Dear Doulaing The Doula Training Alumni,
I'm excited to release the DTD Toolkit for Gaining Entry to Hospitals. It's been in the works for a few months, after two hospitals in my area began accepting my training certificates as legitimate credentials for entry as a birth doula. Writing the toolkit required me to assess my credibility and use it on your behalf. While I have achieved much I am usually pretty quiet about it. But it's about the message, not about me. It's high time doulas got back into labor rooms in every state where DTD alumni live. Let's get back to achieving our goals: increasing bonding and successful parenting; increasing breastfeeding rates; and addressing racial inequities in multiple ways.
The Toolkit has several components: the memorandum which I will personalize for every administrator; a DTD Introduction to Doulas information sheet; a DTD completion certificate; a copy of the DONA International Standards of Practice and Code of Ethics; a copy of the DONA International Evaluation Form.
Email me with the name of the hospital, name of the administrator, their email, and their position title ( ex: Birth Center Director; Director of Nursing, Labor and Delivery; Mother/Baby Unit Coordinator). I will email them the memorandum and attachments and follow up. You and other doulas in your area are also welcome to contact the administrator and let them know of your enthusiasm and availability to serve clients.
RE: Doula Credentials for Access to Labor and Delivery Room of Client
Dear Hospital Administrator,
Currently your hospital has a policy of denying access to doulas who do not possess certification, or is considering this criteria. While on the surface this seems to make sense, it is problematic for several reasons. As one of the primary doula reseachers in the world and the main birth doula trainer in Wisconsin, I would like to briefly explain why. There are several alternatives that would address the situation more effectively.
Why Only Allowing Certified Doulas Is Problematic:
1. Certification standards are uneven and vary across organizations. Currently there are over 100 groups in the US offering what they call certification. However, over 90% simply give a completion certificate when a person finishes a checklist and call this “certification”. After that their relationship with the doula is complete. True certification is when an organization vets your character, contacts your references, and stands by you if there is a complaint. They require continuing education. There are only six organizations that meet that standard. (source: doulamatch.net)
2. Since grandmothers have been excluded from labor rooms because of the “one visitor plus certified doula” policy, someone has set up an online business where you can purchase your doula certification for $75.00. This is unethical but not illegal.
3. Certification is not a beginning doula achievement. It is a goal one achieves after establishing their career - if at all. Consumers choose a doula based on who they feel safe with, not on their credentials. In the medical professions, one needs to be certified first to do any patient care. This leads to the belief that doula certification is also required to practice.
4. Certification with an organization like DONA International is considered expensive by many doulas. Since it is not required and there may be financial barriers, when hospitals require certification for access it then becomes an equity issue. In other words, since certification is often out of reach for financial reasons for otherwise qualified doulas, requiring it means that you are placing a financial burden on the doula. If that burden is insurmountable and the doula is a person of color, it has the effect of being racially inequitable.
5. Achieving certification means being able to attend births in person. So even if someone wanted to become certified right now, they could not because of the “no entry without certification” rule. So this creates a “Catch-22” situation. In order to become certified you need to attend births, but you can’t attend births because you aren’t certified.
What You Want:
1. Doulas who know their place on the birth team is
Emotional support of the laboring person
Comfort measures and positioning suggestions
Enhancing communication between the patient and their medical staff and family
Offering information and support to all family members
Does not tell anyone what to do
Does not speak on behalf of patient
2. Some way to reliably predict professional doula behavior
3. A piece of paper that identifies their training
4. Someone to contact if the doula does not behave within their training
Alternatives to “Certified Doulas Only”:
1. Require that all doulas sign the DONA International Standards of Practice and Code of Ethics and agree to abide by them while supporting clients in your facility. Hospitals have been doing this for over a decade for all doulas. Even if the doulas are not DONA International certified or even members, they agree to follow it. (See attachments)
2. Request that doulas submit a DONA Evaluation Form to each nurse for feedback. This four item Likert scale takes only a minute to fill out but would give every nurse the opportunity to give feedback to the doula, if desired. (See attachment)
3. Accept a Doula The Doula Birth Doula Training Workshop certificate as evidence of adequate training. (See attached example.)
a. UnityPoint-Meriter Hospital and SSM St. Mary’s Hospital in Madison, Wisconsin, have made this their policy. Their reason was that my training met their needs for setting behavior standards for doulas. Second, they didn’t want to place a barrier or burden on doulas that would be unduly felt by those with lower incomes. Since this is primarily people of color, it had the unintended effect of placing a greater burden on them, making it unequitable.
Contact: Here I list names and emails of two people. (But not on the blog!)
b. I train over 90% of the birth doulas in Wisconsin and have for several decades (over 1600 people). My full CV is on my website: amygilliland.com
c. I am State of California Board of Nursing Continuing Education Provider # 16959 and my birth doula trainings offer 15 or 18 nursing CE’s.
d. I regularly have nurses with many years experience take my trainings and learn new things. Several Wisconsin hospitals have me train all of their staff in labor support skills.
e. I’m a Wisconsin Association for Perinatal Care Board Member; one of four people on the Dane County Madison Public Health Pre-FIMR Committee; a member of AWHONN and ACNM. I am happy to provide a list of contacts who can vouch for the integrity of my doula trainings and my work. They include nurse managers at three different hospitals where I regularly do staff trainings; Dane County Madison Public Health employees; UWM SON and UW Madison university professors; and members of the Wisconsin Association for Perinatal Care (WAPC) board of directors.
f. Participants spend over 36 hours interacting with me - that’s almost a full week. The Childbirth for Professionals course is 8.5 hours (plus 8 hours of prep work). Training groups are from 5 to 16 people so I get to know each participant.
Doula Ethics and Confidentiality 1 hour
Labor Support Theory 1 hour
Emotional Support 3 hours
Positioning and Comfort Measures 3 hours
Prenatal Relationships 2 hours
Partners and Families 2 hours
Postpartum 2 hours
Challenging Birth 2 hours
Relationships With Medical Team 1 hour
Advocacy and Communication 1 hour
Business 2 hours
Return demonstration/assessment 1 hour individual participant
Simulation by instructor of person
in labor; apply skills 1 hour (in groups of 2-3 people)
No certification program requires any simulations. Most trainers don’t include them. However I know simulation is a core part of nursing education. Also, a trainer or assistant works with each participant in a very small group for an intense period of time.
g. I would stand behind 97% of the doulas that I have trained in the last five years. Since I have no control over who signs up, that’s a pretty good ratio.
h. If you do have a problem with a doula that I’ve trained I will work with you to resolve it.
I would like to reassure you that I have nothing personal nor professional to gain from the acceptance of my completion certificate as evidence of adequate training as a doula. My workshop attendance is already high; I have nothing to sell nor any financial relationships to exploit.
My main motivation is for people to receive the individualized care that they feel they need to have a positive birthing experience. I want health care providers to have excellent relationships with doulas. I want racial equity when it comes to birth outcomes and one of the primary ways our state, counties and cities have decided to do that is through doula support.
I have solved the problem of creating a highly qualified workforce. Why not take advantage of this unique situation?
Thank you very much for considering this proposal.
I look forward to hearing from you!
Readers - Think this could work in your community? Let's find out! Email me with the name of the hospital, name of the administrator, their email, and their position title ( ex: Birth Center Director; Director of Nursing, Labor and Delivery; Mother/Baby Unit Coordinator). I will email them the memorandum and attachments and follow up. Let's change this!