Doulas: To Certify or Not to Certify

“The hospitals aren’t letting doulas in unless they’re certified.” This is what I heard from colleagues as the pandemic was really starting to take hold.

Right away, my mind went to multiple places: I have clients due any day, does this mean I can’t support them? What message does this send to our community of doulas, especially the ones who work with marginalized families? What does certification have to do with safety and health protocols within the hospital system?

For me, certification was never really in the question. My doula journey began in such a way that it never crossed my mind. I had an amazing mentor who herself was not certified, and proved her skill by the way she consistently showed up for families and built a great reputation with her local providers. Learning in her shadow, I didn’t see the need. I saw plenty of doulas who chose to certify through agencies like DONA International and ProDoula, and did great work. My first training itself was a “DONA-approved” training, and my trainers spoke highly of certification.

When my apprenticeship ended, I began looking into it to see what actually went into becoming a certified doula. I was surprised.

Immediately I was met with a very clear, very direct message about Code of Ethics and Scope. If you aren’t familiar with that lingo, I’ll explain: it’s the certifying agency’s way of making sure all the doulas that train and certify, and are otherwise stamped with the agency’s name, are practicing the same way. We all agree we won’t be providing cervical exams, overriding the medical provider’s decision, and not speaking for our clients. 

But wait...can we?

The “one size fits all” way of practicing is problematic, and one must look at all the intersections at play to understand it.

First of all, doulas are advocates. We speak up, with, and sometimes for, our clients. Not to take away their voice, or make decisions for them, but to empower their choices, needs, wishes, and make sure their unique stories, traumas, and desires are being tended to. Sometimes, there are situations that arise where a doula will need to speak for their client. Maybe a client is unable to vocalize, or is not present in their body to advocate for themselves whilst deep in their experience.That is the nature of the work, and sometimes one just has to go there. Again, it’s not to make a decision for the client, or to put one’s own desires or biases into the client’s mouth, but to be their voice if necessity calls for it.

Second, doulas, lay midwives, and birthkeepers are as old as time. Across every culture in every time period, people have been walking through the threshold of labor and birth with others and sharing with them all the acquired skills and knowledge passed down from hand to hand. In this country, the Black and Indigenous birthing communities especially have had to fight to maintain their cultural practices around pregnancy, birth, and postpartum. From structural racism and erasure, to sweeping anti-midwife laws, to modern day elitism and the constant drive to be clean, professional, and in-line with agencies, hospitals, and insurance companies, Black and Indigenous birthworkers are still at the forefront of the battle to preserve their cultural practices for their communities that they are serving. To have these birthworkers agree to “scope” decided by a certifying agency has the very real, very dangerous consequence of further taking their practices away from them. To say doulas cannot use herbs, cannot do hands-on practices, is not  touching and working against the colonization of the birth world. I can see how scope and code of ethics are there also to protect...often there is nothing scarier than a doula who took a 2 day online training on some herbal technique and is now loose in the world, potentially going on to injure a client. But when approaching scope and certifying, one needs to examine how it either protects, or harms, birthworkers and communities of Color. 

And last, it costs money. Yes, there are scholarships for doulas of Color. Yes, there are trainings approved that center the marginalized experience of birth, lactation, and parenting. But that is not what you see when you first enter the website. You really have to dig for it. Right away, that is keeping certain lower-income folks out. It right away sends the message of “if you can’t pay this, it’s not for you. This work itself is not for you.” This in many ways defeats the purpose of having certified doulas. In a real, heart-wrenching world of racism and birth disparities, and lack of resources for low-income families, what we need most are doulas and perinatal professionals who not only understand their experiences, but live their experiences. We need community serving community. That deep foundational empathy and culture-sharing, to me, is part of the solution of ending the crisis of the maternal mortalities, morbidities, undue CPS cases, and infant deaths that currently plague the US. These certifying agencies should not be the gatekeepers that say who shall and shall not do this work. Period. 

So when looking at the decision to certify or not to certify, it is crucial to take in all that is present, and ask the bigger questions: who are these agencies and organizations? Who are their Board of Directors? How are decisions made? Whose voices are centered? What are their intentions, goals, and missions? How do they address the current assault on BIPOC birthing people and their families? 

In light of all this, there are also very real reasons to certify, too. Soon, here in Washington state, doulas will be able to be reimbursed for their services through Medicaid. Many birth professionals, lawyers, and lobbyists have been working hard for the last many years to get these services covered for the very reasons I mentioned above. But one thing that will be required of the doulas who are reimbursed this way is that they will need to be certified. It creates a complex dilemma: the reality that, yes, families with Medicaid will be able to receive services and cost won’t be a barrier to good care, and the doulas available to them might not be from their community, and may themselves feel locked out of the world of gatekeeper professional elitism. 

What needs to happen is for certifying agencies to step up and provide support and resources for doulas who will be serving marginalized communities, and coming out with statements, strategies, and plans of how they are going to make their certification process more accessible. We need to see direct accountability and action from them, showing that they are not just here for the money. 

So, as a doula, when asking the question to certify or not to certify, consider how your doing so will impact the families you serve and the communities you serve. If you’re a family looking for a doula, consider what it means for a doula to be certified, research it, and decide for you and your family if that is an important factor in choosing a doula. There are no right or wrong ways.

As for me, after years of practicing without certification, I am choosing now to certify. Not because I want to be part of any particular agency and their agenda, but because it matters to me that Doulas For All is passed, and that families on Medicaid have access to my services. 

But I will continue to do work with Open Arms, serve families from my community, and uplift families and birthworkers of Color. I will continue to hold our certifying agencies accountable and bring to their awareness ways that they may be doing harm. 

Like any decision in the childbearing world, it is uniquely personal and intersectional. It is very much the work of the doula to explore all the options, look at all the sides, and listen deeply to what is within these decisions and choices, and offer space to hold that process. The more us birthworkers can practice that, the better we will show up for our families, certified or not. 

For more info on Open Arms Perinatal Services, go to https://www.openarmsps.org/

And check out these two amazing doulas and their journey to remove the rebozo from DONA’s training and put the power and wisdom back into Indigenous hands, https://www.change.org/p/doula-training-organizations-individual-trainers-removing-rebozo-teachings-from-doula-trainings?redirect=false