In New York a bill very important to doulas was passed and is on the governor's desk waiting to be signed into law. It’s important that every doula pay attention to this and consider what is happening in their own states.
First, let’s put this in context. On March 1, 2019 NY state launched their Medicaid doula pilot program and on June 22, 2019 BEST learned legislation in New York had passed regarding doulas and was awaiting the Governor’s signature. BEST, along with many doula organizations, participated in a zoom conference on June 24th, 2019. In this conference, we were told the doula coalition involved in reviewing this medicaid plan were unable to impact the reimbursement rate and were not made aware of the pending votes on bills that would govern doulas (henceforth referred to as The Doula Bill). We were told once individuals from New York became aware of the bill’s existence, some headed to Albany, New York to speak with representatives. Denise Bolds shared that upon their arrival, a closed door meeting was already happening with two New York based certifying organizations, but that everyone else were shut out. The Doula Bill passed within 48 hours of the closed meeting. Doulas in New York expressed concern that they were not represented, were entirely unaware of any opportunity to meet prior to the bill’s passing, and that no doulas engaged in community work were present. It was stated there was no representation of black doulas or black doula training organizations.
Why ALL doulas should care about the NY Doula Bill
Very few states have any legislation regarding doulas. New York is often on the forefront of reproductive rights and social justice legislation, and we see this as an opportunity to be a model to other states. Many doula training organizations have written to the New York Governor to ask that this bill not be signed into law as it is. It’s important to note that every doula training organization who has responded has done so with the same goal, and each from a unique perspective and with their own reasoning. This unity is incredibly valuable. We stand with our sister organizations in our response and look forward to discussing next steps while moving forward together to protect the interests of the doulas we certify. It is likely that legislation is coming to your state in the sooner-than-later future and we are going to do all we can to help you be ready.
Your Certification Matters
The term ‘certified doula’ is the common term used to refer to a doula who had completed a training program with a certifying organization and met all requirements to hold a certification from that organization. Whatever organization a doula used to become certified, the doula put time, money and effort into receiving that training. However, the New York bill legislates the phrase ‘certified doula’ can only be owned by the state of New York and makes the use of the phrase outside of reference to state certification illegal.
Yes, claiming your hard earned certification could be ILLEGAL.
BEST believes all doulas should earn a living wage. Being a Doula is not a high income profession, however the Medicaid reimbursement for doulas in New York (which ironically is the highest we have heard of to date) is not only not a living wage, it is not minimum wage. Doulas have families and lives and deserve to be well and in a position to create financial stability. They must nourish their bodies with food, clothing, and live under a roof, and afford their own health care. Codifying the underpayment of doulas because the beautify and positive impact of our work leads to a misunderstanding of our work, does nothing less than perpetuate a cycle of poverty.
The New York Doula Bill defines a fee for application to the state to use the words “certified doula”. BEST speculates additional fees could be associated with testing, background checks, legal fees, rising insurance fees in response to state regulations and increased legal cases involving doulas (see below). The potential of ongoing fees to remain in good standing with the state is limitless and places a financial hardship on an already financially pressed profession.
Are Your Morals Mine?
The New York Doula Bill states that New York will set parameters for proper doula morality. However, while it states that the moral character of doulas will be judged, it does not define what that looks like. As the New York Doula Bill poorly defines (and by that we mean it is not defined at all) there is vast room allowed for interpretation and exclusion. The implications that there must be proper morality to be a doula as defined by the state is reminiscent of witch hunts and opens the door for persecution. How does a past arrest record, domestic abuse, past drug abuse, citizenship status, sexual expression, etc affect this morality judgment? What will be in place to protect from racism and prejudices? Please see our letter to Governor Cuomo for further explanation of how this is racist and elitist policy that places disadvantaged, minority, and marginalized doulas and families at greater risk.
Vulnerability to Litigation and A Jury of Your Peers is Not Your Peers
The Doula Bill does not state or clarify how accusations or complaints against doulas can be made, what an accused doula’s course of action is in response to said accusation, or who they will face to determine the accusation and its consequences. Doulas often work in hostile environments along side professions, both physicians and midwives, who do not understand what we do and are threatened by our presence. The medical system is failing birthing people and doulas are often the easy target. Doulas may be “written up” by hostile medical staff when they feel threatened simply by the doula’s presence or hearing them remind a client of their legal right to informed consent and refusal.
A doula facing accusation should face a board of peers - other doulas. We know in many states with similar laws, CPMs (certified professional midwives) do not face a board of CPMs, but a board of OBs. This creates hostility, a power imbalance, and a very unfair environment for CPMs. While some certifying organizations have established a tradition of OBs overseeing and approving of the work of doulas, BEST abhors and does not take part in this tradition. We believe its replication in any state regulations of doulas will only result in the persecution of doulas.
The Criminalization of Doulas
The lack of clarity in the bill opens doulas to persecution and legal action for providing standard doula support to clients. We know that those of marginalized and minority communities, especially black people, face higher accusation, arrest, and conviction rates. With the lack of understanding and appreciation for the work we do, and facing hostile care providers who wish for our profession to not exist, and the power and money gap faced by doulas accused - doulas who simply affirm a client’s choice to seek a second opinion could be falsley accused of working out of scope and have little to no hope of saving their reputation, good name or ability to work in their chosen profession.
Can You Afford Your Defense?
Because we do not know what the consequences for a doula accused of violating a state regulated certification, we must assume that the state or deciding board could restrict their ability to practice and therefore cut off income until the case is resolved, an undetermined, but likely lengthy period of time. We already see this with midwives who are brought to review boards. With a review board, the accused is not entitled to a public defender. If you want assistance in defending your case (highly recommended for any profession) this will be out of your own pocket and will easily mount to tens of thousands of dollars. That’s a lot for anyone, but not at all possible for someone who is paid less than minimum wage by their own state government.
What If I Choose To Not Register or Certify with the State?
Don’t want the state certification - then just don’t partake. Right? Wrong. Doulas largely work in massive medical systems. State regulation of doulas means hospitals may then make policies restricting entrance to their facility to doulas listed with the state. This would insure that the hospital and its staff and members have course to file complaints and remove a doula from practice should they feel the whim - so you see their motivation to create and implement this policy? This would push doulas not listed with the state underground - attending births as cousins, etc. Doulas hold knowledge and professionalism, they work for the birthing family, improve outcomes, reduce trauma to birthing people, and should not be forced into the role of “cousins” which may further open them to legal discourse in the state of New York which is codifying the use of the phrase “certified doula.”
Doulas as World Changers
At BEST we believe doulas can positively impact our nation’s maternal mortality crisis. We believe in representation as an answer to racism and inequity in birth. We do not support government regulation of our certifications. We believe every birthing person benefits from doula support and we promote advocacy and community work that allows doulas to support low income birthing people while still earning a living wage. We believe sustainability matters. The work environment of doulas will improve when there is less turn over in doula work, more opportunity to build relationships among other professions also supporting and caring for families, and when doulas are not subject to power imbalances that may unfairly impact their ability to legally do their work.
Many professions that are non-medical have state licensing - like massage therapists. However, in birth work legislation has been used to push out home birth midwives, force midwives practice under the thumb of physicians, and restrict reproductive rights - like the right to choose a health care provider, the right to have a midwife, the right to a homebirth, etc. We believe birthing people have the right to doula support. There is a history of abuses and doulas face struggles that other professions don’t face. Legislation like that passed in New York will criminalize the work doulas do.
We believe it is a reproductive right to choose your health care provider and place of birth, we believe it is also a reproductive right to choose to work with a doula and have a doula by your side in any time a doula is available to support. Any legislation that limits these rights must be addressed and fought. You can write to Governor Cuomo here and let him know that this matters to you, that you oppose this bill in its current writing, and you ask he veto the bill.
Not many states have legislated doulas. New York has a unique opportunity here to be a standard bearer, to truly listen to and hear women and birthing people and honor our choices and reproductive rights. New York has been an ally for LGBTQI people - this is another opportunity to care for everyone. The whole of these United States, women, birthing people, and their care providers, minority communities that rely on this advocacy and support, we are all watching to see what precedent is set by New York in this matter. Our ability to have agency in our births and prenatal and postpartum care hangs in the balance. This legislation will impact the rights of women, doulas, and birthing people in ways that extend beyond state borders.