The state is taking another step toward launching a certification program for doulas, a process that would allow those workers to seek Medicaid reimbursement for their services and reach more people.
Doulas offer physical and emotional support throughout pregnancy, birth and the postpartum period. They also act as advocates for parents during and after pregnancy and help facilitate communication between their clients and hospital staff.
To ensure equity and fair standards in the certification process, Connecticut’s Public Health Department will soon appoint an 18-member panel to provide input, including recommendations for training, experience and continued education, as well as standards for recognizing training that is sufficient to meet the certification mandates. Seven of the group’s members will be doulas, and the panel also will include a representative from a community-based doula training organization, a representative of an acute care hospital and a person with expertise in health equity, among others.
The committee will also review doula training programs and provide a list of approved programs in Connecticut that meet certification requirements. Another bill must be passed for the health department to begin regulating doulas. That could happen as early as the state’s next legislative session.
Health care advocates say expanding access to doulas is important, especially for parents of color, who have higher infant mortality rates than their white counterparts.
Babies born to Black parents in Connecticut are more than four times as likely to die before their first birthday than babies born to white parents, according to a 2020 study by the Connecticut Health Foundation. There are also substantial gaps in the rate of low birthweight babies — those born weighing less than 5 1/2 pounds. Babies born to Black parents are nearly twice as likely to be born at a low birth weight as babies born to white parents, the study found.
Among babies born to Hispanic parents, the infant mortality rate was 3.7 per 1,000 births, while for white parents, it was 2.9 per 1,000 births.
At the national level, Black parents are three times more likely to die from pregnancy-related conditions than white parents, according to data from the Centers for Disease Control and Prevention.
“We know that outcomes are better when women of color have an advocate by their side, which is often a doula, during the maternal process,” said Tiffany Donelson, president and CEO of the Connecticut Health Foundation. “It’s so important for women to have someone they can trust and someone who can be there to help them navigate through the process, to be an advocate in the room for them.”
Four states covered doula services as of July 2021 — Oregon, New Jersey, Indiana and Minnesota, a Kaiser Family Foundation study found — and at least 11 more were considering adding coverage for doula benefits, including four that reported planning to start by the end of this year.
Most doula services are currently covered by private pay.
“This is a really important step for the state in building access, not just for the doula community, but also for more people who are looking for doula services,” said Maura Jo Lynch, an independent doula in Connecticut who has worked in the field for 16 years. “[Certification] opens up access not only to the families to receive services, but also for doulas to attempt to make a living wage while still serving communities who are not communities of means.”
“A doula is a bit of a luxury item, which it should not be,” added Ashley Minihan, who has worked as a doula in Connecticut for seven years. “Everybody should be able to access that support.”
‘Designed for the success of the applicants’
As the state edges closer toward certification, doulas are calling for reasonable hours of training and fair costs in obtaining the designation.
And for experienced doulas, hours of work in the field should count in the process, several said.
“We have to consider the idea of ‘How do you get there?’ If you have been a doula and working for so many years … it needs to be a system that can be flexible,” Lynch said. “We all come to this work from different places. There’s not one way to get here.”
Certification “needs to be designed for the success of the applicants,” she said. “That means it needs to be financially accessible, it means that the hours need to be reasonable, and it means that the core competencies need to be ones that are commonly held across the doula community.”
Cynthia Hayes, a doula for 18 years and director of operations for Earth’s Natural Touch, a training organization and doula collective, said no single training program should become the standard for certification.
“We don’t want certain organizations to be lifted up as the central organization that you have to go through in order to become certified,” she said. “We really want to be able to come together and decide the core competencies that would distinguish someone who is eligible for certification, rather than just where you train.”
“We also want to make sure that the certification will encompass those who want to practice as a doula and become certified and work with communities that are at a disadvantage, that are really suffering from disparities,” Hayes said. “We want those doulas to be culturally competent. We want them to have specific training.”
Minihan hopes all parties will keep the cost of obtaining certification in mind when coming up with benchmarks.
“It is expensive to take these certification programs,” she said. “I don’t think the process necessarily has to say everybody has to take this class, this class, and this class, but you have to have certain skills and certain skill sets, which you can develop in lots of different ways.”
Discussing compensation will also be part of the process, Hayes said.
“I know there have been a lot of other Black women who are professionals, even outside of this field, who want to practice as doulas, but they don’t know if they can afford to do that because a lot of Black doulas aren’t being paid appropriately,” she said. “So we want to make sure that this will also bring appropriate compensation to the doulas.”
Chris Boyle, a spokesman for the state’s public health department, said the advisory panel will help mitigate “unintended consequences” of certification, such as shutting people out.
“The key is to establish qualifications that don’t unnecessarily exclude certification for people currently working as doulas now or establish unnecessary burdens for people looking to work as doulas in Connecticut,” he said. “There are no national standards to rely upon, and this process will help minimize unintended consequences that can occur when occupational regulation is established.”
The Rev. Robyn Anderson, a co-founder of the Ministerial Health Fellowship, a health care advocacy network based in the state’s Black churches, said she hopes the certification program will bring more recognition and appreciation to the work doulas are doing every day.
“I think we have to really work on the medical field in terms of seeing the value of doulas. Their value does not take away from the expertise of doctors [or] of nurses,” she said.
“It’s been proven that when women of color have doulas — having that kind of emotional support of people who look like them, who are part of the community — they tend to have healthier babies and higher birth rates. And so the certification process is so important for doulas to get the credit for the work they’re doing.”