I was reading an online discussion recently about the benefits of doula certification. There was some discussion about the fees and how some doulas don’t receive referrals from their certifying body which, by the way, is NOT the point of certification. Then this comment caught my attention:
… where I live most people have no idea what a doula is so certification is irrelevant most of the time.
To me the decision to pursue certification is a no-brainer. Sure it’s challenging, time consuming, and costly, but in my military mind it’s an outstanding weeding out process that separates the professionals from the amateurs. A 2012 article which shows favorable results from continuous labor support is popular among doulas. While it doesn’t distinguish between certified or uncertified doula care, there’s a fun little tid-bit which is often left out that specifically states trained and experienced doula care is best:
Continuous support from a person who is present solely to provide support, is not a member of the woman’s social network, is experienced in providing labour support, and has at least a modest amount of training, appears to be most beneficial. [emphasis added]
But those quotes solidified a belief that I’ve had for a while which is educating the consumer regarding the benefits of CERTIFIED doula support is instrumental in ensuring the birth doula role is:
- Sustainable
- Credible
- Desirable
A solid core of acceptable practices that are held by all doulas not only builds a community of support but more importantly adds credibility to the profession, both in the eyes of medical professionals and peers. This in turn makes certification a desired qualification of consumers who are shopping for doula care…but only if they’re made aware of the benefits. Support, credibility and a market share of women seeking certified doulas makes for a sustainable future. Especially if some hospitals are requiring doulas to be certified and many women are seeking reimbursement from their insurance provider to cover the cost of labor support.
Getting back to that first quote, if you practice in a market where the consumers don’t value labor support and certification, what are you doing to change that? If the family who is shopping for doula support doesn’t hear it from you, the certified doula, then who will they hear it from?
So I decided to do my small part and draft a semi-unbiased comparison of certified and uncertified doulas. Rest assured that what follows is not an opinion piece on why doulas should be certified. I’ve already opened up that can of worms.
Let’s take another look at that infographic and break it down…
Provides labor support
Certified and uncertified doulas both provide support to laboring women.
Trained
A certified doula will always be trained. The uncertified doula may or may not have taken formal training. It’s important to make sure you don’t confuse “trained” with “certified.” Many uncertified doulas will attend training then choose not to certify and advertise themselves as “trained.” There’s a lot more that goes into certification besides taking an approved training.
Code of Ethics (COE)
Most certified doulas are required to adhere to a COE. I say “most” because it depends on the certifying organization. However, uncertified doulas are not required to practice according to a COE. That’s not to say they “don’t” they’re just not bound by any organization to do so.
Standard of Practice (SOP)
My personal favorite, the SOP defines how a doula practices and is often referred to as their “scope of practice.” For example, DONA certified birth doulas are not allowed to perform clinical procedures, which can be anything from a vaginal exam (yes, it happens) to something seemingly simple as taking mom’s temperature. Uncertified doulas are not bound by an SOP. Again, not to say they don’t abide by one, but it’s not required.
Accountable
In addition to their client, certified doulas are accountable to their certifying organization for the way they run their doula practice. Everything from how they treat other doulas to the methods they use while supporting a woman in labor is defined in their COE and SOP. Clients often have an avenue of recourse through the organization if they’re unsatisfied with the certified doulas practices. Uncertified doulas are not accountable to anyone except the client.
Continuing Education
Depending on the organization, certified doulas are required to attend a minimum number of continuing education hours, just like any other professional career field. However, there are certifying organizations that will take a doula’s money and bestow the honorary title of Certified Doula for Life with no continuing education or re-certification requirement, so be wary. Doulas who are not certified, since they’re not required to complete an initial training program in the first place, don’t have to attend continuing education either.
Peer Reviewed
The process of achieving certification and re-certifying with most professional organizations is a rigorous one and for good reason. DONA certified doulas are peer reviewed to ensure they uphold the high standards of the organization. No such requirement exists for doulas who are not certified.
Insurance
Insurance is becoming a big deal lately, so I include it here only to make the distinction that the services of a certified doula are more likely to be covered by the client’s health insurance than the uncertified doula. The certified doula has credentials and the backing of her professional organization to help sway the insurance company’s decision while an uncertified doula is on her own.
Credentials
Like I mentioned earlier, there’s a difference between “trained” and “Certified.” Correction…there’s a HUGE difference. The easiest way to tell if your doula is not just trained but certified is to look for the credentials behind her name.
Different certifying organizations use different credentials, but by far the most common is the title of Certified Doula, which DONA awards as the credential “CD.” So a doula with the letters CD after her name is certified. With DONA as well as some other organizations, the credential is only valid as long as the doula maintains membership with the organization. The certification and re-certification process requires the doula to jump through multiple flaming hoops of death so it only makes sense that the doula stays current in her membership status. If in doubt, ask the doula to see her credential certificate which should have an expiration date.
Doulas who have chosen not to seek certification will use the title “Birth Doula”, “Trained Birth Doula” or “Professional Birth Doula” but they won’t have a credential after their name. They may have taken a formal training and even use that organization’s name in their title in an effort to make it appear more desirable (i.e. “DONA Trained Birth Doula”) but don’t be fooled by fancy titles. Look for the credentials after their name and ask to see their certificate. Certified doulas will gladly show you the fruits of their labor!
Reblogged this on DONA Birth Doula Workshops and commented:
This is going to be so valuable for primary careproviders , third party payers and clients. Thank you for spelling it all out.
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Thanks, Melissa.
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The problem with that comparison chart is that it gives the impression that non-certified doulas do not do those things. I am not certified and yet I have been formally trained, get more continuing education that most doulas I know, and am experienced. I follow my OWN code of ethics, which I hold to a very high standard. Part of our consumer-based system is that, even if not peer reviewed, we are all accountable and can be reviewed by our actual clients (on-line, via references, etc.). Some certifying organizations have guidelines in their standards of practice that are too restrictive, such as being able to use essential oils. We need to put our faith back into the mothers who are hiring their doula to ask the right questions about training, experience, scope, etc. Certification does not equal value. – Jess (NON-certified Doula, Registered Yoga Teacher, Certified Prenatal Yoga Teacher, CPR and Neonatal Resuscitation Certified)
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First, thanks for your reply Jessica. Sorry I didn’t reply earlier but I just sat down to the computer with a glass of something on the rocks. I’d like to start out by saying that the infographic does exactly what infographics are supposed to do, which is summarize the information, grab the reader’s attention, and hopefully get them to dig deeper – either through their own research, reading the accompanying article, etc. The graphic doesn’t say that the doulas don’t follow a COE or SOP, rather it makes the factual statement that those are not *required.* Trust me, I’m happy to hear that you’ve been trained, continue the pursuit of knowledge through continuing Ed, and that you follow a COE & SOP, but you’re not required by any organization or governing body to do so. Which is the point of the graphic and the blog post – as an uncertified doula you *may* do those things but you don’t *have* to.
Quite the contrary to certification not holding value, our consumer based, free-market economy has actually determined that it does. On average, certified doulas get more customers and make more money per client than uncertified doulas. I suspect that you value your CPR, neonatal resuscitation, and prenatal yoga certifications otherwise you wouldn’t have pursed them. I’ve been a CPR instructor and I’m currently CPR certified, but I can tell you that even without the certification I can still perform CPR as good if not better than most nurses or physicians because I’m very well practiced in the art of pushing hard and fast on someone’s chest until help arrives. Just last weekend I attended a two day wilderness first aid (WFA) course that required me to be CPR certified. So there’s value in certification.
But who determines the value? The guy teaching the WFA course of the guy who keels over in the restaurant and is saved by someone who was trained to do CPR five years ago? Many homeowners tend to over-inflate the value of their home when it comes time to sell. People think their used car is worth much more than the dealer will give them in trade. My point is the market sets the value, not the seller. I see it often in conversations that doulas are encouraged to “charge what you’re worth.” But unfortunately the customer gets to determine your value, not the doula.
Speaking of customers, all doulas are accountable to their clients for the level of service they provide, but that’s where the trail ends for the uncertified doula. The certified doula must actually abide by their COE and SOP or risk reprimand and even lose their credentials.
You’re absolutely correct, some organizations do have restrictions on what the doula can do – such as using essential oils. However, those same groups do not stop their doulas from achieving a certification as an herbalist and using oils under a different scope of practice. You just have to wear a doula hat when you’re providing labor support and your herbalist hat when you’re prescribing the use of over-the-counter substances.
I agree that mother’s looking to hire a doula need to know the questions to ask. But if certification holds no value, then consider the following scenario: You’re shopping for a doula and you’ve nailed it down to two “Jessicas.” They’re exactly the same in every respect – training, experience, personality, fee, etc. One of the “Jessicas” is certified and the other isn’t. Convince me that the “uncertified Jessica” is the one I should hire.
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As an unassisted birther who enjoyed having a doula at her birth, but struggled to find one because every. single. one. was cetified and terrified to lose their (unregulated) certification. (There is no one orgnaization that governs doulas, but you know this!)
I am a doula who is unregestered and will attend unassissted births anyday of the week for free. I will support all mothers, not just those that are medically minded.
So, your chart girl, its a bit skewed. All of those things certified doulas do, I do. Except I have a drive and desire for informarion that is gathered from fellow natural minded women in our community of natural Birthers instead of a paid sit in conference and “weeked training session”. I have put months into my educations. More than a year if we want to pull out exact numbers.
Reevaluate before you make fulty charts. How disgusting of you.
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Thanks for reading and taking the time to leave a comment. I can tell it struck a chord so I’ll try to keep it civil…although “unregistered” (or are we calling them “undocumented”) doulas aren’t typically too concerned with civility because, well let’s face it, they don’t have much to lose.
Let’s start with how the chart is skewed. I challenge you to provide an instance in which the chart is misleading in any way. I know you’re not going to care for this, but I’m going to say it anyway: by achieving credentials, certified doulas are held to a higher standard than un-certified doulas. This is not misleading, unfair, nor untrue. Certified doulas are held accountable for their actions by their certifying organizations. The same can not be said for undocumented doulas.
To whom is an un-certified doula accountable that a certified doula is not? Not the client. They’re both accountable to the client. Not the law. They’re all accountable to the law. So, what is it that gives the pregnant mom a warm-fuzzy that the doula they hired is going to practice in accordance with a defined COE and SOP? If you said certification then you’re correct!
Also, you seem to take offense by something you either misread or interjected into the article. As I explained, just because un-certified doulas are not held to a COE and SOP doesn’t mean they don’t practice accordingly. Un-certified doulas may very well hold themselves to a standard…it’s just not published so nobody knows what the standard is. Oh, and did I mention they aren’t accountable to anyone else for that abiding by that standard?
If you think the information is presented in such a way as to infer that I believe finding a certified doula is preferable to hiring an un-certified doula then you’d be correct. But the unsettling (to un-certified doulas) truth is that the chart sheds a glaring light on what is often a hot topic in the “birth worker” community. And since a common tenet of many doulas’ code of ethics is to “treat colleagues with respect, courtesy, fairness, and good faith” you won’t find too many willing to waste their time arguing a point that they already know to be true.
Finally, the blog is called “Doula Baby Daddy.” If you bother to read the articles (rather than just look at the pictures) you’ll quickly discern that I’m a male. How would the other crunchy moms feel about you assigning gender roles and not asking for preferred pronouns, girl? Simply disgusting… ( sarcasm.)
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