about making care accessible to folks who could never afford to pay sometimes thousands of dollars for a doula.
For me, it's also about a lot more.
The framing of economic accessibility is important but it’s not the whole story. I have a conversation about my sliding scale with all of my clients, including those who are at the top of the scale.
What I tell all of my clients in person and what I’ll tell you here is that, for me, the sliding scale is also about trust. I understand that hiring me means trusting me with an incredibly intimate part of their life. Offering a sliding scale is one way I express trust in my clients: I trust that they have thought about the value of my support and also that they are experts in their own finances and can come to a decision that reflects both.
Sliding scales are about trust, they are about economic justice, they are about acknowledging that people are more than their financial reality and that we don't need to be ashamed to talk about money.
How do I figure out where I fit on the scale?
There are so many ways to answer this question and I trust you to find an answer that is doable for you, your family, and your values. I will put out some of the ways I think about it.
As an example, let’s talk about my sliding scale for my birth package. The scale I list is $600-$1600, which is admittedly a big scale. In my head, I am thinking about three scales:
Top tier: $1300-1600
Middle tier: $1000-1300
Lower tier: $600-1000
I also work with folks who pay less
Sometimes descriptions are helpful. I personally love this image from Alexis J Cunningfolk on how to decide where you might fall on a sliding scale:
Some of the things I typically see in my work:
Folks I’ve worked with who have paid birth fees in the top tier often had already budgeted to pay set fees (Often $1200-2000 in the Boston area, sometimes more) for a doula. Price might not have been a large factor in the decision to hire a support person. They may have access to familial wealth even if they do not have a lot of cash readily available.
Most of my clients have paid birth fees in the middle tier. Often they are graduate students or teachers or other helping professionals. They might have asked family and friends for money to help cover support services. They might have gone back and forth about whether they could really afford to hire someone. This cost would represent some sacrifice but would not create financial hardship.
Folks I’ve worked who have paid birth fees in the lower tier or in prices below the listed scale are folks who have been struggling financially. One or multiple partners might be unemployed or underemployed, they may not have access to other people who will help pay for support. Higher levels on the scale would create financial hardship.
Bartering, payment plans, and more
I love getting creative with folks about how to align the value they place in having a support person with the resources they have access to. For some folks, the resource they have is money. For some folks, they might have access to some money but also have other kinds of resources that they can offer in lieu of or in addition to money.
I have worked with folks who have been able to offer acupuncture treatments, yoga classes, or other services that they provide as part of their birth fee. I think it is really magical when I get to exchange services with another practitioner.
Payment plans are another place where I get to be flexible with clients.
Typically, I ask for a 50% deposit when we sign a contract and the other 50% before 38 weeks when I go on-call. The reality is, 50% can be a lot to have to pay all at once.
Sometimes folks can put down 50% for the deposit but could use monthly reminders to space out payments between the deposit and the final payment
Sometimes folks need to place a smaller deposit and spread the rest of the payments out over the course of the pregnancy
Sometimes unexpected things happen and it just isn’t doable to pay the whole fee before birth and payment happens later
Sometimes folks commit to a lower fee and then, if their financial situation changes, reevaluate during pregnancy or before we conclude our postpartum visits
Won’t people take advantage?
I think this is the biggest fear I hear from people thinking about offering sliding scale services.
Lots of us are living in a scarcity framework fueled by capitalism. Thinking about money this much might be scary, might bring up memories of not having enough, might bring up anxieties about what constitutes enough. For lots of us, that scarcity mindset means we might pick a lower price point when given the choice because we are afraid of being without.
The reality is, there are people who could afford to pay a full fee who, when presented with a sliding scale, choose to pay less. Maybe fear kicks in and they do not realize that they do actually have enough. Maybe they feel excited that they got some kind of deal. Maybe they aren’t aware of their own class privilege. It happens.
For some folks, this risk isn’t worth it and I get that. Sliding scales don’t work for everyone. There are emotional and financial risks that lots of folks can’t afford to take.
Does offering a sliding scale mean you will get paid less? Possibly.
Most of my clients pay less than a “typical doula fee” in my area.
That said, my financial situation is such that I do not face personal financial hardship by working with clients who pay less and I love the clients that flexible fee structures bring into my life.
In my experience, I am often surprised at just how thoughtful my clients are in thinking about what they can afford and how we can work together to create a package that is fair and accessible.
Where can I learn more?
A lot of my understanding of my sliding scale has been shaped by reading blog posts from other folks describing their sliding scales.
Here are some of my favorites:
Alexis J. Cunningfolk has a whole series of blog posts about sliding scales that are full of insights and ideas and resources:
Hadassah Damien's writing on sliding scales, including a number of sliding scale examples for everyone to learn from on Ride Free Fearless Money
How Do You Set Your Rates? Shared wisdom on the Sliding Fee Scale & Business Practices for Economic Justice by Ihotu Jennifer Ali which includes wisdom from a number of different practitioners on sliding scales.
