If you have been a doula in the last 10 years, the topic of certification has been a prominent one. It is met with varying opinions and discussions concerning philosophy and equity. Let's begin with the main point of training. There are many certifying entities in the doula market. Like religion there are many philosophies and scopes of practice. It is during the pandemic that the microscope on these differences is magnified. Why?
As laboring persons struggle to have more than one support person in hospitals during these times, it often means either putting the doula on the back burner or seeing the doula as essential and limiting other family members. This has caused a bit of panic! Imagine not being invited into the birth space as a grandmother, sister or cousin if this was the original plan? Imagine being the doula who has spent months nurturing the relationship with a client only to be called "non-essential". Many states have been flip flopping with the decision to allow doulas in hospital spaces. Just recently NY signed an executive order deeming doulas essential to the birth process. It is expected that NJ will follow suit eventually. This is good and bad news for some doulas. (But that is a different story).
SO why bring up certifications? Simply put the doula industry is expected to save laboring persons from disparities, to educate, to support, and to advocate for families concerning all things birth. Now that the word "essential" is added to the mix, ensuring a person who claims to be a doula is ACTUALLY a doula is paramount! There are desperate families trying to gain access to hospital and birth center spaces posing as doulas. There are also frauds who seek monetary gains to exploit families by claiming to be a doula. How do we differentiate between those persons and a real doula? Proof of Certification! It upholds the integrity of the profession and does not allow those who think it's just about massage and hand holding to do it a disservice.
Doulas know we have come a long way when it comes to being called "essential". Many organizations have studies that prove the presence of a trained and professional doula can improve birth outcomes. We can not afford to take steps backward now that we have been given an arena to shine. Many would argue that this leaves the doula in training on the proverbial side of the road. How will they ever obtain the necessary experience and births required if certification is needed to enter the hospitals? I submit that certifying entities provide these doulas with other types of completion certification. Or some other official document that allows them access and that hospitals abide by these newly formed documents. Or they should rethink their certification processes that require birth attendance before certification altogether. If a doula is properly trained he/she should be able to do their job day one! On the job training should not be left to the student who is paying hundreds or thousands of dollars to be certified. Reporting and obtaining evaluations can still happen, if necessary. But seriously, simply taking a seminar or workshop does not make one a doula. The time to create a fully educated doula is one that most of these organizations do not want to invest in, thereby requiring "on the fly" training. This does not do the laboring person any good if their doula is asking questions on Facebook..."help, this mamma is....what do I do now?" Where's the mentoring? What tools have they been provided? Some agencies just take their money, expect them to self-train and offer no support along the way.
The other piece of this puzzle that needs to be addressed is the seasoned doula who decided never to certify with organizations because of some of the reasons mentioned. Where do they fit in? Here I think letters of recommendation from midwives or OB's could suffice. If you have been around the block, you are known! Your work may very well speak for itself. This category of doulas obviously does not like the requirement of certification. It's all tricky, I know. I am also not equating certification to regulation either. (Again that's another story) Doulas aren't medical professionals, we fall back on this often. We can't have our cake and eat it too, though. We want to have insurance companies accept our fees of service, we want to be viewed as essential but we don't want to be regulated or certified. Going back to the religion analogy, we want government funding but we don't want to pay taxes.
As a certified doula with renewal fees each year and continuous education courses and exams, I proudly submit my certification when requested. Like my degrees, they hold a sense of pride and accomplishment. As the doula coordinator for The Birth Center of NJ, part of my job is to ensure that doulas entering the center are ready for the task at hand. That they understand the difference of their role in the Birth Center versus a hospital and that they have some experience. In protecting liabilities, it makes the most sense to choose doulas with certifications as well as experience. To reduce surprise at the hospital or birth center door, when hiring your doula please inquire about their certifications. It might be OK for you if they don't have them or they aren't up to date. But know that they may not be allowed to doula you in some places. So it is critical to be a savvy consumer. If you are a doula in training, ask if your certifying entity offers credible and reputable certifications. Ask if your certification is lifetime based and how will/can that be updated to show you are current? Not renewing every year may seem like a bargain but if you certified in 2020 how will that be viewed 10 years from now... If other organizations are updating annually? Also ask them how do they support you when you have questions at future births? Will you too have to resort to Facebook groups for help? A dear doula friend who counts every single birth she attends said that she felt she hadn't fully known all there is to know until she attended over 100 births. The moral of the story here is that there is always something new to learn. Unless we have a sure fire way of weeding out those who pose as doulas, certifications will and should be required in many spaces.
Doulas and doula organizations should want to do all they can to protect this industry. We should have a way to fast track those who have already taken doula trainings but want to certify with someone else based on philosophy and support. We should have a way to mentor and protect new doulas in the industry so they can grow and feel ready when that phone rings! And we need to do all of this BEFORE state regulations start to pick and choose specific doula organizations as the role models that do NOT serve all populations nor doula philosophies. There is no ONE right way to be a doula, all cultures and styles should be available. All certifications should have value. But all organizations should be held accountable when their "trained" doula is left hanging looking for answers.
I welcome your respectful comments!
When others doubted my suggestions, more are flocking to find a birth solution out of hospitals. COVID-19 is building panic in the birth world. Midwives are now overworked and birth centers at closing in on capacity. As policies change around support persons, doulas are left to wait in parking lots and support virtually if the partner is with the birthing person. I want to remember this time I was interviewed not even a month ago. Not as an "I told you so", but at how quickly views shifted.
We will get through this, but we will need to ensure that families get the healing they will need once it's all over. Planning for birth in this climate will be a challenge but not impossible. I'm teaching childbirth education classes now more than ever as parents are forced to become their own advocate. As well as their own comfort measure expert with guidance from virtual doulas, if applicable. There was a campaign some years ago called "take back birth".
This rings true to its core today!
Breastfeeding, postpartum care, anxiety and depression will all have new meaning during the pandemic. Different versions of the new normal with take place in parenthood. Lack of support should not be one of them. Creating a postpartum plan is CRITICAL, even if that support is virtual. Rethinking birth plans also means rethinking life after baby. There are many postpartum doulas, nannies and nurse aids who have redefined their support structure during these odd times. Reach out!
I'll end by wishing everyone beautiful birthing journeys in the new landscape of birth. Know that your rights can still be preserved and patient centered care can still be obtained. I do wonder if that doctor in the article above still thinks it's overkill to suggest different birth options now? In addition, the couple on the fence did switch to a birth center birth!
There are many types of doulas! Fertility, Labor and Postpartum are just a few examples. As the benefits of having a labor doula are flooding the internet, creating panel discussions and influencing policy changes some parents still are not sure when to actually hire the doula. This blog serves to speak about LABOR or BIRTH doulas only, those whose primary function is to attend the birth itself.
So when is the right time to hire your labor doula?
The quick answer? As soon as possible!
Hiring a Private Practice Doula:
To gain the full benefits of having a doula, time should be spent getting to know each other. Of course, this is assuming you have completed an interview process with local doulas and chosen your favorite. One who aligns with your values, birth philosophy, target experience and budget. I am not going to get into all that here. But should you like more information on how to begin finding a doula here's a good link.
One you have selected your doula, hiring is the next step.
Ideally, you should be about 5 months pregnant or less. This may sound early, but your doula is also trained to assist you during your pregnancy. Comfort measures to alleviate headaches, nausea, back pain and all other pregnancy induced minor annoyances can be handled with a simple text to your doula. Your doula could also be a childbirth educator; so you may need more time to either attend classes or have detailed prenatal visits with education as the focus.
Navigating the “lay of the land”, your experienced doula has first-hand knowledge working with local providers and can give you some background based on your preferred options. Sometimes this may mean changing providers to obtain your desired birth outcomes. So hiring your doula the earlier the better to ensure getting this information in a timely manner. For example; you are currently with a practice that does not support homebirths, water-births, birth center access, or VBAC (Vaginal Birth After Cesarean) and you want your best chance to obtain one or more of these birth choices. Your doula also has a vast resource list, from doctors/midwives to pediatricians to chiropractors.
Sounds great, right? However, a great doula is usually booked, so do not miss your chance to hire them and GET ON THEIR CALENDAR!
I'm a private practice doula who insists on childbirth education classes with me before hiring me as your doula. That's just my philosophy. It builds our relationship while you attend classes, creates trust and an overall sense of empowerment. My clients actually prefer it that way. Most say "you don't know, what you don't know!"
Hiring a Community Doula:
Depending upon the community program there may be several procedures in place that would warrant getting started early. There may or may not be an interview process.
Some programs will assign a doula to you. In any event, resources and information will still be available in this collective of Community Doulas. The beauty of this program is the community based aspect, culturally appropriate and usually low-cost or subsidized if you qualify. In-house back-ups! As birth is unpredictable having a community of doulas can ensure someone will be at your birth. With a limited amount of doulas serving a large community, these doulas can be overbooked as well.
Call early to GET ON THEIR CALENDAR!
Here is a great community doula program in my area!
Hiring a Doula from a Collective:
Almost similar to the community doulas, this is a private group of doulas covering a specific area or demographic. The likelihood of interviewing your doula is greater in this format with the option for an in-house back-up. Covering the same benefits and resource aspects as the private doula with a greater pool and maybe even some discounted services due to referrals. The volume of work coming through this collective almost ensures the need to reach out early to
GET ON THEIR CALENDAR!
2020 will likely see me create my own private Doula Collective...stay tuned!
I also coordinate the Doulas affiliated with the Birth Center of NJ :)
There are some hospitals that will have doulas on staff. You are likely not able to meet them beforehand to establish a rapport but it would be handled similar to nursing staff. How you pay for this service depends heavily on the individual hospital policies. Call ahead to determine if and how your hospital handles these services, they may be on a first come first served basis and NO CALENDAR TO GET ON!
Sorry but I honestly don't know the best way to find you a link for hospital doulas.
These programs seem to come and go. Or they just aren't advertised well.
The last thing a doula wants to do is turn away an expected parent because their calendar is full, we usually work with other doulas to ensure support and good coverage.
Nevertheless, sometimes it is just too late in the game to help.
Signs you are NOT on the doula’s calendar!
· Calling the day before your induction for a consult is too late
· Emailing about services near the end of your 8 month with a list of different pregnancy conditions is too late
· Setting up an initial consult, signing the contract, never paying a deposit but calling while you are in labor is too late
· Talking about hiring your friend/colleague as a doula, never signing or paying anything or even talking about it anymore but calling when you are in labor is too late
· Calling when you aren’t pregnant and looking for a ton of information via dozens of emails means you need to take my SAVVY BIRTH 101 Workshop
· Having a great connection during the interview, then ghosting the doula until you just want to “ask for advice” and asking if the doula wants to “show up to the birth for experience” you wouldn’t mind is just plain wrong
I have been a doula for 15 years and all of the above have happened to me, one of them just a week ago. This is a business and warrants business transactions and contracts, (to protect you and the doula). I am certain there are some unprofessional doulas who just don’t show up for births. They do not represent the rest of us!
This is passion to serve AND a career for many. If you want a doula at your birth, hire us at the appropriate time in your pregnancy so that we can be most beneficial to you!
Reach out as soon as possible and don't wait until the last minute. If you are holding out for refund checks or lottery winnings you are missing your window of opportunity to find the best doula for you. We are worth every penny and so is your birth story!
Need a postpartum doula?
You should start that process in your 7 month of pregnancy or less ;)
Owner of Baby, Please Birth Services
Childbirth Educator and Doula
Evidence Based Birth® Instructor
Michelle has been a doula and childbirth educator for 15 years. As a professionally trained scientist, evidence based practices are her focus. Building trust with families through experience, education and a sense of humor puts birth into a human frame of mind and creates space for empowered miracles.
(These stigmas were also listed in an interview for the West Orange Patch dated 2/28/2020)
1) Under educated; Barriers to prenatal care and birthing options are often seen as a lack of willingness on the part of the black parent to either seek proper care or learn more about their options. The truth is black families aren't given the same options as white families. The conversations regarding alternatives are barely spoken since the assumption is we either can't afford them or don't understand them.
As a doula my first step is providing the necessary childbirth education, clear discussion on interventions, birth options and alternatives. My goal is to empower birthing parents with the information needed for true informed consent.
2) Black women are difficult; We are seen as angry, loud and difficult. When the reality is we are not heard! Listening to our daily stressors, micro aggressions and challenges of navigating health care built on systemic racism is the first step to changing this narrative. We only want the best for our families and our voices simply aren't heard.
Having had two children myself and helping hundreds of women navigate the birthing spaces in NJ and NY, I listen to black women. Understanding their values and concerns should be of interest to medical providers, so when that doesn't happen their doula is there to amplify their voices.
3) Black bodies are imperfect; reading any risk factor for a condition from hypertension to diabetes a common risk factor is simply being "an African-American". More black women are labeled "high risk" than any other group during pregnancy. This leads to greater chances of inductions and cesareans sometimes unnecessarily. When we are seen as a mass of imperfections straight from birth it is no wonder we have greater risks during labor itself.
Once hired, I reassure my clients that pregnancy is not an illness! That their bodies aren't broken, the system is broken. I work with them to ensure they stay 'low risk" and are seen as an individual and that blanket statements about black women are merely stereotypes.
4) Black women don't have partners; pregnancy is normally a very special time in a person's life. For black women in relationships, they spend an enormous amount of time convincing people they aren't alone. This 'poor pregnant black girl image' is one that most married or partnered women have to shake. Answering questions like "do you know who the father is?' is something very few white women are asked during prenatal visits.
My husband and I teach a childbirth education course with the partners in mind. It provides them the tools they need to support their wife or partner
during this beautiful time in their lives. Coaching and advocacy from the partner also helps amplify the birthing person's voice!
5) Black women don't breastfeed; This unfortunately is tied to slavery after being seen as "wet nurses" for white families the stigma of breastfeeding has been passed on through generations. Formula is also heavily pushed and advertised in our communities. This leaves black babies vulnerable without the benefits of breastfeeding, especially if the option was viable one. As a result many healthcare providers just assume it's not wanted or rarely offer support when things get difficult.
Immediately after birth I work with families to ensure skin to skin and breastfeeding initiation. We talk about the benefits to mom and baby while working on a plan for success. Additionally two more home visits ensure correct latch and proper feeding techniques. We also tackle any other postpartum issues as they arise, particularly anxiety or depression.
As a full time coatings expert for BYK USA, a chemical additive company, most people ask how I got into the birthing business. It's rather simple, I'm needed! As a mother of two who had natural physiologic births in a hospital space and at home, my birth experiences were not traumatic. So I know first hand there are options not given to other black women. Honestly, some of these options aren't given to most women regardless of race. The freedom to eat and drink during labor. The freedom to walk and rights of refusal of drugs, IV's or constant monitoring in low risk situations. When we remove the stigmas of birth and the routine procedures predicting that EVERY person needs a heavily medicalized approach we can start saving lives. But perhaps equally important we can empower ALL women in their own birthing spaces.
Childbirth Educator and Doula
Owner of Baby, Please Birth Services
While bringing doula work to light is important, it must be done with integrity. I had the extreme pleasure of being the only doula on the Netflix episode of 'Childbirth Explained'. It was part of a 4 series episode of 'Sex Explained', beautifully narrated by Janelle Monae. My initial excitement of actually seeing myself on video clouded what the 30 minute episode was actually discussing. You see, we had no idea what the context or even what series our involvement would appear. I venture to guess that most of the other participants had no idea either.
When I say we, I am referring to the mother I was assisting and the doctor who was attending her birth. We were in the last minutes of the episode and we were the only black women. The Birth Center of NJ had been open for less than a year, when Netflix approached them for a series on "natural birth". Pre and post interviews were asked of the doctor and the birthing mother. I was not granted such a luxury. To be fair, the Netflix crew that arrived at the birth had no idea what a doula was until the day of filming. So when I was asked to sign the release form I provided a description of doulas, used by the narrator much to my surprise!.
So, what was wrong with this video? A lot! Namely the focus on pain during childbirth and the misinformation about the average length of labor...9 hours? I think they meant 9 months gestation. More to the point, our main goal at the birth center was ruined. We wanted to provide evidence in action regarding natural childbirth, freedom of movement and the low intervention environment that a birth center can ensure. Instead we were in a mash up cervical stretching, primate birthing and numerous birth stories of trauma and pain. Not exactly what we had planned.
What was captured? A few snippets of me administering oxygen to an exhausted laboring person. What wasn't captured? The hours in the tub, walking the hallways of the birth center, showering, on the birth ball and the CUB. All the love, encouragement and peaceful moments were narrowed down to her final pushing minutes. Birth is more than just the pushing stage!
I'm glad this new mother felt strong, empowered and supported during her labor.
I'm upset it will go down in history as a typical birth in America.