Lose the License

Why Doula Certification is Not Part of the Birth Work Revolution

Does something about doula certification just not sit right with you? Welcome to the club! Sometimes I genuinely forget that being anti-certification and pro-autonomy is still a radical position to take. Thankfully, I am a part of some pretty mainstream birth worker groups so every now and then I get a stark reminder—oofta! This article is for you if you have ever wondered why certification just feels…off, and is especially for you if you are looking for something to share with others who don’t understand why you might feel that way!

How Licensing Leads to Eradication

The cultural beliefs in the US are so bizarre. We are supposedly rooted in the idea of individualism and that each of us has the power to shape our own destiny. Conversely, we are taught to rely on the government and experts to protect us from other people by way of permits, certifications, licenses, and laws…

How did we get into this birth mess we are in: the high cesarean rates, total disrespect for birthing women, the near eradication of traditional birth attendants (midwives and other birth helpers)?

The way all of this came to pass was through the application of rules, regulations, certifications, and licensure. Read the books Making Midwives Legal, and Birthing Justice: Black Women, Pregnancy and Childbirth for some background on what happened to Black Midwifery in the US as well as the resurgent midwife movement of the 70s and 80s.

In both instances, the dominant group methodically delegitimized midwives and home birth by first creating hoops to jump through to gain legitimacy, and then once that took root, subsequently eliminating the option to jump through the hoops at all. This is an abusive process of power and control, making the box smaller and smaller, and the remaining midwives more and more compliant with Western medicine’s demands.

Licensure is a process of looking OUTSIDE for validation. How are we supposed to support our clients to look INSIDE for the power and authority over their own body and birth when we weren’t able to find that ourselves?

Do We Want to Be “Legitimate”?

Certification is touted as a way to seem legitimate in the eyes of the hospital system. But the question that I want you to think long and hard about is this: Why do we need to prove our legitimacy to them? That assumes they are in a position of power over us, where they can hand down their stamp of approval. Shouldn’t they be proving their legitimacy to us and to our clients? And further, isn’t it curious that they would assume a doula was illegitimate as the starting point?

It is because in our culture, women are not to be trusted, and infinitely less if they are entering an arena (the hospital) with the intention to use their voice, ask questions, and possibly interrupt the hierarchal power dynamics. A doula COULD be dangerous to the system, and a potentially revolutionary person, which is why many hospitals didn’t allow them in (and yet women continued to go there…but that is another big topic). Now doulas are looking for legitimacy, but aren’t stopping to ask the question: What is the price?

If a woman is planning a hospital birth, and wants a doula, I would ask her this: Do you want a doula who the hospital thinks is “legitimate” or do you want a doula who makes the hospital staff a little nervous? Because a doula that the hospital staff “respects,” is probably a doula that doesn’t ever question the status quo. And if you wanted the status quo, why did you hire a doula?

There is a subset of clients who perhaps want this sort of doula—someone to rub their back while they get the status quo kind of care. But there is also a huge swath of birthing people who want a doula who is willing to stand for something, and who is there to guide them, coach them, and stand beside them as they make their own choices. And until hospitals become radically consent-based, or until women start birthing at home in much larger numbers, this second type of doula is the kind that women need.

Licensing Means Deflecting Personal Responsibility

Licensure is a process of looking outside for validation. How are we supposed to support our clients to look inside for the power and authority over their own body and birth when we weren’t able to find that ourselves?

If you can’t imagine calling yourself a doula without a piece of paper to point to, then you have some serious work to do around your self-worth. Study, educate yourself, never stop educating yourself, of course!

Work with amazing birth work mentors. You will know when you are ready, and you can look to those mentors to help you decide when you are ready if you need that additional support. The process is messy and non-linear, which is why a clear cut (very masculine) “now I’m certified” moment is alluring to so many.

But birth, my friends, is not linear, and neither is birth work.

Another argument is that certification makes us accountable. I am all for the idea of accountability, but accountability to who? DONA? How about being accountable to the clients you work with? To the community where you live? This taps into a much larger conversation about restorative justice and strengthening our communities so that we are able to solve our own problems.

This may seem unrelated to birth, but it isn’t.

Jump back to the start of this article, and you’ll be reminded that we are partially in this mess because of legislation that was meant to remove community autonomy around justice, and instead have the State be in charge of sanctioning and punishing midwives. To restore health and wholeness to birth, we need to create healthy, whole communities that can be in charge of their own accountability processes.

This is not to say that all of us need to spend our time working on these issues (shout out to all the people who do work on these issues), but that you need to be aware of them, and how you fit into these other moving pieces.

Birth Work is Part of a Larger Revolution

If birth work isn’t part of a larger vision of social change for you, then I would invite you to spend some time thinking about that. Do you want to just help some clients have marginally better births? Or do you want to see the system turned on its head, restoring and honoring the life-bring-ing power of women? This revolution is not about needing more evidence, or more legitimacy to try to help women get their voices heard in the hospital. It certainly is not about a certification.

If you’re on our team, which is a RADICAL shift towards love and life, then it is about envisioning and leading the way towards that fundamentally more life-affirming society. That would include a radical shift in all of our institutions—hospitals, prisons, policing, schools, and the government structure itself. If your birth work doesn’t include looking at all of those areas, it will feel hopeless, and like you are trying to put a bandaid on a fire hydrant.

Hang out with us online at Indie Birth, where we are turning the fire hose off, and restoring balance to the sacred birthing year.