Compare and Contrast Certified and Uncertified Doulas

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!

Shopping for a Doula – Part 1: Dad’s Worried!

 

Gentlemen, it’s come to my attention that most of us without girly parts are often placed in a situation where we have go shopping.  Sitting at Starbucks while your wife shops for a new pair of Dansko’s is one thing.  But shopping for somebody who’s going to be assisting your woman – and you – during childbirth will require a little more participation on your part.  While this may seem like a daunting task, don’t worry…I’m here to help.

In this first of four articles, I’ll be discussing a little bit about why you should get on board with your wife’s plan to hire a doula.  I’ve been asked several times to sit in on an interviews.  It’s usually because the guy is dragging his feet and the woman would like her husband to get a man’s perspective.  Here’s what I’ve found:

Price

It’s been my experience that there’s two main reasons why men are hesitant to hire a doula.  First and foremost is price.  The father-to-be looks at how much they’re about to shell out for a professional birth labor coach and he thinks to himself, “Hell, I can do THAT.”

But that’s not what he’s going to say to his wife.  He’s going to say “Gee whiz love of my life, that’s an awful lot of money.  What if I promise to attend all the classes and read all the books cover to cover?  Then I could be your doula and we can save almost a thousand dollars.”

Ladies, I have no doubt that your husband loves you very much and is only trying to do what he thinks is best, both personally and financially, for his family.  However, this is your cue to remind him of the time he tried to fix something on his own, failed miserably, and had to hire a professional to come in and clean up his mess.

 

 

Gentlemen, you have no idea what you’re in for.  I don’t care how well engaged you’ve been in the last nine months.  When your little bundle of joy decides she’s ready to greet the world you are going to be a hot mess.  Trust me, the money you spend on a good doula will be so well spent that you’ll be asking for her business card to share with your other manly friends who are also oblivious to what they’re about to encounter.

Doula care pales in comparison when you look at how much you’ll spending on your little girl’s car insurance, her college education, and her wedding.  Couples will often make concessions to save and spend money on those important life events.  Your wife’s labor and delivery experience are equally, if not more important than any of those.  Ask any 90 year woman to recall the births of her children.  You will be flabbergasted at the amount of detail that lady will remember.  It’s that big of a deal in a woman’s life and it’s worth the small investment now to help her achieve the birth she desires.

Surprisingly, you’ll never be more happy to have someone boss you around because a doula has something you don’t have:  experience.  A trained, certified, and experienced doula will not only ease much of your performance anxiety, she will give you specific direction on how to help your lady and make this experience even better.

Stranger Danger!

Which brings me to the second reason men will be flaky about hiring a doula:  having a stranger around during the birth.

Often the husband is worried about having some lady he barely knows hanging around.  He’ll have valid concerns about things like:

•  I barely know this lady…
• Isn’t it going to be weird having someone else there?
• What’s the doula going to do that I can’t?

These are good things to worry about.  That’s why the interview process is so important.

Men, you should do your homework in regards to the doula’s qualifications (more on that in a later article) and make it a point to interview two or three doulas.  If the doulas are members of the same agency or if they’re in business together, you should not only interview them all, but also look outside that organization.  You’ll find that doulas who belong to a certain group will have aligned themselves around a common ideal so the interviews may all sound very similar.  I’ll also be discussing the interview process in a later article.

Trust me, it isn’t going to be weird having a doula around.  There’s going to be all kinds of people coming and going while your wife is in labor.

You’re about to share this very intimate and special time of your life with a doctor, a couple of nurses, maybe an anesthesiologist, a CNA, and the janitor.  The doula is part of the team, but she’s your ace in the hole, because she’s there solely for you.  Shifts will change and nurses will come and go.  You’ll only see your physician at the end when the baby is born, but your doula will be there during the entire ordeal.  By the time its over, your doula will be the one that was there just to support you and your wife.  It will seem kinda weird that everyone else was there.

As far as the doula’s role, Dad shouldn’t be asking “what is the doula going to do”; he should be asking “what is she not going to do?”

The doula is going to set the mood.  Then the doula is going to be the bad guy and tell your mother-in-law that she needs to go wait in the lobby because your wife can’t stand her negative energy and wants her out of the room.  Then she’s going to tell your wife what a great job she’s doing.  Then she’s going to answer your questions when the nurse comes in and says some random medical terminology you don’t understand.  Then the doula is going to remind you to change positions and go walk around to keep the labor going.  When your wife’s contractions start getting stronger, the doula is going to be a model of confidence, assuring you and your wife that she CAN do this.  Then she’s going to do a hip squeeze.  Then the doula is going to remember all that stuff you forgot to help labor progress – like using a peanut ball, a TENs unit, or taking a shower.  She’ll stand guard outside the door as the proverbial handkerchief-tied-to-the-doorknob when you two want a little alone time.   The doula will be giving you a break when you get tired and you’ll be relieving her when she needs to re-energize.  The doula is NOT going to be judgmental when mom wants pain medication or an epidural.  When the time comes, the doula will tell you to get in your wife’s face, hold her hand, and encourage her.  Then she’s going to cry (just like you) when your beautiful daughter is born.

And then you’ll be like, “Damn, why did I ever think we didn’t need a doula!”

 

Certified vs. Trained – Perhaps the most epic doula debate of all time.

It’s my opinion that birth doula certification is a weeding out process.  A means to separate the girls from the women.  It takes a considerable amount of time, money, effort, and perseverance to achieve certification.  But then so does anything that’s worthwhile.  It’s kind of a big deal.

Doulas will often attend an initial training session yet fail to follow through on the certification.  Below is a partial list of excuses I’ve seen regarding said failure:

• It’s too expensive.
• I don’t want to be put in the box.
• They don’t support me from a business aspect.
• You don’t have to be certified to be a good doula.

I’ve even seen such extreme Bravo Sierra as:

• They don’t focus on the race side of providing doula care.
• I don’t agree with the protocol.
• They never tackle the tough issues.
  • sexuality, bereavement, etc.

In a recent newsletter to members, DONA has made a stand and told the non-hackers to knock it off.  They’ve raised the bull$h!t flag and I’m glad.  Forever may it wave!

What should a certifying doula call oneself? “DONA trained doula” is a misleading and inaccurate term. A credential is what is included in the name of a professional or academic. CD(DONA), PCD(DONA) or BDT(DONA), PDT(DONA) – for trainers – is the credential you may use when your certification is granted or your trainer approval is awarded. The only other appropriate use of the DONA International name is in the other measurable status of membership. All other use is prohibited. Members working toward certification can refer to themselves as, “Member – DONA International” or can simply state, “birth doula” or “postpartum doula” in reference to themselves.

How many times have you seen the word “trained” appended to an organization in a doula’s title?  For expample, “DONA Trained Birth Doula” or “ICEA Trained Childbirth Educator”.  This is “misleading and inaccurate” at best and a big, fat, hairy pile of leech slime at worst.  The way I read it, DONA has said, “if you’ve taken your training, get off your butt and get certified, but don’t go around telling potential clients that you’re DONA trained as if it’s some sort of big accomplishment.”  I don’t think I need to explain how making excuses for not achieving certification and then trying to use the organization’s name to make yourself look more appealing to potential customers is bad form.

And herein lies the irony.  When a “doula” uses any of the aforementioned excuses for not achieving certification, but then lists “DONA Trained Doula” on their love me wall, it’s a slap in the face to certified professionals.  And yes, your keen intellect has picked up that I equate certification with professionalism.

In what I’m sure will be an ill-fated attempt to legitimize my position, I’ll address a few of the excuses listed above.

It’s too expensive.

Yeah, pretty much anything worthwhile costs money.  Put your wallet where your mouth is and throw money at what you think is important.

 

I don’t want to be put in the box. AKA I don’t agree with the protocol.

I read this as, I don’t want to follow the rules – namely the code of ethics and standards of practice.  I want to challenge the system!  I should be able to give vaginal exams while listening to fetal heart tones and applying essential oils.  Cuckoo!

 

They don’t support me from a business aspect.

You can lump this into the same category as:

“They don’t focus on the race side of providing doula care” and “they never tackle the tough issues – sexuality, bereavement, etc.”

Take a look at the topics offered at any professional conference and you’ll see that’s just not the case.  Basically, what you’re really saying is “you should teach me every single little detail about how to be successful in every single aspect of my doula practice for a couple hundred bucks and do it in two weekends.”    If you’re excuse is “it’s too expensive to go to a conference” see the first excuse.

 

You don’t have to be certified to be a good doula.

With this, I actually concur…if your definition of a “good doula” means you follow the standards of practice set forth by any of the reputable doula certifying organizations.  I use the term reputable because there’s plenty of organizations that will ask you to sign a statement saying you’ve read a couple of books, take an open book test, and then certify you as a doula for ever and ever, amen.  As long as you keep those checks coming every year.

This is guaranteed to be a topic of debate.  Feel free to comment, just don’t expect touchy-feely replies any more than I expect touchy-feely comments.