Doulas: Balancing Dynamic Tension

Oct 26, 2014 by

Downward-Facing-Dog22“National Certification will mean that I can’t…”  “I’m a traditional doula and I don’t want a national certification organization to tell me that…”  “I don’t want to go to a lot of births, will NC mean that I have to…?”  I have said it before and I will say it again, clearly, out loud:  We need all kinds of doulas.  There are all kinds of women in this world, who need a doula who they feel safe with, who they can trust, who believes the same things they do, and who supports her birth and/or postpartum vision.  No one doula can be the right doula for everyone.  Ergo, we need all kinds of doulas.

A national certification organization will not be the right fit for everyone.  However it can, if we create it in the right way, be a very effective tool for the vast majority of existing doulas.  But the real growth is in our future – to pave the way for ethical and professional behavior for people who haven’t yet become doulas.  We have an opportunity to impact doula work and the American way of birth itself.

First we have to embrace this primary task:  balancing the dynamic tension of creating a professional doula certifying organization and embracing the reality that we need all kinds of doulas.  Does that mean all doulas must achieve certification with the organization?  No, not at all.  We need to respect that doulaing is an essential task – one that exists in a professional way and one that exists in a non-professional way.  Neither way is better than another, they are just different.  Both are meeting women’s needs – the women who need one or the other are different!!!  If we are to go forward in a positive way, we need to respect one another.  Multiple ways of being in this world need to be respected by ALL of us (or at least most of us).  Otherwise we’ll end up bickering amongst ourselves and accomplish nothing on a larger agenda.  That would be pointless and a waste of energy.

What does it mean to balance dynamic tension?  In yoga there is a pose called Downward Dog.  In it, one’s body creates a triangle, with both feet and hands on the floor and one’s hips at the top of the triangle.  The goal is to elongate the spine and the legs, raising the hips to the sky while simultaneously reaching one’s heels towards the floor.  This creates tension between the legs moving in both directions simultaneously, however both directions need to be strived for in order for the position to be effective.  Back, forth, up, down, hips, heels, the body dynamically balances the tension of both muscles stretching in each direction.

Balancing dynamic tension is not a task that is completed once and then forgotten – it is a way of being in the world.  Like a yoga, this is a task we do all the time as doulas.  We support a mother in her sacred vision of her birth in a hospital that is not set up for it.  We believe in a woman when others do not, whether it is in her ability to birth or breastfeed or nurture her child.  Development of this skill – holding the space for all things to be possible – is essential for the effectiveness for ALL doulas.  I do not think it is beyond reason that we apply it to ourselves and our profession as we grow.

It is why I believe we can value all kinds of doulas and simultaneously have a strong national certification organization.  Not everyone will need it in order to practice in their area.  Not all will follow its standards of practice (for a variety of reasons) even if they are clearly evidence based.  I do not believe diversity is antagonistic to the cause of national certification.  If we gather together to create it, NC has the possibility of offering us legitimization to medical people ON OUR TERMS.  If it has the highest standards possible, it can lead to consistent compensation at a livable wage from third party payers, this will enable all women – not just wealthy ones – to access doula support.  It can offer consumers a measure of protection which they currently lack.  Consumers will make up their own minds about what kind of doula they want and what kinds of standards are important to them; that is one of the main principles of a market driven economy.  We live in a world where most people use the energy of money to compensate for products or services.  Accepting payment for an energetic exchange is not demeaning of doula service; it is how we as a society have agreed to compensate one another.  Now there are doulas who are not interested in any of those things, but there are many who are.

Those of you who might say, “Amy’s always followed DONA’s rules, so she doesn’t get it” are wrong.  I spent my first eight years as a professional birth assistant, I trained and used homeopathy for births and even learned to do vaginal exams, palpation, and listen for fetal heart tones.  So I do understand that in some practices you might want to offer those services, even though I now feel they undermine the true power of service that is the essence of doulaing. I have Been There.

We need to hold both truths simultaneously, side by side, as valid.  When doula services are ethical and the mother is placed at the center and not the doula, we are both on the same side.  Our venues are different, our clients are different, our ways are different, but our aims are the same.  We just need different tools to meet our own and our clients’ needs.

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Posts In This Series:

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

2.  This Post: Balancing Dynamic Tension – Respecting All Doulas 

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

4.  Benefits of National Doula Certification

5.  Fears, Downsides, and Challenges of National Certification

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


  1. Well said. I am a ALACE (ToLabor) trained doula and a board certified music therapist. As an MTBC I have a national certifying agency. There are so many benefits to having this type of quality assurance for competency, ethics and scope of practice. The CBMT is a body that approves and awards continued education credits fo all MTBCs nationwide. I can say with confidence that this particular board is continually assessing the needs and rigorously testing to ensure we have applicable, innovative and diverse training across the nation. That’s what doulas need too, especially as a rapidly growing service field. Since I have a doula training and board certification as an MTBC I have chosen, at this time, not pursue a doula certification. Mostly because of the variances in training philosophies and lack of quality assurance within some training organizations. Too often I see new doulas ask for opinion of a certificate program and their choices are based on cost and trainer personality and not on content or how it will relate to their preexisting strengths, business goals or creative resources. Through my national music therapy organization, and the certification board for music therapists I adhere to a code of ethics, a scope of practice, and maintain clinical competency, boundaries and self care assessment through required supervision. Thankfully for my client’s sake this includes standards on informed consent, assessment and boundaries and termination. I do believe my training as a doula better prepared me to support women during birth. However, I can say with confidence that it is my national certification as a music therapist that makes me a great doula. I’m consistently referred by my clients who remark I am professional, compassionate, knowledge and caring. I know because of the national guidelines I follow that I am also ethical, unbiased, competent and diverse in skills and thinking. So, I’d certainly be open to hearing how we can develop a national standard for doulas. Thanks for your blog on this topic.

    Kate Taylor, MA, MTBC, birth doula.
    Owner, Creative Childbirth Concepts.

  2. I think you’re totally right. I think that because hospitals I’m some areas are offering doula services in which insurance pays for but there is certifications involved with that like HIPAA and OSHA, a more versatile doula who can teach birthing classes, prenatal yoga and I think the appeal of the certified postpartum doula becoming main stream as dealing with postpartum issues has been built as a goal.of the affordable care act. Having a strong national certification program does offer the hope of serious access to birth doulas and taking on infant mortality rates another goal built into the affordable care act… and the possibility of giving access to more women postpartum doula services would serve to start the healing of a very broken system. . Sorry for the rambling I’m on my phone.

  3. You’ve written a lot of theoretical pieces about inclusion, but haven’t shared what you would like that to look like. I don’t agree the this is necessary or inevitable, but I’m interested in what guidelines would think should and should not be included.

    • Amy Gilliland

      I’m getting there Mandi! I also incorporate other people’s ideas in my posts – this is a dynamic discussion that I’m facilitating. If you have ideas, please join the conversation!


  1. Benefits of National Doula Certification | Doulaing The Doula - […] 2.   Balancing Dynamic Tension – Respecting All Doulas  […]
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