Certification Overview Doula Certification & Cross Certification
What does it mean to be a certified doula?
Certification for doulas is optional as we are a self-regulating profession. There is no government-mandated regulatory or accreditation entity that oversees doula training and certification programs. Thus, there is no real meaning to a claim of "national" or "international" certification by a training organization. Most doulas are self-employed and can decide for themselves whether they choose to certify.
Certification in the doula world simply indicates that one has completed the requirements of a particular training program. Certification, at a minimum, guarantees that the person calling her/himself a "doula" has:
What is the difference between "certification" and "licensure"?
In the United States, licensure is a function of the individual states. Licensure involves government mandates, fees, and oversight, and is required for many professions such as hair stylists, daycare providers, home health care agencies, and more, on a state-by-state basis. Currently, there are no states where doula licensure is required in order to practice as a doula.
A little history and how the doula world is changing
Historically, as newly trained doulas entered the field, many discovered that certification was not necessary. The value of certification was such that many doulas who did undertake the additional trouble and expense to certify did not bother to re-certify when their certification expired. However, in recent years, a shift has taken place in favor of third-party reimbursement for doulas based on certification status. While still voluntary, today a growing number of doulas are finding that certification is required to serve some clients.
Indeed, the doula world is changing! A growing number of states now reimburse doulas for services provided to Medicaid-eligible families. Each state makes up its own rules for doula participation. Additional third parties—in particular, Carrot (a fertility benefits provider)—are reimbursing for both birth and postpartum doula services. These companies and private insurers each create their own terms, conditions, and process. It's de-centralized, complicated, and in flux!
I have long maintained that third-party reimbursement for doulas is a double-edged sword. The "up" side is obvious as it makes doula support more accessible to low-income families and makes doula work more sustainable for doulas serving lower-income communities.
The downside can be summed up as an increase in regulatory power over doulas, threatening our autonomy as a profession and, potentially, bringing doulas under the control of the medical profession and insurance industries. These are the very industries whose dictates oftentimes negatively impact outcomes for the families we serve and whose failings create the gaps in care where doulas fit. Witness the state of Ohio’s recent legislation (accompanying implementation of Medicaid reimbursement for birth doulas in the state) which places doula certification under the authority of the Ohio Board of Nursing.
Holistic, community-based doula support evolved as a counter-balance to the fragmented, overly-medicalized, and profit-driven constraints dominating modern maternity care. In my view, doulas achieve measurable benefits in outcomes for both moms and babies precisely because we are not part of the system. Doulas bring a unique blend of heart, continuity of care, and consumer advocacy that is typically absent in mainstream care models. The more doulas seek to be “validated” by the system, the more we will come under its control. This is the danger we, as a profession, face.
Nevertheless, the handwriting is on the wall and I believe that doulas will continue to encounter an increased regulatory landscape. Hopefully, this push will result in greater sustainability for the doula profession and a living wage for doulas, especially those serving lower-income communities. Let's hope we can keep our integrity as a profession as these changes roll forward. I believe it is essential that we maintain a decentralized, community-based model of care wherein we are not all crammed into a cookie-cutter one-size-fits-all system. Doulas are not clinical personnel, mini pseudo nurses, nor public health home visitors, and it is fundamentally compromising to our purpose to seek validation through the regulatory authority of other professions.
For more information, read our blog on Medicaid Reimbursement for Doulas: Overview, Considerations, and Status Report.
Where do End-of-Life Doulas (EOLDs) fit in this picture?
Currently, there is no third-party reimbursement for EOLDs in the U.S. Our services are not covered by Medicare and neither certification nor licensing is required in order to begin providing services as an EOLD. However, as the exponential growth of the EOLD movement continues, I expect to see a similar push by EOLDs and others for national certification, third-party reimbursement, and regulatory oversight. I intend to continue this conversation so that doulas can make informed decisions about the future of our profession and the need for mainstream validation of our purpose.