Doula Certification and Regulation

Update December 2023: I am thrilled to announce I am finally FULLY certified! Woohoo!

Scroll to the bottom of this page to view my certificates.

Regulation/The History In The U.S. of Birth Workers

Collection of the Smithsonian National Museum of African American History and Culture, Gift of Robert Galbraith © 1987 Robert Galbraith

I’ll start by sharing that as of now, there are not any states in the U.S. that regulate doulas or require them to receive a certification before working. The topic of certification in the birth-working community is a controversial one. Doulas have been providing support to birthing people for centuries. This is documented in ancient artifacts and figures showing birthing people and their labor companions. Historically, doulas were often a family mender or friend or perhaps a midwife who oversaw births in a region. Before the 20th century, people birthed at home without medical intervention. In the 20th century we had a huge rise in technological advances and medicine that could decrease maternal and infant death. By the 1930s only 15% of births were overseen by midwives and most families had switched to hospital births with an OBGYN delivering. This definitely medicalized birth. Laboring people often experienced labor and birth without the option of having any support from friends, family, a partner, or a doula. OBGYNs required that birthing people labor on their backs to make medical tools easier for them to use. Because of the medical technology, the hospital became the place that most people and organizations considered safest to give birth. Sources vary, but it is estimated that the doula profession that exists today emerged around the 1960s and 1970s accompanied by the feminist movement. Midwives began attempting to reform and reclaim birth spaces to give control back to the birthing person.

What Is A Certified Doula?

A certified doula is one that has received training and certification through an organization that provides them. Remember, there are no states in the U.S. right now that regulates doula trainings or services, so these certifications come from organizations rather than the state. A well-known and credible organization is DONA. Organizations such as DONA provide trainings that typically encompass a curriculum of about ~25 hours, birth attendance requirements (some organizations do not require attendance for certification and some require as many as 5), and requirements regarding caring for postpartum clients and a number of clients before receiving the certification. There are also different certifications a doula can receive such as a birth doula or postpartum doula certification. Some certifications (depending on where it is received) allow you to be hired in professions like being a hospital doula. Some of them allow youth accept medicaid. As you can see, a “certified doula” can mean many things depending on where they receive their certification and what the requirements are.

Why Is Certification Controversial?

Cons

BIPOC communities and birthing people are disproportionately affected by birth inequality and the dangers it poses. The U.S. has the highest maternal death rate of all industrialized countries and BIPOC birthing people have the highest maternal death rate. Statistics show that having a doula present during labor and delivery lowers the likelihood of needing medical intervention, medical pain relief, cesarean sections, and infant/maternal mortality rates. The fact that BIPOC birthing people are at highest risk of the preceding list makes them people who could benefit from the support of doulas the most. Doulas in the BIPOC community have been supporting and advocating for their communities for decades regardless of certification. The fear in these communities is that certification is yet another system of oppression. Certifications can often be expensive, especially if you want to receive it from a well-known organization. There may be a wonderful, uncertified doula practicing in your community who is overlooked because of new doula had the privilege and resources to receive a certification. This is one area I encourage white birth workers to assess their privilege. There is no such thing as too much support, but evaluate the space you are taking in the community and if you are uplifting marginalized people in your community (birth people and birth workers) or are you taking up sacred and healing spaces? A certification can be a great tool to encourage credibility and professionalism, but it can also be a disadvantage for uncertified doulas who have been practicing for years to support their communities if there are new requirements for certification such as those put in place during the COVID-19 Pandemic. The pandemic changed the way that birthing spaces such as hospitals and birth centers allowed doulas to provide services. Many of them began requiring certification to attend labor/birth. Some of them had seemingly “made-up” rules like requiring you had a working doula website to discourage birthing people from bringing friends as support and calling them a “doula”. These changes were disheartening to me because I believe that a birthing person should be allowed to allocate a friend as a doula. However, I also acknowledge the severity of the pandemic and the need to protect communities and prevent hospitals from being overworked and understaffed. The pandemic affected BIPOC birthing people and birth workers negatively in an intersectional way. Marginalized communities already have a constant disadvantage in birth resources and the standard of medical care. The requirements that emerged and have stayed constant since the pandemic only perpetuate these issues.

Pros

There’s also possible benefits to doula certifications for BIPOC communities. Due to socioeconomic inequalities for BIPOC communities, many birthing people cannot afford doula services. If a doula recieves a certification from an organization that will allow them to accept medicaid, this may help address this disparity since medicaid now covers doula services in some states (this is also controversial but I’ll be making a post about that in the future and will come back to link it when I have finished it). Some organizations also offer scholarships for certifications and trainings. I personally have received trainings from organizations such as Birthing Advocacy Doula Trainings exclusively through applying to scholarships. I am a member of the BIPOC community and former foster youth so I have relied heavily on scholarships, both for birth work trainings, and to graduate with a Sociology degree from a California State University. Another pro to certification is that it makes it easier for doulas who are new to birth work to get started. They can decide they want to be a doula, seek a certification program, complete the courses/requirements (if they can afford to), and then they’re a doula!

You do this work because you are passionate about serving birthing people. It comes naturally and it feels like a duty.

Am I Certified?

I am currently working toward certification and will be certified by the end of 2023! I will be receiving my certification as a Full Spectrum Doula from Cornerstone Birthwork Training. (Edit December 2023- While I did complete the Labor &Birth course from Cornerstone Birthwork, I received my certification through Madriella Doula Network and The Somatic Arts & Sciences Institute).

I honestly did not feel the need to receive a doula certification until the pandemic hit. This work is not something I have been doing to make money and if you ask most birth workers they will tell you the same thing. I started by supporting birthing mothers I was already nannying for. Many of them had never heard of doulas, let alone think of their nanny as someone they wanted present at their birth—but I was! I also have supported friends during pregnancy, labor, and postpartum. You don’t do this work to get rich, you do it because you are passionate about serving birthing people. To me it feels like a duty. I have received other various trainings such as Newborn Care Specialist trainings, Infant & Child CPR/First Aid Certification, trainings through nannying agencies, and my education from a California State University which focused on discrimination based on race, religion, and LGBTQ issues and identities. I had been supporting birthing people for years without a certification before the pandemic, and I felt confident in my knowledge from my experiences and trainings. I was also working full-time as a traveling nanny before the pandemic and most of my income was reserved for my costs of living, finishing my degree, and saving. I decided to start my shop during the pandemic to work towards saving for a doula certification when I realized that the new requirements in birthing spaces would be a barrier for me to provide services without one. I continue to attend trainings and workshops when I can afford to through BADT and other doula training organizations. I received a partial scholarship to attend formal training and I am excited to be certified by the end of 2023! Beyond certification, I continue to pay for and attended specialized trainings to broaden my scope off knowledge and stay current with all best practices.

Thank you for reading!