Should We Have ONE Certification Organization for Doulas?

There’s been some talk lately (nothing new really) about having one national organization for certifying doulas. While it seems like it could be a nice idea, I have some concerns.

First, the good…

In terms of recognition, one doula organization could do some great things. Marketing and awareness for the consumer could be broadened. Recognition in media outlets may increase. We may gain respect as an industry – think of the recognition achieved by being an IBCLC as opposed to a lactation educator, etc.

Recognition for the consumer would be wonderful. With more women aware of doula care, it’s certainly possible many more women would be interested in exploring this in their own birth. If I fully embrace my idealist side, I’d even go so far as to say birthing practices would change en masse and we may see a turnaround in our cultural birth practices.

However, I think have one organization would certainly have some negatives. These negatives have the potential of out-weighing the positives.

Personally, I’m hoping to begin doula certification within the year. I’ve gone back and forth about doula organizations to certify with throughout my pursuit of this career. There is the possibility of doing a DONA training in our area in the fall; otherwise, I’m generally looking at doing distance learning or traveling three hours or more.

However, I’ve never been totally comfortable with certifying through DONA. I’ve had it recommended to me many times before (I’ve even blogged about deciding to certify with them). But it seems to be such an impersonal organization. I don’t want to join an organization simply because it is “premier,” (which is very true of DONA, and I certainly respect that), but there needs to be something more. Maybe I’m missing something, and more consideration will certainly follow before I make any decisions.

That little tangent discussion of DONA will be relevant later; I’ll come back.

I think for some, the biggest issue with having one certifying organization would be in the possible restrictions placed on its members. Most commonly, the restriction doulas complain about is involving “free birth” or unassisted birth. For me personally, I’m not sure I agree with having a doula (a trained support professional) at an unassisted birth, and I’m not sure I would take a client planning unassisted birth. However, there are doulas who would like to serve women and families in such capacity (I can think of one I know personally who is skilled in this area). And I think they should be allowed to do so (and encouraged! If you have such expertise and feel called to serve in such a way: do it!!)

I’m a little concerned that having one doula certifying organization would in some way “medicalize” the profession. Doulas are non-medical professionals, and I feel they should remain so. Doulas who are student midwives/midwives’ assistants walk a fine balance, and I don’t know how they juggle the two. But for the majority of doulas who are not in that situation, medicalization would harm the profession. I’d be afraid of “protocols” and “standard practice” and other such generalized guidelines that might interfere with the personalized care doulas are “famous” for. Doulas are uniquely available to hands-on at all times, without having to stop and chart or do a particular procedure. While many doulas do chart their notes, they typically wait until the birth is finished and the family is settled before hurriedly scribbling.

I’m not saying that I am afraid a certifying organization would begin to require doulas to do medical tasks. However, I do think that unfortunately some families already feel that doulas are part of the medical team, particularly in assisting the midwife. This assumption may cause them to not look further into the possibility of doula care. So many believe that doulas are only for homebirth, possibly stemming from that assumption of assisting the midwife.

So what should be done?

I honestly don’t know.

Back to my concern about DONA, one of the great benefits of the current situation in having multiple organizations is that there are many different philosophies. A common piece of advice for new doulas trying to pick a certifying organization is to “see which philosophy fits you best.” Losing this could be detrimental to the profession.

It also allows some to study and become experts in doula care and choose not to certify. There are a number who go this route, and they should be allowed to continue to do so. I think that families are able to interview doulas and decide for themselves who best to serve them, whether or not they are certified. I would be concerned that simply one organization would attempt to push out “rouge” and “uncertified” doulas.

Me, I’m choosing to certify. I do think that for me, especially among nursing professionals, having certification will be one step in showing my skills. But for all the other doulas out there, I don’t know that any one person/organization should be making that same call.

How do you feel?

FAQs about Doula Services with Healthy Mama Childbirth

What is a doula?
A doula is a trained labor professional who provides support during labor and birthing. The word doula comes from the Greek, meaning “with woman.”

What help do you give as a labor doula?
I provide emotional, physical, and informational care throughout the entire course of labor. I can give you information about labor and birth to help you make informed choices, reminding you of what you have learned in classes and of your desires for labor and birthing. I provide emotional support in the form of encouragement and constant presence. I can give you suggestions to help your individual labor progress well and help you have a healthy birth. I support you physically with comfort techniques, such massage and counter pressure. I also support your partner, giving him suggestions and help for taking an active role in your labor support, allowing him to take breaks, and giving him informational and emotional reassurance regarding the birthing process. I will help you labor at home if you desire. I may also help you know when to go to the hospital or birthing center, or when to call the midwife.

What support do you not give as a labor doula?
A doula never provides medical care. I am however trained in medical interventions and can explain how they work as well as the pros and cons.
I do not replace your partner; instead I support the couple.  I will help as much or as little as the couple desires. Your partner has emotional investment in you; a doula usually does not. This is both a pro and a con. Your partner’s emotional investment in you allows him to truly understand you and provide care. A doula’s lack of emotional ties allows her to be objective and unbiased in your care.

What are the benefits of having a doula? From The Doula Book  (Klaus, Kennell, Klaus).
“In studies of over 5000 women involving comparisons of outcomes with and without such support [as a doula], we have seen a major reduction in the length of labor, a greater than 50 percent drop in cesarean sections, [and] a remarkable drop in the mothers’ need for pain medication.”

Why can’t I just rely on my doctor for everything?
You can, and you should, rely on your doctor for medical advice.

Unfortunately, many doctors don’t seem to have the time necessary for support. Are your prenatal visits less than 30 minutes? Do you have long wait times to see the doctor? If these are YES, then you probably have unanswered questions. Most simply don’t have the time to address basic needs such as what you eat, how you manage stress, or how you plan to arrange life post-partum.

Many women find that their doctor is not present during labor. Most doctors do not come until the pushing stage.  Your doctor may not be on-call when you go into labor, and someone you may never have met may be catching your baby.

A doula is the only trained professional who will be present with you throughout your labor, birthing, and early postpartum period.

Aren’t the nurses there to help me? What about my husband/partner?
Yes, the nurses are there to help you, but the help they may be able to provide might not be what you need or expect. Nurses are responsible for a number of patients, limiting their time to spend individually with you. Additionally, their responsibilities also include a variety of clinical tasks and paperwork. A nurse will certainly help you when she is able, but you will likely find you need information, comfort, and support “NOW” rather than when the nurse is finished with another laboring mother.

As for husbands and partners – while many men feel confident before labor begins, they often find this confidence wanes as labor progresses. They may resent the fact that they have to put aside their own needs and fears to support a laboring woman. Additionally, most men lack the experience and training necessary to continually provide comfort, support, and coping techniques required for a laboring woman. Many men, no matter how well trained in childbirth education classes, find recall and actual practice of techniques more difficult than they imagined.

It is normal for men to feel this way, and doulas are there to both validate the partner’s feelings and give him the support to in turn support his partner, the laboring mother. A doula can offer the informational and emotional support the partner needs. Some partners become overwhelmed just when the laboring mother needs to most support; a doula can allow him to take a quick break while still meeting the laboring mother’s needs.

What if I want an epidural? Are you going to try to make me feel bad or talk down to me?
No! I firmly believe that each woman (and couple) needs to make the choices they are most comfortable with at the present time. I feel my job is to help you make an informed choice – I want you to know and understand all the benefits and risks “common” procedures (such as epidurals and IVs) have.

I do support natural, unmedicated childbirth, and I feel that every woman is more than capable of having that kind of birth. But I won’t think you’re a failure if you don’t have an unmedicated birth. The thing I believe is most important is a safe, satisfying, healthy birth. Some women have it with epidurals, some don’t. Some women have it with natural childbirth, some don’t.

How do you feel about hospital birth? Do you think all women should have home births?
I operate fully under ICEA’s motto of “freedom of choice based on knowledge of alternatives.” Therefore, I fully support women and families in the choices they make in childbirth from elective cesarean to home birth, whether I would personally make the same decision or not.

I fully support home birth. I also fully support each family as they make the decision of birthing location based on both the knowledge of facts and personal needs and comfort levels. Many women in the United States choose to birth in a hospital or birthing center.

Is doula support covered by insurance?
Usually no. However, some families have been able to use funds from their health savings accounts for doula services. Most families find that doula services are worth the price.

I offer payment plans for my services. I also offer some services at an add-on price. However, all basic doula services – prenatal visits, on-call period, labor and birthing support, postpartum visit, and phone/email consultation – are included in the basic price.

Also, because I am currently in the process of certification through ICEA, I offer my services at a lower price than a certified doula.

Certifying Organizations for Labor Doula - A Dilemma

Had a good conversation with a dear friend the other night about certifying as a doula and childbirth educator. I’ve been putting off certification primarily due to monetary issues – we just can’t afford to put me in a program right now.

But I’ve also put off certification because I’ve had trouble deciding which organization to go with.

Initially, when we could afford it, I was going to certify through DONA. The closest course was in Toledo, so I was going to drive the six or so hours, in February. Before I signed up and paid my down payment, I found I was pregnant. Driving to Toledo in February while pregnant is simply a bad idea.

While I was pregnant, I discovered CAPPA and liked that organization pretty well. CAPPA also seemed to offer trainings a big closer to home, so I began to concentrate my planning in that direction.

Then I stumbled across Childbirth International, which is still my favorite organization for a variety of reasons. Overall, I think their program is very thorough; it’s been described as a mini-midwifery course. I like it that the course is entirely distance based and offers a variety of payment plans. I appreciate that I’m not required to become a member of any organization or maintain that membership in order to keep my certification. Once I’m certified, that’s it – doula for life.

My only problem – Childbirth International is just not nearly as well know as some of the other organizations – think DONA and CAPPA.

So, back to the conversation with my friend, a midwife who practiced in our area before it was time for a family move. I trust her judgment in the birthing business. We talked about area midwives for me down the road when my husband and I are ready for another and the conversation of course turned to me becoming a doula.

“K---, I’m going to just go ahead and put my services out there as a doula and childbirth educator. I feel I’m ready even though I’m not yet certified. But I do want to be certified on down the road. Who do I go with?”

Almost before the question was out of my mouth, her reply – “DONA.”

She had good reason – if my aim for certification is so that I have more client recognition, then I should certify with the most well know organization. Otherwise, why certify? I’ve done so much self-study, and have personal experience, that I don’t need certification in order to get the basics needed to begin attending and providing my services at births.

(I do, just to be clear, feel that all doulas should keep learning and studying, even after certification. A good doula is always adding to her knowledge.)

My friend agreed that Childbirth International has a great program, but that the problem of being less well-known is a factor to be considered.

So I guess I’m back to where I started – DONA. Spent part of the morning downloading the certification information to read through. (Also downloaded the information for ICEA’s childbirth educator and to become a board certified lactation consultant. Aim big.)

Now if we can just get the money together, I’ll be content to drive to Charlotte or Cleveland or D.C. I just want to help women as they’re birthing babies!

BTW: What do you all think? I’m content with DONA’s program, but really like what I’ve seen of Childbirth International. Do I go with recognition anyway?