doula zoe supports laboring client
Birth doula Motherhood Postpartum Pregnancy

Doula Certification, Hospitals, and COVID-19

When I decided I was going to start my own doula training and certification organization back in late 2019, I had no idea what the doula world would be facing with the global COVID-19 pandemic. I had no idea that doulas would be subjected to some of the hardest working conditions I’ve ever known of since doulas formally began practicing in the 1970s(ish!). I had no idea how important it would be to train more doulas into the world, and do so in a way that breaks out of the “old thinking” doula paradigm. Covid has changed everything. You already know that. But you may not know how it has impacted the doula profession.

With the exception of a certain few hospitals and hospital based doula programs in the U.S. (and I only speak to the U.S., as that is where I practice), doulas have been “allowed” to work at hospitals all over, with no accountability to the hospitals themselves, only to their clients. We have existed largely outside the system, and for, to my mind, good reason. Hospital based doula programs do increase access to doula support, and I appreciate that, but receiving a doula whom you have no relationship with in labor does not fulfill the doula role to me, because so much of my work is done prenatally in making deep bonds with my clients before we enter labor land. I digress, what has changed since covid at most hospitals in the U.S., is that they either have banned us altogether by only allowing labor & delivery patients to have one support person (which yes, could be a doula, but few folks with non-professional/familial/friend/romantic partners would choose their doula over their partner), or they have created a policy that only “certified” doulas be allowed as additional support to the patient’s primary partner.

I’ll say, especially locally to me, that I am incredibly grateful to Saint Francis Park and Baptist Women’s hospitals for welcoming doulas during this pandemic. I can only imagine that this has been completely shocking, stressful, and harrowing for these hospitals. These hospitals, and others around the country, clearly see the value we provide to our clients, and their openness to us is not going unnoticed. To the hospitals who have continued to bar us despite clear examples that allowing doulas in right now works, is beneficial to their patients, and can be done safely…. well… I don’t have such nice words but I’ll keep my lips zipped for the moment.

While we doulas are grateful to be able to continue supporting our clients in person (don’t get me started on how rough “virtual doulaing” is…), I do wish there was a better understanding of doula training and certification, as only allowing in certified doulas does a great disservice to families and to doulas themselves. Let’s talk about doula training organizations for a second. Since the founding of the first official North American based org in the 1980s, DONA, dozens and dozens of doula training orgs have come and gone. Over the 9 years I have been a doula, I have seen the doula world change vastly, especially having spent most of those years in Los Angeles (which I consider to be one of the best, most professionally oriented doula communities in the country). Community agreement regarding advocacy, business, scope of practice, certification, and more have evolved, unsurprisingly, as the needs of birthing people, and of doulas, have changed. Doulas began speaking out about their lack of preparation for the work, from not knowing how to market themselves or run a small business, to not knowing how to navigate advocacy and the hospital system, to making this rewarding, yet taxing work sustainable from burnout.

What I have witnessed in the past few years is a growing demand for a better doula world. Not only do doulas deserve better than we have received (regarding our education, our reputation, our relationship to the medical system, etc.), but birthing people absolutely deserve better (from doulas, from the medical system, and our culture!). Several progressive doula training orgs have emerged, and I am so glad, because the older orgs are tired and they aren’t trying hard enough to meet the doula world where it is today. They continue to keep their stronghold on our community, via indoctrination and expensive SEO packages, and as they churn out more and more undereducated doulas, I hear more stories of disappointment, failed doula careers, and receive more demand for mentorship.

I had thought about becoming a doula trainer for years, but when I moved to Memphis in 2018, I knew I had to get on it, and fast. Memphis had no locally based doula trainers, and was shipping in trainings from other states, which brought trainers who did not understand the unique landscape we face in the South. I thought, well, if no one has had the gall to do this for Memphis, why not me? I considered training through a few different established orgs, despite a few people encouraging me to start my own, but none of them showed me that they understood the needs of doulas in the South. So I decided to start my own, knowing how difficult, time consuming, and energy-sucking that would be. And it has been all of that and so much more.

Over the course of many months, I and my co-founder, Celina Wigle-Olias-Varga (a NYC based postpartum doula and soon to be sex and relationship therapist), wrote over 120 thousand words of text for our birth and postpartum doula training student manuals. These pages encompass our combined years of experience, our tireless research, our passion for doula work, and our dedication to giving doulas the very best education and continued mentorship possible. In October this year, I trained 9 new birth doulas and 6 new postpartum doulas in Memphis, at a generously donated space at the Church Health Center. (We limited capacity so we could ensure covid precautions were met). We have created a doula organization that values embodiment (I mean, we did name it Embodied Doula Trainings after all!), sexuality, human animality, intuition, evidence based and innate/traditional wisdom, anti-racism, queer and trans affirmation, and more. We are committed to offering full scholarships to Black doulas, and partial scholarships and payment plans to others who need support in accessing our trainings. We are working on establishing the org as a non-profit so we can seek funding to support our scholarships. We have a lot of work to do, and a lot of fabulous folks who are jumping on board in 2021 to bring EDT to national level.

When I went to write our policies, certification steps, etc., I took many unofficial surveys and observed in the national doula Facebook groups what people liked and did not like about the processes they went through at their respective training orgs. I took to heart some serious criticism regarding privilege, access, and racism among the established doula orgs and their gatekeeping of certification and the doula profession. What I concluded was that I would offer lifetime certification, as some of the newer, more progressive orgs do, because I know that doulas who are serious about their careers will continue to educate themselves over the years of their career, I don’t need to collect money from them every 3 years for them to prove themselves worthy of the title. And that’s where the hospitals show their lack of understanding of the doula profession. Doulas are an unregulated profession, like herbalism. There is no national or state based licensing, regulatory body for doulas, and I honestly hope there never will be, despite some doulas’ push for that, especially as it pertains to insurance coverage. Licensure undoubtedly comes with even more gatekeeping and fees, and that will limit access to many who wish to become doulas. I do support insurance coverage as long as they don’t require us to be licensed–that’s another conversation for another day, though. But since we are unregulated, and literally anyone can start a doula training organization and start certifying doulas, doula certification doesn’t hold much weight. It’s always been more about the doula’s experience after training, and perhaps who they trained with/who their mentors are. Most established, experienced doulas I know (prior to this year) were working without certification for a variety of reasons. 1) It isn’t necessary to do the work, 2) most clients do not care, 3) why throw money at orgs for basically no reason, 4) issues with orgs’ scopes of practice/limiting how doulas work, 5) other issues with the concept of cert itself. I myself let my CAPPA certs lapse in 2016 for a variety of reasons, one being issues I had with local CAPPA leadership in LA, as well as the very limited scope of practice. I had no intention of certifying with any org again unless it was lifetime and with an org I believed in.

When the hospitals announced that doulas would have to show proof of certification in order to get in and support our clients, I was pretty outraged. There are doulas in the community with little experience who have taken the steps to certify who would be allowed in over folks I know who have worked for decades who are uncertified. That is wrong. It is also wrong that it makes it so newly trained, not yet certified doulas wouldn’t be able to get in and get the births they need to be certified! Since all this started, I have heard of doulas showing their expired certs, their training completion certificates, their client contracts, and even made up certs they made in Canva in order to get in and do their work. I fault none of them for doing what it takes to support their clients. And to an extent, I get why hospitals are requiring “proof.” They want to make sure that people aren’t pretending to be doulas who are just someone’s mom or friend in order to get in. But honestly, if they’re allowing doulas, they should just allow any second support person in, because everyone should have the right to a second support person in birth, regardless of their training/background. But again, that’s another, deeper conversation.

I did not wish to show the hospitals an expired CAPPA certification, since that was not honest or authentic. So since I had already established that Embodied Doula Trainings was a thing, and would be training and certifying doulas this year, I became the first certified doula through our org. It felt silly to certify myself, but certainly every first person of every doula org had to do so! I continue to joke to other doulas about how my doula cert says Zoe Etkin certifies Zoe Etkin. It is silly! It speaks to the overall absurdity of doula certification. However, for anyone questioning its validity, it is fully accepted by the local hospitals, without question, because I have this beautiful organization growing and flourishing to back me up. I explained to each that I had founded EDT this year, and they were both fully welcoming of me and anyone who certifies through EDT! Not that I worried about it, honestly, but it’s great to have an open dialogue and know that they support us and welcome us to their labor units. I do hope, as the world hopefully begins to recover from COVID-19, that these hospital restrictions will lessen, and that doulas of all backgrounds will be welcome again, or that they’ll ask to see client contracts instead of certifications. But it feels great to know without a doubt that so long as doulas are welcome in the hospitals during the pandemic (with the exception of a severe uptick in cases that would restrict visitors even further, so they told me), that I and the Embodied Doula Trainings students are welcome to our local hospitals with open arms.

It’s been quite a year for us all, in so many ways. I am grateful for this work, these families who entrust me with their most intimate of experiences, and for the opportunity to welcome more doulas into the world.

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