Benefits of National Doula Certification

Dec 3, 2014 by

CleanPlusFadeNational certification is a tool to enable professional doulas to move in a particular direction.  What benefits could a program with strong behavior centered standards of practice offer?

1.  Respect from and engagement with physicians, midwives and nurses at every hospital because they have a clear understanding of the accepted standards of practice of nationally certified doulas.  They could ask one question and know what to expect:  Are you nationally certified?

National standards means a group of doulas in a community could negotiate with a hospital to gain privileges and respect for their knowledge.  Possibilities include getting into the OR reliably, being consulted about their client’s progress, sharing knowledge at educational meetings, and discussing conflicts in an arena of professionalism.  Both birth and postpartum doulas could be considered part of the team rather than adjunct or isolated from their client’s care.  Some doulas already have this situation.  But out of the tens of thousands of hospitals and hundreds of thousands of medical staff, I can count those places on my fingers.  Wouldn’t it be great if we all had that negotiating power?

2.  We get to define the standards for appropriate doula behavior, not each individual hospital.

3.  Respect and easy establishment of credentials when moving from one area to another.

4.  Consumers (parents) would have clear understanding of national, evidence based standards of practice and materials that explain “What to expect from a nationally certified doula”.  They would have an established outline of what to do when those expectations are not met, someone objective to listen to their concerns, and an organized grievance procedure.

5.  National behavior centered competencies would outline uniformity in services offered so a unique, standard billing code can be used with Medicaid and other insurers.  There is no guarantee of this, but scientific evidence plus strong standards equal a greater likelihood of this occurring.  I cannot see it happening without it.

6.  The opportunity to participate in public health initiatives based on doula credentials, not on academic or nursing credentials or having someone vouch for you.  Doula support is a key part of the solution for many maternity issues.  But we are not included (or taken seriously) because there are no strong national standards.  Initiatives cannot plan to include doulas because they have no easy way to say who will be eligible to fill the doula’s role unless they do all the training and certifying themselves – which is an initiative all on its own and beyond the scope of the funding they are applying for.  So doulas are left out.  These are missed opportunities for jobs, influence on the maternity care system, and better care for mothers and families.

7.  Doulas are seen as a luxury rather than a necessity for birth and postpartum families.  But for maximum health and well being, there is no substitute for the one on one care a doula provides.  Done well, national standards allow our profession to grow so that not just wealthier families or women lucky enough to live in areas with community-based programs get this service.

8.  Right now, there is no system that recognizes achievement as a doula.  One of the possible reasons we have so many training programs is because the role of “trainer” is the only one achievable after “doula” or “certified doula” in a particular group.  Recognizing levels of achievement and leadership within the profession would meet this very human need to strive for something and be recognized for it.

9.  Separation of training and certification.  A national certification organization would set competencies to be met.  The applicant’s responsibility would be to meet those competencies – likely from a variety of sources and beyond the initial two or three day training workshop or correspondence course.  The term “competencies” is used in many professions especially those that involve education and caring at their core.  Competencies state an area of expertise and specific behaviors that demonstrate that ability.  In your comments to me many of you have mentioned that you deal with competencies in order to be certified as massage therapists, realtors, respiratory therapists, and certified nursing assistants.  For an example of how a competency based system works, go to this home visitor organization web site, and click on the “gold” list.

The next question is, “Who sets the competencies?” and “Who provides the training for these competencies?”  The answer is we do.  This system allows for a natural progression of training that focuses on obtaining the skills that ensure doula success but cannot be taught in an initial 16 to 24 hour basic course.  Interpersonal skills such as listening, relationship closure, debriefing, minimizing trauma, and conflict management come immediately to mind.

10.  National certification with competencies and behavioral standards would allow for expansion of the doula role into other fields.  Community health education workers and home visitors could easily include doula work into their own job descriptions, or permanently include doulas into their programs.  While this is occurring in a few places (Illinois’ the Ounce), it is most often haphazard and dependent on a single person or limited time grant.  Even though the evidence is available and there is a program to replicate, other stakeholders outside the program also need to be convinced.  Funders may also not be able to give money for initiatives where workers do not have established competencies.  Evidence based national certification standards set by doulas makes it more difficult to minimize our effectiveness or brush our contributions aside.

11. National certification available to all shows that we take ourselves seriously, have professional competencies that define our role, and makes that statement to the world.  We are not just hippies, hipsters, yuppies, hobbyists, bored at home parents, soccer moms/dads, frustrated midwives, or trying to exert power over someone’s else life experience.  The market demand for our services shows that we have a part on the team to play, we are here to stay, and we believe that what we have to offer makes a positive difference in the quality of health care and the emotional lives and memories of the families we serve.

12.  Being a part of other health related professions would expand doula employability, wages, and the number of mothers who could receive doula services.  It would also enable more people to become doulas and hopefully at a wage that would support their families.  Many trained and effective doulas are not cut out to be independent business owners.  But this is the only choice for many.  Respect for and expansion of the doula’s role would allow for different models of employment, such as working for social programs, agencies, HMO’s, physician and midwife groups, and collectives.  We don’t have this now because there are no strong standards for employing doulas on staff or for third party reimbursement for their services (see #5).

In sum, national certification offers us legitimacy and opportunities to move our profession forward.  Some of those directions are dependent on interaction with others, however once we start taking our work seriously it will positively influence how we are perceived.  Most likely it will open doors that cannot be imagined today.

 

Note:  What’s the difference between accreditation or certification?  Certification verifies that a person has attained a level of competence and met requirements to practice in a certain discipline.  Accreditation evaluates institutions and programs and ensures they have met standards.  Click here for more.

 

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Posts In This Series:

1.  Social movements – The Next Step In The Doula Revolution

2.   Balancing Dynamic Tension – Respecting All Doulas 

3.  Do We Want A Place At The Table?  National Certification and Public Health

4.  This post: Benefits of National Certification for Doulas

5.   Fears, Downsides, and Challenges of National Certification

6.  Back Door or Front Door?  What the Process of NC Would Need to Include

24 Comments

  1. As someone trying to determine the best route to becoming a Doula, I appreciate this conversation. It does seem like there are a plethora of small schools who will certify. Some offer a weekend or two of training and a long list of books to read, others require two years of correspondence training and apprenticeship. In every case, the organization training is the certifying agency and I’m not sure I understand what gives them the right to certify. This conversation also brought up a question for me. DONA calls their certification international and that it follows international standards. So, my question, after reading these posts, is it an international standard and is that the path a woman seeking to become a Doula should follow?

    • And I realize you, as a DONA trainer are, of course, in support of DONA standards. I guess what I’m really asking is, are any of the other training programs going to be worth following if certification becomes a reality? I’m also confused by this conversation in light of DONA’s calling their certification international.

      • Amy Gilliland

        Hi Sara,
        As a newcomer I’m sure it can seem confusing at first. Right now any organization can train and certify their own doulas. Standards vary widely as do philosophies regarding care. National certification aims to cut through those differences in training and philosophy by setting agreed on competencies for professional doulas behavior; and certification of their experience veracity to do this work. NC as I’ve been writing about it doesn’t train doulas. Its only purpose is to certify doulas to a rigorous standard that can be relied on by consumers, medical professionals, and third party stakeholders. Doulas would be able to go to a variety of sources to fulfill the NC’s competencies.

        To follow through with your example of DONA, only people who have taken a DONA training are eligible for DONA certification. At my last count there were 26 organizations offering a certificate of completion and/or certification, you can imagine how confusing it is for anyone outside this field. Just as it is confusing to you, too.

  2. C Garcia

    I do agree that Doulas need to be more respected; and accepted; but I don’t agree that a National Certification is the answer. I believe that capitalizing “Doula” is the first step.

    Secondly, there are already training programs that offer national certification. Each training organization gives Doulas the opportunity to train with the organization whose philosophy most closely mirrors their own. I feel that it is up to the families to choose the Doula whose training also most closely mirrors their own philosphy. With “one” national certification defining competencies, I feel that it would adversely affect women choosing to become Doulas; as well as affect family choices. Many Doulas choose not to certify at all; that doesn’t make them incompetent, or unable to get clients. Most families are not even concerned whether or not a Doula is certified.

    Thirdly, as someone else has already mentioned, I agree that one national certification would further restrict Doulas’ practice and privileges within hospitals; and insurance reimbursement, not enhance it. There are already many insurance companies and Flex Plans; including some of the Medicaid Plans that are now paying for Doula services without having one national certification; and a uniform billing code has already been established. Possibly all of the training organizations could require an additional x # births after training to gain competencies before being able to call themselves a “Doula”; such as a Graduate Nurse (G.N.) does an externship after training. Until those births are completed, they could be called a Graduate Doula (G.D.)

    Fourthly, Doulas are able to advance by taking a Midwife Assistant or Monitrice training to become a Monitrice.

    Lastly, as long as there are Doulas who offer services for free; Doulas will never gain the respect that other professions have. There is not any other profession that offers free services. I agree that low-income women need to be able to have access to Doula services as much as women with higher incomes; however, I feel that a sliding fee; scholarship, etc. should be offered; but not free services. New Doulas without experience, also should not offer free services. They have training and expenses also, and should offer a lower fee; but not free.

    It seems like a lot of the responses here agree with one national certification, and my views may not be popular; however that it how I feel.

    • Amy Gilliland

      Hello C! Thank you for your well written comments. Many of the points you make I have already refuted in earlier posts in this series. I do not envision a national certification process that is compulsory, rather it offers an option and legitimacy that the haphazard situation we have now does not. I have stated clearly and repeatedly that certification has nothing to do with getting clients, rather it has to do with protecting both ours and other doula’s clients. NC would be optional and likely only be a step for professional doulas making a life career out of doula work. It would not be for the hobby, neighborhood, or sometime doula. We do need lots of training programs that serve lots of different people who want to become doulas. We all need doulas, and we need all kinds of doulas. But professional doulas want a higher standard, greater levels of respect and opportunities to grow. I do not think it is a problem for there to be all kinds of doulas – see my earlier posts on this topic – “We Need All Kinds of Doulas” and “Balancing Dynamic Tension”. Lastly, my next post will be on the Cons and Challenges of national certification. I am blogging sincerely about this topic because this is a conversation we NEED to have, and I thank you for taking the time to join in.

      • C Garcia

        Amy,
        Thank you for responding to my post. After reading the comments that you posted today; addressing a summary of the comments that you have received from various sources I did further research. I am now more concerned about a National Certification than I was before. I learned that Minnesota Medicaid began paying for Doula services in January of 2014; however, they only pay for Doula services of a “Certified” Doula, who is certified by a handful of specific certifying agencies. You state that a National Certification would be voluntary, and we need Doulas from a lot of different programs; however, I feel that a National Certification, as a stated earlier, would further limit free choice for Doulas and families. Particularly Doulas serving low income women receiving Medicaid. This trend will eventually eliminate Doulas who have chosen not to certify; or who are already certified by one of the agencies not on the “chosen list”; including Professional Career Doulas, who by choice are not certified.

        • Amy Gilliland

          Government programs are not going to pay to just anyone who bills them. They will always want a recognition that some professional standard has been met. That is not arguable.
          Why should there be a lower standard or no standard for women who are receiving Medicaid? Shouldn’t they have the same type of high quality care that a woman paying out of pocket does? My concern is that lower income women often get the least trained people or no doula support at all. Therefore, to me, NC offers the best opportunity for improvement.
          Your concern is that low income women will only have the choice of certified doulas because they will be able to bill (hopefully) Medicaid. But right now that is not a choice because doulas are not available to most lower income women at all. Doulas choosing not to be certified who want to serve lower income women will need to figure out an alternate way to be paid (which is the status quo).
          Minnesota doulas were desiring to expand the availability of support in their state, which they have accomplished. At the time of the legislation, the organizations on the list were the ones that existed. Please don’t read into it any malice on their part that new doula training programs were not included. The number in my count doubled from 14 (9/13) to 26 (9/14) in12 months, and some of them have already folded. Some MN doulas are trying to figure out how to respond to this change while not limiting people’s training choices, but are unsure exactly what to do. Hopefully this background helps you to understand how the situation has evolved.

          • C Garcia

            It seems that your position is that low-income women do not have access to Doula Care; and will not unless Doulas are nationally certified. Also that uncertified Doulas provide sub-standard, unprofessional care. I do not feel that this is an accurate perception. There are many Doulas, both certified and uncertified who provide care to low-income women on a sliding scale, based on ability to pay or provide free service (which I addressed in a prior post). Also, many Doulas are trained by major certifying agencies, but choose for various reasons to not be certified. The care they provide is just as professional as Doulas who pursue certification. As I also stated in an earlier post; I agree that a longer period of practicum or extenship should be required across the board by all Doula training programs before someone can call themselves a Doula; because the hands-on experience is invaluable in being competent.

            In regard to Medicaid, it is a fact that low-income women are covered by Medicaid. It would of course be a benefit if Doulas could be reimbursed by Medicaid. Most State Medicaid programs to date do not provide reimbursement for Doula Care at this time; however, being a organizationally and/or nationally certified Doula is not going to provide reimbursement either. Doulas will be required to apply to become a Medicaid Provider, just like Doctors, Nurses, etc. and will need to meet additional requirements to become an approved Medicaid Provider. Regardless of whether or not their was a specific reason as to why only certain Doula programs were included for reimbursement by Minnesota Medicaid; the fact remains that it is stipulated in their statutes which certified Doulas can be reimbursed. There are other well-known quality programs that were in existence at the time of the legislation that were not included; and which continue to remain in existence. These Statutes since January 2014 have effectively eliminated all other Doulas from possible Medicaid Provider Status and potential reimbursement. No other State Statutes or Medicaid Policies stipulate which programs Doctors, Nurses, Physical Therapists, Anesthesiologists, Massage Therapists, Midwves, etc. need to have graduated from. If the attempt was simply to validate the profession this would not be the case. It would have been just as easy to state that certified Doulas of a recognized training program in existence more than five years would be eligible for Medicaid Provider status.

          • Amy Gilliland

            You have interpreted my position incorrectly. I am on the board of our local volunteer doula service which has many uncertified doulas that provide very good care for the women in our program. I know many uncertified doulas who are excellent, and have no problems with their lack of certification. NC is a tool that some doulas want and others do not. My purpose in this blog was to use my skills to effectively communicate different points of view and stimulate discussion and dialogue. I am thankful that you have taken the time to write yourself and post it so that other people can engage with your ideas. On the record I have very mixed feelings about national certification, several of the 13 objections in the “Fears, Challenges” blog post were my own, although all were reflected in other people’s comments as well.

  3. Kim M. Smith

    I agree with every point you have presented! If we want to be recognized as professional, I beleive we must take these steps. National certification will benefit the role of doula and legitimize us as a member of the birth team. Thank you for your work Amy!

  4. Hi Amy,

    The way you have provided this information is wonderful. Thank you for all that you do!
    I believe that competency focused certification is key to our profession growing consistently. ..and respectfully.
    I have a passion for passing on my knowledge and wisdom to help ensure an enhanced level of care to postpartum families. I would be interested in playing a part in this uncharted territory..in any way I can!

  5. Shelly Gilliland (no relation to Amy!)

    Interesting stuff, indeed. If there became a national certification, would anyone be allowed to call themselves a doula and still have access to attend hospital births without being nationally certified? Thinking out loud. For instance, a person who has gone to school for respiratory therapy cannot “work” in a hospital setting unless they pass the national certification for that field. Now, for sure, there are definitely “good” and “bad” respiratory therapists but being certified does not weed out the good from the bad. If you pass the test for certification… you’re certified! The same would be true for doulas.

    I chose not to certify for several reasons but have never “not been hired” just because I’m not certified. I’m not sure if I would pursue national certification. I see the role/job of a doula in a different light than that of a nurse or doctor. By current definitions, doulas do not do anything medical. Thus, maybe we should be governed or certified differently?

    Just as there will always good and bad doctors, nurses and every other kind of professional… a national certification program won’t ensure that “only good doulas” get certified. But it’s not good doulas who get us in trouble or give us a bad name!!

  6. Thank you for your time and work in this area Amy! I agree with the idea of national certification. I also feel that by doing this, Doulas as a whole would be more respected and recognized. I’m also a music therapist. When I was in college, it wasn’t required to be board certified and there were 2 national organizations, which was confusing. Eventually, even though there was some resistance, both organizations merged and created a national board of certification, which all music therapists are required to pass and maintain on a 5 year cycle. Having one national organization and adding a national certification board has added so many benefits, made the National pool of music therapists stonger and more united and offers a great protection (personal and business) to our music therapists. To me, national certification just makes sense!

  7. Thank you Amy, for writing this post and sharing your thoughts so succinctly. I am enjoying your entire series on this topic. I particularly agreed about the idea of competencies, and that it takes more than a 2-4 day training to make a competent doula. Misinformation or lack of information about evidence based birth procedures, a fuzzy or inconsistent scope of practice between “certifying” organizations, and the fact that anyone who wants to hang up a shingle can decide that they certify doulas (and anyone who wants to can call themselves a doula) means that HCPs and the public may be on the receiving end of incompetent paraprofessionals who can actually make things worse, instead of better. While I worry about falling down the rabbit hole of poor compensation, lots of restrictions and inflexibility, and mountains of paperwork if doulas were recognized and covered by insurance and medicaid, I think we have to figure out how that can work. It is important to be seen as the skilled professional I believe a trained and competent doula can be, and how we can have a positive impact on maternal-infant health outcomes. The research supports this. I welcome your leadership as this process moves forward and am happy to contribute in any way I can.

  8. This is a very interesting topic, one that I’m glad is being discussed. I see why you write of the need to separate training orgs from a national/international governing body, but can’t it be possible to have each training org still issue a certification (like how universities issue degrees) but have the national/international society issue a license similar to nursing boards? And I don’t use the term “license” loosely, I’m aware of the immense emotional and practical burden it entails! I can imagine that the many certifying organizations will still feel very possessive of their certifications and credentialing brands. In my area we have the Screen Actors Guild and other entertainment societies that do offer some wonderful benefits and negotiating strength, but there are certainly restrictions that apply to individuals. It’s a give and take.

    • Amy Gilliland

      Hi Mary,
      a
      Licensing is a government function, organizations are accredited, so the appropriate concept is certification. While many organizations say they certify doulas, most of them have a certificate of completion that they call certification. The proposal that I am bringing up for discussion is a much more extensive process that goes beyond current organizational certification. It would also be available to everyone and not be limited by who you received your training with.

  9. Amy, I appreciate your well thought out post. While I do agree on some of your points, and have thought about this concept, I am wondering who “we” is? Do you envision representatives from all the certifying organizations coming up with the requirements? I definitely like the idea of the certifying organization being separate from the training. That makes sense to me. I know there are many that are absolutely opposed to your ideas, but not everybody would have to become certified, just as it is now. There are many great doulas who are certified and many who are not. And there are many not so great doulas who are certified. National certification could be one option for those that choose it, and could open up doors for many. Thanks for sharing your thoughts on this.

  10. Julia Franken

    Some things I fear about this….If we start working within their system, we are more restrained in our rolls…such as, attending home births, etc. Also we are unlike any other profession, in the time we sped with our clients. I don’t want insurance companies telling me I can only spend x-amount of time with my clients. Or they only get 12 sessions postpartum…but maybe they need me 30 times postpartum (as a pp doula) I think it all seems awesome…but the grass is always greener it seems. Just some thoughts….

  11. Very Important that the profession is recognized as legitimate in this way. Beneficial on so many levels. Thank you Amy for your work towards this.

  12. I couldn’t agree more. I whole-heartedly believe the current certification requirements for many doula organizations let us down as a profession. To be certified after attending only 3 births (in many cases), says to the the wider medical profession that is all the experience we need to be considered fully competent. I don’t know of any other profession which asks for so little to be achieved, studied, practiced before being considered ‘certified’. I may be an outlier, but I think the current certification programs offered by our myriad doula organizations are hurting our efforts to be recognized as respected professionals. Thanks for your post!

    • Linzi I agree with you in that certification does not have much meaning right now. There are so many organizations offering it and such a variation in trainer qualifications and certification requirements. I think that doula trainees should be awarded a certificate of completion for course work, and then the experience should be much more than three clients, along with other comptency tests before certification is awarded.

  13. right on! Good descriptions of the benefits for the profession and for individuals. Very clear. Thank, Amy.

  14. I am very pleased with your proposal. After 19 years of active service as a certified Doula, both private pay and volunteer, the most distressing aspects I have encountered in order are…non access to EVERY Woman who is birthing, inconsistency with facilities (I have served in 22) and care providers (I have served with hundreds), lack of 3pr for those who have great insurance and the lack where most needed-medicare. I appreciate this Amy, very much! Thank you Woman for keeping the dream alive!

  15. Amy, if money, time, resources were no object, what would you do (or perhaps are already doing) to get this program off the ground? Are you in talks with any national organizations that could serve as a sponsor or at least a boilerplate for making this project successful? I champion your efforts!

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  2. Do We Want A Place At The Table? | Doulaing The Doula - […] 4.  Benefits of National Certification […]

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