There’s 67 Different Doula Training Organizations! Uh oh! Or maybe not?

Jun 13, 2017 by

Version 2Recently, Kim James of reported that birth and postpartum doulas have listed 67 different training organizations in their online profiles. Why are there so many? What are the implications for our profession?

If you think about it, there are few ways for someone to utilize the knowledge they’ve gained as a doula except to train other people. While some organizations have individual recognition for a member’s achievements, that’s about it. There are no national awards and no career ladders to climb. Expansion into more lucrative positions is expected in other paraprofessions; but if you want to continue as a doula the only obvious paths are to train others or start an agency. So that’s one reason – individuals want to move forward in their career options.

Unfortunately, some people are more invested in making money than in furthering the doula profession or ensuring that the doulas they do train are qualified. Anytime price or speed of “certification” is advertised over the educational experience, I know those people have missed the point. These days it’s easy to offer an online course. The problem with online courses is that doulaing is a relationship that is based in touch, eye contact and the stimulation of oxytocin, and you can’t effectively teach most people how to relate to others in those ways unless you are also face to face. Some online courses include a Skype or FaceTime mentor, which is better than nothing. But I have had several people who took an online course subsequently enroll in my in person workshop. They were familiar with the concepts but didn’t have the deep knowledge or confidence to actually apply them with a client.

Sixty seven different training organizations means we have little unity and uniformity in training standards. Preparation could be sloppy or exhaustive. Doulas could learn its okay to judge people’s choices and that some ways to give birth are better than others, and our role is to herd people into those “better” ways. There is no standard ethical platform. No practice standards that we all agree on. There is no unifying principle that we can assume about one another.

The certification that is offered by most of these groups has no vetting. To me, “certifying” that someone is a qualified doula simply because they wrote an essay, read some books, made it to a few births and summarized them is not enough. Is anyone making sure they are good ethical people? Has the organization contacted and spoken with several of the doula’s references? Will the organization stand by its certifying of the doula if a complaint is made? I consider an organization to be a strong one when they will stand behind their doulas, stating they have been trained in the most rigorous way possible.

If consumers or careproviders have a complaint about your behavior, they can bring it to the organization’s grievance committee and be heard. They have recourse. From my checking, very few groups certify doulas at this level. What they call certification is merely the completion of a checklist of requirements. There are few qualifications for character or job performance, and no recourse for future complaints.

Because training quality is so variable, it contributes to an “anything goes” atmosphere. We look unprofessional and unorganized to outsiders. This fuels the reluctance many medical professionals have in generally recommending doulas. They may recommend an individual doula, but not doulas in general. There is no guarantee of quality and no consumer protection. If parents are unhappy with their doula’s performance, they may not have any recourse. This could bounce back to the medical person who recommended them.

Now I’ve been doing professional labor support since before the word “doula” was in use. I was a part of the conversation when the first four large scale training organizations (ALACE, DONA, CBI, CAPPA) went from an idea in someone’s head to creating certification standards. It used to be that calling yourself a “doula” meant that you could assume certain things about that person. With the differing standards and philosophies from sixty-seven organizations, that is no longer true. Because we have a diluted group identity, I see many people seeking strength in an organizational identity.

Globally, we are in a time when nationalism has become more prominent. Rather than thinking about what is best for us on a planetary or humanitarian scale, people are concerned about the well being of their own nation. They see themselves as belonging and being similar to that group, rather than to people as a whole. I see the same thing happening with doula identities. Are you a “Xxxxx doula”? Are you “Xxxxx proud”? The organizational identity substitutes for the larger sense of connection we had with one another no matter what our training and certification affiliation. Being independent and staunchly unaffiliated with any group is also an identity. While this might work for an individual or the organization, it doesn’t serve the movement as a whole.

At the same time, I don’t think this scattering of training organizations is something to get too excited about. For one thing, when I examine the histories of both social movements and the growth of professions, it seems that this diversification is a natural stage of development. It is a part of the spreading of the movement’s belief system and the increased demand for workers to do this job. It is unhappiness with this stage and the lack of uniformity in standards that usually leads to large scale organizations to create universal standards. The desire for this comes from within and without. For example, doulas who see the need to affiliate around common values and behavioral standards. But that isn’t enough. There is usually public pressure to provide standards that protect consumers and offer remedies when [in this case, a doula’s] promises are not fulfilled.

So, if I take a step back and look at things over time, I can see 67 training organizations as a positive sign of growth in the demand for doulas. It is a stage in our profession’s development. For the most part, growth has been driven by people who want to offer the service, not by people demanding the service. It’s been up to doulas to educate the public about why they would want a postpartum or birth doula. As far as I can find, no one has tried to educate the public about why they would want a doula whose certifying organization has personally screened them and who offers a grievance procedure in case there are problems. Nor has anyone, besides me, tried to guide wannabe doulas into asking questions about a trainer or training BEFORE they’ve spent their money. Several high quality trainers have mentioned that they are asked for discounts for their workshop because someone already spent their budget on a lousy one.

What about if we look at The Really Big Picture? Where did doulas come from anyway? We came from women helping other women to flourish during pregnancy, labor, birth and postpartum. We came from a tradition of listening to one another and respecting one another. For those of us who had no formal training when we started (like me), we learned from doing the work. We learned from going to births. We learned from listening to women. We learned from listening to one another. Birth itself is always our biggest teacher. I have hope that even if someone is poorly trained, if they are paying attention and asking to learn, Birth will step up. Birth is the most important trainer of all.

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  1. Just one other thought. I also think we need to give a little slack to new doulas coming in and perhaps making mistakes that we then blame on their training. I like to say that when I got my RN that I got permission at that time to learn how to be a nurse. And, quite frankly, very little of my schooling trained me to be a labor and delivery nurse. I was, quite literally, really trained on the job. The same thing goes for doulas. I would be very hesitant to blame a training company for a new doula’s mistakes. I also feel we do very little in the doula community to continue educating new doulas.

  2. As one who has developed an online training, I love this article. Even though I am online, it takes a lot of work to make a program that can provide quality doulas. I don’t make bank at all being online and it is NOT easy at all. I have spent countless hours studying education, online learning, and research involved in how to best education this population. I am always working at improving the course to better serve doula students. I have had women tell me how much more prepared they felt with my program than the weekend in person course they took. Maybe because of that, I appreciate this article even more. Creating a quality program, online or not, is hard work. I am grateful to all these trainers who work hard to make sure they provide training that will help further the doula education. I also appreciate this conversation, because it is really helping me to look closer at what students need to become better doulas.

  3. Amanda

    What is one to do when they are low income and live somewhere that does not have in-person training options?

    • Amy Gilliland

      Since I live in a state that is mostly rural by land mass but with most of the population in two cities, I face this dilemma as a trainer. I’ve also traveled to North Dakota where people don’t think twice about driving two hours each way to go to the store. I think it depends on what the doula’s goals are. Is it to have a business and make money? Is it to provide labor support in their community but income matters less? Is it to attend the births of friends and family members or to enhance a nursing career? It’s not a one size fits all answer, but I’ll offer my general thoughts.
      First, are in person training options really out of the question or is it a matter of finances? I work with people to creatively finance their training and that is an individual process. Two, what is the cost of a trainer coming to you? Are there other people who would be interested? If so, how much are they willing to pay? Generating a birth community will be more advantageous to the doula in the long run. This takes time and a willingness to contact other people, but has also worked in the past. Third, if travel is not an option for anyone, then you just have to plan more and find the best online training you can. Nikki McFarlane began Childbirth International in Singapore in the late 1990’s because there were no resources there for anyone. There were interested individuals all over Southeast Asia but no way to get them in one room. She developed her program using email with each person working with an individual trainer/coach; she integrated Skype as soon as it was available. No matter what online training is chosen, knowing who the trainers are, the standards of practice for the organization, and a history of graduating high quality doulas would all be indicators of quality (of course there are more). Next, the person could predict areas where confidence might be low and make a plan to remedy them.
      I think its a different story when you are truly isolated with no in person options because everyone where you live is in the same boat. Many things they might want to learn have to sought outside the community, so that’s what everyone does. Because of that people are more forgiving I think when you’re trying out your newly acquired skills – plus they have differing expectations. They aren’t comparing themselves to Doula A and Doula B who took four day in person trainings – or competing with them for business.
      Many of these points are brought up in my post about the Top Ten Questions to Ask When Choosing a Doula Training, which is referenced above in the post. There are different kinds of people, different cultures, and different goals, so there needs to be different ways to train people. What I wanted in my twenties from a training is very different from what I would’ve wanted in my forties. Birthing is a human being activity, nestled in culture. But it still involves oxytocin stimulation*, a protector to keep the laboring person safe, good communication from the birth team (if any), and empowerment of the laboring person – no matter what.

      *Hugging, hand holding, positive touch, dancing, eye contact, etc.

  4. lbennett649

    Interesting points. How does DONA make sure a Doula candidate is one of those “good ethical people”? How do you suggest that is done? As an experienced midwife and now doula trainer, I am very interested in your response.

    • Amy Gilliland

      I am not saying that any system is foolproof, there’s no way for that to be guaranteed. That’s why a grievance procedure is so important, so that everyone can be heard if there is a complaint. I do think having letters of reference, information and feedback about the doula from multiple sources, and phoning and talking to those people is a part of the picture. The doula also needs to agree to follow the ethical standards and policies of the organization; and those will vary depending on their values. But I think we can all agree that the autonomy and voice of the laboring person needs to be at the center; the doula needs to follow through on what they commit to; and the doula should not be giving medical advice but facilitating communication with the medical careprovider. No matter what the organization, I think those are minimum standards. DONA’s certification procedures are detailed on their web site, but I’m more interested in the bigger picture.

  5. Penny

    Wow… So another biased article, biased towards DONA. Crazy. Rating doula organizations? Based on what? What are your qualifications to review organizations? You work for one. Doulas are not accredited. Doulas are not recognized by anything. Are you saying DONA background checks all students? Insures they are not criminals? Are you now taking the Prodoula crap tactics to promote your message. Shit on everyone so “we” look better. Horrible. So many trainings are better than the ones your seem to love, and some have been around longer. But, I get it a 50 page manual from DONA is enough…..

    • Amy Gilliland

      Hi Penny W! I’m not quite sure how the essay is biased towards DONA…in fact I got some feedback today that people felt I was criticizing the big groups! If I’m criticizing anyone, its the people who want to make a buck on low income people who don’t know what to ask. Their trainees end up not being able to do the work even though they paid for a training (online or in person). Usually their web sites don’t mention WHO is doing the training or their qualifications.
      Also, I don’t work for DONA, I work for myself. I train birth doulas but while DONA trainings have 16 hours of standard curriculum, trainers are free to add topics and activities. I actually have eight more hours of curriculum and 134 additional pages in my training manual. The current DONA manual is 120 pages. I’m not quite sure how the post supports larger organizations over smaller ones, as long as doulas are known and vetted that can work on the local level too (see Janet Padgett’s post below).
      I’ve been a professional birth assistant since January 1987 and my doing the work predates any birth assistant trainings or even the word “doula”. Polly Perez and Cheri Grant were the first people to teach workshops that I can think of, and that was almost a decade before DONA even started. So I think I’ve earned some perspective over the years watching the profession AND the social movement of doula support grow (both birth and postpartum).

  6. An awesome post Amy! This post touches on many of my own feelings. I have been with DONA International for almost 15 years and trained DONA doulas for over 11 and still going. Becoming a doula simply cannot be learned online. And the shortest, cheapest, easiest and fastest route is seldom the one that leaves you the most qualified and competent. I am deeply concerned by the quality of training that many of these 67 organizations are pushing. And the length (SHORT!) and the lack of leadership. and so many things. If you want to be a doula, it is well worth your time to thoroughly investigate the history and quality of the workshop and trainer you are interested in along with the certifying organization. If you have a question, reach out, I am happy to talk! I have a personal vested interest in this because when I arrive at a birth after another “qualified” doula was there yesterday and left a bad doula taste in the mouths of staff and providers, my job is harder than it has to be. I am curious what the future holds for the doula profession.

    • Amy Gilliland

      Thank you for your insightful comments, Sharon! When nurses ask me about doulas, I tell them its okay to ask about where they were trained AND how do they perceive their role. If the doula seems uncomfortable, you can smooth things over by saying that you want to work TOGETHER with the doula to serve the mom. The more you know about how the doula sees their role, the easier it will be. This should relax the doula and you can have a conversation. Make sure to be warm and let her know you are there to work together and if she has any concerns or questions, to let you know. Unfortunately this puts the responsibility on the shoulders of the nurse when its the doula who is a guest in the nurse’s house, but it works.

  7. Yeeessss!!!!! As ancient as our role is, we are still so fledgling as a profession. There are growing pains as we evolve into a state of maturity. While, like you, I deeply appreciate the diversity of the different trainings and the need for people to choose what resonates with them, we can also see that “nationalism” develop at the COST of professionalism (though it is often in the NAME of professionalism). “Birds of a feather: can have its challenges too. Ethical behaviour, such as confidentiality, not losing one’s shit when challenged, respect for all clients, COLLEAGUES, care providers, and those who disagree, treating those in your collective ethically, etc…THESE are the things I look for when it comes to certifying my doula trainees. How we treat people is more important than walking around with encyclopedic birth knowledge at our finger tips. I believe in investing in good educaiton, I believe in hands-on. Oh, the money I could make if I turned my CORE training into an online one. I wouldn’t have to travel, etc. But I have committed to furthering QUALITY of doula work. If we are going to be embodied listeners and holders in birth, I believe training needs to reflect that. I think advanced topic trainings can be great on line, but I am committed to the in person experience. I believe it shows in the work of my students. Most are not online bombarding the public forums with praise for their training or jumping down dark rabbit holes of argument about who the best organization is…because they are too busy going to births and being present with their communities, as well as being confident in themselves.

    Thank you for this. Brilliant as always.


  8. Hi Amy, thank you for writing this article.

    I too was a doula before we knew what to call ourselves, and before certification- I’ve been doing this since 1990. When certification became available, I was the first regional rep in this area, but ultimately resigned after a couple of years for the reasons you outlined in your article: attendance at a workshop, reading some books, and attending births without benefit of a mentor or shadowing opportunities seemed unwise to me, and ultimately led to receiveing complaints as the rep that a doula had ‘ruined our birth’ or took over for the partner, or caused friction with a provider.

    Ultimately this led to me creating training specific to serving clients through my company (Birth Partners – in CT) and which includes workshops on ethics, biases, communication, advocacy vs crusading, as well as education in things like comfort measures, and the components of labor and birth we need to know as professionals serving our clients- and role play, shadowing opportunities, reports, etc. Each trainee is mentored, one on one, in this process and we have high standards for completion of the program.

    Over the years, we’ve considered doing away with the training as it’s extremely comprehensive and time consuming for us as well- but shouldn’t it be? In the end, we feel that every component from screening the candidates to the training itself is so needed and so valuable in serving birthing women at the highest level. Many/most of those who come to us to train to work with our clients have already been “trained” and certified elsewhere, and inevitably, by the end of the training, they will tell us how little they knew coming in, even as a “certified doula”.

    So yes! When a potential client calls, I do talk with them about the benefit of hiring a personally screened and well trained doula, with our company right here to support them should there be problems. Honestly, we’ve been fortunate in that over these 26+ years the problems have been few, but again, that goes back to setting the bar very high with a training that insures that bar is met or exceeded.

    Again, thank you for this article!

    • Amy Gilliland

      Hi Janet! I think you’ve given a great example of a regional or local training program that really serves the area. Providers know they can trust doulas who have been trained by you or come through your program, and so do parents and consumers. You know the idiosyncrasies of your hospitals and the preferences of the people who live where you do. International, national, regional or local, the best training and certification programs get to know and vouch for the individual doula. Amy

      • Hammina

        Hi, Amy, I’ve read a couple of your articles and they really speak to me and a lot of the questions I have rattling in my brain. I have reached out to a couple of doulas and haven’t gotten a response, so the topics you touched on helped answer a few questions. I really want hands on learning, and mentoring, rather than just an online education. I’m just having a hard time finding my options. Reading your articles have been great, giving me a lot more perspective but now I have even more questions. Is there a way to find reputable hands on training in SoCal ? I know there are nearby workshops but I’m looking for more than on line learning as my
        Only means of education and certification. Is there a trusted network you can suggest?

        Thank you!


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