As a modern organization working to break down the boundaries that have been created to birth work, we do not believe such policies are ethical as they create inequities and pressure on Doulas to work for free or below a living wage; and in the most difficult scenarios, make certification entirely unattainable.
Tradition - the transmission of customs or beliefs from generation to generation, or the fact of being passed on in this way.
Innovation - new methods, idea or product. Change, revolution, transformation, or a breakthrough.
The History
Traditions involving childbirth and the celebration of new parenthood are rich and varied. Helping one another through the process of birth is one of the most steadfast traditions through time and across the globe . Doulas in one form or another have always been a part of that tradition.
For most of history, women simply supported each other as neighbors, sisters and other close family members. Birth was "woman's work" and helping each other was done as a matter of safety, practicality and community. When birth entered a more medical sphere and as societies became more self reliant and families more spread out - the role of the supportive person during labor became more specialized and the term "doula" made its debut.
At this time, those who wished to serve as doulas primarily learned through apprenticeship and they spent time with other doulas as they supported expecting families. As both doula work and doula training become more sophisticated, the idea that a certain number of certification births (ie births attended by the doula that were "supervised" by another doula or midwife) became an established rule of becoming a doula.
But the rules have changed. In fact, almost everything about doula training and birth work has changed. Doulas are not supervising each other at certification births. Their trainer is rarely there with them (in fact, thanks to the internet, the doula trainer may be a thousand of miles away and may have never met the new doula). Today's doulas also need training in marketing, website design and a solid understanding of liability on top of all the doula skills they will need as they serve families. At BEST Doula we recognize that doula training has changed and so our policies reflect that modern reality - and we don’t require certification births.
The Issues
As the profession and society have evolved, we feel there are a few ways that the tradition of certification births hold back our profession.
The requirement encourages doula, as a stated or implied term, to work for little or no cost so that they do not earn a living wage.
The policy may require the doula to show proof that they were with their client at a certain time as defined by a clinical marker such as dilation for the birth to ‘count.’ This devalues the doula’s work.
The policy may require that the doula be with their client a certain amount of time or that the birth occurred in a certain way (typically vaginally). This places focus on vaginal births, when in fact doulas are qualified and are beneficial at all births and doulas are not responsible for birth outcomes. This devalues the doula’s work.
Certification Births don’t offer any info into the doula's relational support outside of the actual labor and birth.
Certification Births often required the doula to get an evaluation from hospital staff, OBs or other care providers. It is preposterous and the installation of a patriarchal model that any profession validate another; nevermind that doulas are not part of a medical model of care.
In addition to these issues, additional red tape and loops add uncertainty to the certification process and are most harmful to populations already marginalized in birth work.
The LOGIC
At BEST, we do not ever want our doulas to feel compelled to work for free in order to be certified. We teach sustainability and believe that encouraging new doulas to provide free births/low cost births in order to gain certification not only undervalues the work doulas do and their training, it makes sustainability challenging. Limiting someone’s ability to earn money drastically limits those who can be a doula and also makes it more difficult for all doulas to charge an adequate amount to make a living wage. Doulas are still a predominately female workforce and encouraging anything less than sustainable wages also inadvertently encourages a culture where services provided by women to women are once again undervalued by society and by women themselves.
Birth happens, and measuring how it happens is not the doula's role. We also know that doulas support all births and that birth unfolds in many ways. To say that a birth has to happen in a certain way at a certain time is not how BEST believes birth or families are best respected. We want families to have their best birth and our doulas to support them in their choices. We never want to tell a new doula that she cannot become certified because her clients had a Cesarean birth or because they chose not to call her until late in labor (in fact this may be a sign that she provided excellent prenatal support !).
We love OBs and nurses, but asking a care provider to fill out a form presents more than one issue. Fundamentally, they are not qualified to say how well a doula is doing their job. The care provider may or may not know what doulas do beyond the short snippets of time they spend in the room, which does not reveal the full expanse of the doula’s work which began weeks if not months before meeting the healthcare provider. Secondly, care providers are busy and when they are on shift - they have a lot to do with other patients. A doula's certification should not hang in the balance of the good fortune of having a care provider who has time to fill out an evaluation; this is gate-keeping.
There's so much more to the job of being a doula than what happens at a birth and even with clients. Certification births place all the emphasis on what happens during labor but they do not evaluate doulas as they start their business. Are the doulas marketing effectively, ethically and collaboratively? Each of these is a big deal – every bit as important what happens when a doula is with a client. In fact without these things, a doula is unlikely to have many clients or the respect of her community and her colleagues.
The BEST Way
The solution to the problems of certification birth is not only to get rid of certification births, but also to provide inclusive forward-thinking training and ongoing mentorship. BEST Doulas attend our intense, comprehensive workshop only after completing their coursework. Our doulas take their exam on the last day of training and when they pass they are certified doulas ready to support an expecting family and to start an ethical and collaborative business. We do not need further proof that they are ready - we know our curriculum and we know what we teach - and we know the doulas are ready!
BEST Training does not stop there. Our mentorship continues to develop each of our BEST doulas as they work and grow their business. At BEST we created a doula training focused on supporting each doula in their goals. With a strong focus on business skills, ethics, sustainability and working together we have a unique doula training that leads to success.
Have we broken with tradition? Sure, a little bit. Maybe a lot. But that is a good thing. Want to join us at BEST Doula training as we help doulas change the world? Find a training near you!