One of the purposes of this blog is to offer an analysis of current issues of importance to the doula profession. One of the issues that have lingered over the years is certification. It used to be viewed fairly simply: certification was an individual decision. While that is still true, it seems that along with our profession the issues of certification have grown in depth and complexity. Certification dilemmas exist on system, organization, and personal levels.
What set me on the path of examining certification was another post about what it means to be a professional. Putting on my researcher’s hat, I set out to gather data relevant to certification issues. Data collection consisted of the following methods: 1. In eight different doula groups on Facebook, I searched for the keyword “certification” in past conversations going back about 9-12 months. 2. I wrote to several people who identified themselves on FB as having “private” opinions, asking them to elaborate on their thoughts on certification. 3. I read blog entries doulas had written on certification. All responses I read were from women. I stopped when I reached “saturation”, meaning that I stopped hearing anything new. So I can’t tell you how many people have a particular opinion, but I can tell you that opinion exists. From my examination I’ve been able to isolate several key questions or issues.
System level questions:
- What is the meaning of certification? What does it mean to certain stakeholders? Does it have value to these different stakeholders? Why or why not? Stakeholders are identified as an individual doula, doulas as a group, certified doulas, third party payers, clients (mothers), client’s family members, physicians, midwives, nurses, and hospital administrators.
- What is the process of certification? Does it provide value for the doula seeking it? Does it provide value for the organization that is granting it? Are there built in mechanisms that soothe feelings of frustration and increase feelings of accomplishment throughout the process?
- What is the purpose and value of recertification? Why do some organizations grant certification in perpetuity, and not recertification? What are the assumptions underlying the necessity of recertification? What are the assumptions made by organizations that do not see recertification as necessary?
- What levels of certification are there? Does it still have meaning if some groups offer certification to a person completing a correspondence course when there are no standards of behavior to observe or maintain by being certified? When it is left to what each individual thinks is right to her own conscience, is that valuable? How does that affect the profession as a whole? (See question 1.)
Organization level questions:
- As the system is currently set up, certification is linked to an individual organization. When women choose a training, they are connected to that organization. However the organization has values and support products that are separate from their certification process. Are trainers communicating the values of the organization before people spend money on the training? How significant is this conflict in a person’s certification decision?
- There are now at least 16 organizations in the United States and Canada offering birth/labor doula trainings (that I am aware of). Many have different standards for certification or offer a certificate of completion that is stated as certification. Does it have any meaning when there are so many different standards?
- Is there any value to separating certification from the multiple organizations offering doula training, education and mentoring? Is there any advantage for some stakeholders if certification is achieved through an independent organization?
- Is each organization’s certification process following best practices for experiential and independent learning? Are there built in mechanisms that soothe feelings of frustration and increase feelings of accomplishment throughout the process?
Personal level questions:
- Many doulas think certification isn’t important because potential clients don’t weigh certification heavily in their selection of a doula. Because certification isn’t bringing them business it is not seen as necessary. Do clients perceive certification as a benefit at a later time in their relationship to their doula? Would a non-certified doula be privy to this realization on their client’s part?
- What other advantages does certification have? Doulas responded with these answers: 1. For your peers – when you know they are certified, you know what to expect. 2. A third party payer will only reimburse if you’re certified; 3. When the patient sues all the lawyers breathe more easily; 4. It is a plus when you want to get a job, put it on a resume or curriculum vita or school application.
- There is another theme reflecting a doula’s personality traits (“I see myself as a rebel”) or issues around control (“I don’t like anyone telling me what I can or can’t do with a client to meet their needs.”)
- One of the themes is that certification is seen as being restrictive and not allowing the doula to follow her own conscience about what behavior is appropriate. My thoughts: What behaviors does a doula want to enact that are outside those standards? Would other doulas agree as a group that they want someone calling herself a “doula” to behave in that way?
- Can people’s individual conscience be enough? (Comment: Any other profession says “no”, which is why there are professional standards that are protective of the client and the industry.)
Pondering those questions led me to these questions
- Is disregarding certification as important related to the idea that carework does not have value and thus professional standards are irrelevant? A human being can possess both of these conflicting attitudes, such as “our work has value” and “I don’t want my behavior to be regulated”. What are the implications of those attitudes for that individual and for other stakeholders?
- Does not having uniform behavioral standards and a goal of certification for all doulas make certain stakeholders take us less seriously and lessen our perceived value? Many doulas stated that certification had little personal value because most clients considered it irrelevant. However, the implications of this attitude may be limited in focus – not seeing beyond one’s self to see how this decision may affect others and the profession.
In essence, the issue that is identified as “certification” has multiple levels and symbolic meanings for different people. When certification is discussed on social media, not everyone is talking about the same thing. The number of factors to consider in her decision often overwhelms the original person posing a question about certification on Facebook.
Within each of these questions are a number of responses and possibilities. To me, the fact that we have the opportunity to take in this information and be reflective about it is significant. It allows us to make choices about how we want our profession to proceed. My goal is to explore these issues in more depth in future posts.
If you have a comment about any of these questions, or feel there is an additional issue I have not listed, please email me at firstname.lastname@example.org
Gilliland, A. (2009) “From Novice To Expert: A Series of Five Articles”, International Doula, publication of DONA International (feature articles) Autumn 2007-Winter 2008; reprinted as e-book, June 2009; currently available here