Some thoughts on doula certification and DONA inspired by maia

Maia from Guerrilla Mama Medicine has some greats thought up from the International Center on Traditional Childbearing Conference. She also talks about her own experience with DONA, the primary organization that trains and certifies doulas:

but i never finished getting my DONA certification.  something about DONA rubbed me wrong when i was in my 3-day workshop.  i guess, it was the protocal.  the protocal that says i am not supposed to contradict the doctor or midwife or nurse.  the code of ethics and the scope of practice that describes ways to communicate that are presented as ideals of respect when they are really white culture-centered forms of respectful expression.  also the workshop and training programs never require for doulas to deal with issues such as race, class, sexuality, etc.

but i kept convincing myself that i needed to complete my DONA certification because i had already invested so much money and time and energy into DONA.  even if i did feel a little dirty inside about it all.


i have been having dreams of birth sisters…women who support women through birth, no matter what. revolutionary sisters.  women who will go to jail for a birthing person.  someone who will support you as much or as little as you need.  through an herbal abortion. a miscarriage. on the phone during an unassisted birth.  without insurance.

when i told midwives while i was preggers that i wanted an unassisted birth, they thought that it was because i didnt have the money to afford a home birth.  it wasnt that at all.  i wasnt desperate.  i was confident in my body.  and the level of racist and classist condescension i received from midwives in minneapolis (which is supposed to be such a mecca midwifery in the states) makes me cringe for the future of professional legal midwifery.

help me think of a name…and we can start a fire that burns all of the pretentious midwives who go to mexico as midwife students, but then return to the first world and finance their upper middle class lifestyle by giving birth to upper middle class women’s babies with the skills that they learned from the bodies and strength of brown women whom they only see now washing dishes and pushing strollers.  brown women who usually cannot afford such professional expertise birthing professionals.

I have had similar thoughts and feelings about DONA over the years. I did my training with a DONA certified trainer (the now famous orgasmic birth advocate Debra Pascali-Bonaro). I really like Debra, and I think she is a great birth advocate. But what Maia says is true. We never talked about race, class or other issues that impact the women we might work with. There was also a focus on the “business” side of doula-ing. I never had any interest in being a professional doula, in making money from the work. For me, it’s a form of activism, a way to support and accompany women through their labor. Women who are in need, immigrant women, young women, low-income women, incarcerated women. I think that all the doulas out there who work for professional women, with class privilege and the ability to really choose their birthing environment are great. Necessary. Important. All women deserve to be supported during their births.

But I, like Maia, yearn for a community of radical doulas who want to use their doula work as a way to impact the larger systems that oppress us. Who want to empower women of color, young women, incarcerated women. Who want to talk about systems of racial oppression, sexual oppression. Who want to support and be supported by radical queer, trans and gender non-comforming doulas. Who want to re-center our medical system around the needs and wants of the people in our community, who have historically been abused, marginalized, manipulated.

I did my DONA training, but I never completed my certification. This process takes a few years, a significant amount of money and A LOT of paperwork. The paper work was my biggest deterrent. The only doula work I have ever done was as a volunteer. After offering my services to women in a public hospital, I felt that it was unfair of me to then ask them to fill out paperwork about my role as a doula. I didn’t want to do my doula work in a way that was self-serving. It wasn’t about me, it was about them. So I never became certified, and I hope that the day I begin my work as a doula again, this will not stand in my way.


28 thoughts on “Some thoughts on doula certification and DONA inspired by maia

  1. whatsername November 30, 2008 / 7:22 pm

    A very thought provoking post. I’ve given thought to becoming a doula before, and really connect with the idea of community you’ve outlined here.

  2. InexplicableWays November 30, 2008 / 11:09 pm

    Great post! I have also chosen not to certify as a doula. My thoughts go something like this: If the very word “doula” means servant, then I must serve my families. In whichever form that takes. I cannot be limited by a scope or outside protocol. Birth is such a unique experience–for each woman, each time. We must not apply cookie-cutter forms to them.

  3. PublicHealthDoula December 1, 2008 / 11:40 am

    What a great post! I am going to link to it in my blog because I think it says a lot about the perspective I come to doula practice from. I am not DONA certified because I trained as a doula in AmeriCorps and previous doula teams in our program had commented that the DONA training was not suited for our focus. Our supervisor, a nurse and former homebirth midwife, designed a curriculum based on DONA but with a public health orientation, and it was a great preparation for our work. We were certified by our clinic, but that has sometimes been difficult to explain to people – I have considered going through the DONA process in order to have that “credential”, not so much for my personal doula practice as for future public health doula work where I may need to work with organizations that require some kind of stamp of approval. I would love to see an “official” doula organization that has more of a community-based focus.

  4. wisewarriror December 2, 2008 / 10:19 am

    Essential yet hugely marginalized perspective ! ! !
    I know because I have been a Mother and doula for two and a half decades and was one who did not seek credentialing through a certifying body and always spoke of diversity across the board and radical advocacy.

    I will write here that I am of Italian descent and seem to defy categorization.
    Some view me as “white’ – whatever the hell that means, anyway – others, mostly who you describe as “people of color” – once again, whatever the hell that means as well – view me as “not white” but rather “Italian”.
    And what is the opposite of “people of color”, can you say?

    I did not partake of the privileges of the upper middle class as you speak of yet I had home births, including a planned “unassisted” birth – I prefer “free” or “undisturbed” birth – and was the first amongst my friends and family to do so.
    Hell, I didn’t even know anybody that had a home birth, save for my Grandmother and she did so because that’s what families of lesser means did at the time.
    My partner and I had very little money and did not have our own space when I birthed our first child 24 years.
    I found my way to that which fulfilled my intention.
    I breastfed for frickin’ ever, did not circumcise, vaccinate or even send our children to government schools !
    All without being a “hippie” or having any familial or filial reference for doing so.

    We speak much of oppression, injustice and ethnic and financial inequality.
    Let us be mindful that so sharp a focus allows for peripheral blindness.
    “Brown skinned” midwives were not the only midwives and those who may be oppressed one way or another have no less personal responsibility than those who are not.

    In regard to making money as a doula.
    Should we not be compensated for leaving our families/lives wherever and whenever we are needed ?
    Just as it is an honor to provide care, so should those I guard partake of the honor of giving as it allows for the worth of the exchange to be fully realized.
    When need be, we can do so creatively.
    Barter is one solution but I caution, not and easy one.

    I remind each of us to beware of the pitfalls of ethnocentricity
    And I’ll say this as well…
    It is a people divided that can bring no change.

    • doulatraininghq April 17, 2012 / 12:45 am

      So i am 4 years late, but I really enjoyed reading this post as well as your response. Two equally valuable points of view. Thank you.

  5. Nechama December 9, 2008 / 11:13 pm

    thanks for a really thoughtful post. i am a homebirth midwife, and i often think about doulas, doula training and the whole idea of “professionalizing” (which i agree with the original post often just codify white culural norms into strict standards, at the exclusion of other cultures) something that women have always done for each other. I trained as a midwife on the U.S. / Mexico border, and was very aware of the culture, race and class elements of my training, of predominantly white women serving predominantly brown women. It’s hard to live in la frontera and be unaware of these elements. I chose the school i went to there partly because it emphasized culturally competent care, and encouraged students to look at how racism impacted our lives, and the lives of our clients, including questioning how and why our clinic was comprised of predominantly white women serving predominantly brown women.
    I decided to become a midwife because I have a strong belief that what happens to all women’s bodies is vitally important, and, at the time, midwifery seemed like a good vehicle for helping to empower all women. My goal when i work with upper class professional women is to help them make the connection that, jsut like their birth experience is important, and what happens to their body is important, what happens to the bodies of the women washing their dishes is important, and what happens to women’s bodies during wars is important. i strongly agree that addressing oppressive systems is important to empowering women, and i thought being a midwife would help me do this.
    i graduated from school 2 years ago, and went back to the pacific northwest. after “growing up” into midwifery in a school that did emphasize looking at systems of oppression as part of midwifery, i have been dissapointed, to the point of wondering if midwifery is really the most effective way for me to go about my goals. I’m frustrated in the same way that other people who posted seem to be-i want a more radical community that asks hard questions of ourselves, and doesn’t accept entitlement as an answer. I’m trying hard to open my practice to a more diverse group of women than the upper class women who seek out midwifery here, and i would love feedback about how i can be more effective at this outreach. the issues that concern me professionally are about disparities and over-medicalization of birth. I’m concerned that the U.S.’s cesarean rate is almost 1 in 3 women, and that these rates are higher in communities of color. i’m concerned that so many women are unable to access prenatal care at all, let alone the respectful, informative, trusting and culturally respectful care we all deserve. i want midwifery in the true sense of trusting and empowering women, really serving families on their own terms and providing safe maternity care, to be available to all women. i’m frustrated with how the birth community often seems unwilling to address classism and racism in the interest of being “professional”, and i struggle with how i can make classism and racism birth issues, important to the birth community. i’d love suggestions.
    i know that this blog is about doulas, but it seemed related enough that i started ranting. i’m really glad to know that you’re out there, and i fully support all the uncertified doulas out there doing good work for and with women. thanks

    • Anna Marie Poppa May 25, 2013 / 3:48 pm

      This is a wonderful site. I assisted at births and also assisted as a postpartum doula for many years. The last birth I assisted at was a little over 3 years ago. It was a midwife assisted birth. It ended in c-section. Most of the births I assisted at were midwife assisted. Over the years I’ve seen what a mess the establishment has made of midwifery. The labor, 3+ years ago, was a horrible. I don’t know what was up with the midwife but she seemed to be rushing everything and did so many internals I seriously lost count. I was beside myself. She was worse than the ob assisted birth I had assisted at. It was torture for my young client. The midwife was trained in a big city hospital. Let’s face it, they are trained like docs but don’t get the pay. The last few births were horrible. Midwives wispering under thier breaths to us that they had to watch what they do in the hospitals. They have one hand tied behind thier backs. Todays midwifery is a different animal. After that birth, 3+ yrs ago, I stopped doula work. Too many clients want to have a “natural” childbirth as long as it doesn”t hurt. So many are not afraid of c- sections; they are seen on tv all the time and things go fine(they think). I was on my way to triple certification through CAPPA. Childbirth Educator, Labor Doula, Postpartum Doula. I wanted the certs because I was going to start to advertise for clients. I stopped it all. It made me very sad but I could’t take the hypocrisy anymore. I had such wonderful experiences with my midwife. It truly saddens me what has happened to the profession. I wish natural birth midwives would come together en mass and stand up for themselves, the traditional ways, and the women they could empower. My “natural” childbirth experience changed me. It truly did empower me like nothing else had up to that point. The decision to remove our children from private school and homeschool them also change our lives- for the better. Taking responsibility for ourselves isn’t a burden, it makes us stronger and wiser. It gives us more control of things that are truly important to us. It’s so sad what goes on in this country today. God bless you all who continue to attempt to assist women through the best possible birth experience. I pray that one day the spirit will rise among you and you will open free standing birth centers, run by traditional midwives, geared toward “natural” childbirth but prepared for anything that may happen. Thank you for allowing me to post.

  6. radicaldoula December 10, 2008 / 12:57 pm

    thanks for your thoughts nechama! midwives and other birth advocates/activists and allies are always welcome here.

    i understand a lot of what you are saying and think it’s totally true for midwives maybe even more than doulas, because the time constraints make it harder to do it on a volunteer basis.

    midwives need to make a living, just like many doulas do.

    and wisewarrior, i definitely hear what you are saying. social constructions of race and complicated and ever shifting. i know that as a light-skinned Latina who often passes as white I understand the difficulty that these categories present. race is not the only oppression that is important, but it deserves attention.

    thanks to everyone for their thoughtful comments. it’s inspiring to know there are other doulas and midwives who feel similarly!

  7. linsey December 12, 2008 / 12:47 pm

    I am DONA certified, but will likely allow my certification to lapse. I hate the politics fo the organization – the birth politics and the politics of power.

    My training was more culturally competent than most, I suspect, because it was in the context of a staff doula program in an inner-city with an incredibly diverse population.

    Justice, class and privilege were not hot topics, thats for sure. But, a big chunk of the class were African American nurses getting CEUs. Which brings me to this: I think professionalization of doulas is important. If we’re looking toward a model of doulas serving the communities they are in, you can’t rely on a volunteer model. Doulas have to make money. In addition to supporting renegade, activist and radical doulas, I think it makes sense to advocate for Medicaid and private insurance reimbursement for professional doulas. There are many fine staff doula programs at hospitals nation-wide, and advocacy to keep them funded is important.

    The doulas working in the now-defunct staff doula program at our hospital were a relatively diverse, politically minded and mostly women-centered bunch. Now that its gone, these women have moved onto other things that pay money.

    I would like to work with women who can’t afford to pay me my private fee, but mostly I feel like we should use our privilege to advocate for programs to help women support other women within their communities.

    In order to make doula work accessible to (and for) people who are not white, middle-class and in partnered relationships, there has to be funding for training and employment. There are many more WOC CNMs than CPMs, for example, at least in part because of the access to federally financed education and funded job opportunities.

    • Joy February 2, 2011 / 12:07 pm

      I could not agree more with everything you say here. I think there is a fine line between making services accessible and affordable (or free) and making sure things are sustainable and that you’re valuing your own work and able to make a living.


  8. wisewarriror December 16, 2008 / 1:17 pm

    Dearest Radical Doula,
    I would very much like to suggest the possibility of a “gathering” of sorts.
    Perhaps you would be interested in such.
    It has been a long, long time since the last “CUNT” gathering, which was slotted to be ’bout “Death & Dying”.
    It could easily concern itself with “Radical Doulas”.
    As you read before, that was what its original intention was.

    Keep on keepin’ on …

    I look forward to your thoughts on this.

  9. Danielle December 18, 2008 / 5:21 pm

    I also didn’t get certified, mostly because my philosophy is much akin to Miriam’s. Being a doula seems to be the best, most direct way I have found to actively change my community. When I speak to midwives and other doulas about this philosophy, I often assume they will be in complete agreement, and then realize that I am getting blank stares back. I had thought this was the basic foundation for all people in this field, but I do think it is a smaller group. I really admire groups like The Birth Attendants, and the public healthcare model in Asheville, NC, where access to doulas is increased (in Asheville, medicare covers the expense, and the hospitals have doulas on call). These models should be in every city.

    The idea of the boutique doula is popular, and it makes sense because it is hard to make a living as a doula, or hold down a 9 to 5 job when you are on call for a birth. My ideal is that each city has a syndicate of doulas that donate services for three births a year, or work a regular shift in a maternity ward where they join parents as they start labor.

    Really interesting conversation here. Thanks!

  10. peta January 28, 2009 / 10:13 pm

    People like you are the reason why doula’s are not widely respected in the medical/midwifery industry. your ideals on birth and pregnancy a great but the reality is that perinatal and postnatal complications happen and women and babies die as a result of inexperience and inaction from people such as yourself… what will you do if a labouring woman has an obstructed labour or a post partum haemorrhage?? Do you know how to deliver a baby with shoulder dystocia??? Do you know how to revive a flat unresponsive baby??? How will you manage a uterine rupture???
    Pregnancy and labour is not a disease but it is also not a risk free event without complications… women should be supported in natural birth and have intervention kept to a minimum only to be used when absolutely necessary.. but will you let these women die as a result of you arrogance and lack of education in child birth… good intentions do not save mothers and there babies….
    Think about whom you’re doing this for … are you empowering women and just fuelling your own misguided ego…..?

  11. radicaldoula January 28, 2009 / 10:45 pm


    First off, I think you’re confused about the role of a doula. Doula’s are not medical providers, we are focused on emotional and psychological support for birthing people. The issues you bring up are the domain of midwives, not doulas.

    Secondly, there are a lot of arguments to be made that doctors are also not doing what is best for birth. Yes, some births have complications. But many births also have complications BECAUSE of the interventions of these medical professionals.

  12. peta January 29, 2009 / 3:42 am

    “………..i have been having dreams of birth sisters…women who support women through birth, no matter what. revolutionary sisters. women who will go to jail for a birthing person. someone who will support you as much or as little as you need. through an herbal abortion. a miscarriage. on the phone during an unassisted birth. without insurance…”

    “women who will go to jail for a birthing person.”

    i believe your not just refering to spirital support in this paragraph from your opening statement…..

  13. radicaldoula January 29, 2009 / 10:38 am

    That’s a quote from a sister blogger and birth activist. I can’t speak to exactly what her vision is, but I know that in my ideas of the role of a doula, medical intervention isn’t there. In the way I interpreted her statement, she is referring to support. Pregnant and birthing women have been criminalized for their choices, and I believe that is what she is implying, that she will follow those women wherever their fight for autonomy takes them.

  14. wisewarriror February 8, 2009 / 4:37 pm

    You assume much…
    Understand little…

    You cannot know – from what it written here – what any individual knows & what their training may be
    Go back – if you are so inclined – and carefully read what was posted.
    The support spoken of here is support for what the BIRTHING WOMAN HERSELF CHOOSES.
    If a Woman so chooses to have support for, let’s say, a “Free” aka “unassisted” birth or an herbal abortion, that is her decision and hers alone.
    If she requests that her support provide some sort of care that includes trouble shooting a complication during labor, that is between the people involved.
    It is not for anyone outside of them to pass a judgement on what is appropriate for them in any given circumstance.
    Personal responsibility for what they need to know,
    whether that be deciding to “Let the Universe provide” to getting so called “medical” training, is up to them.
    What is now the “exclusive domain” of “Medical” intervention, was in the not too distant past, merely doing what needs to be done.
    It does not take a doctorate in medicine to handle dystocia or revive a baby.
    Hell, I’ve personally witnessed Docs imploy invasive interventions when dealing with a “stuck” baby, instead of just getting a Woman to change to more advantageous positions !!!

    And let me say this…
    I have very strong opinions – for instance, about “Free Birthing” and how to prepare for such –


    It is simply…
    Not the issue, now is it.
    Supporting a Woman in her birth choices by honoring her intention IS – by the very act of doing so -“Spiritual”.
    There is no distinction between “emotional” or “physical” support being more or less “Spiritual”.
    It is in fact, the blatant disregard for a Womans birthing intentions & lack of evidence based education & care that allow for pregnancy, labor & breastfeeding experiences, that can very well leave Women & Babies traumatized and in many instances physically damaged !!!
    All in the name of “Modern Medicine” & “Sound Medical Care” !!!

    It is a Doula “worth her salt” that will “jump into the fire” to provide support based on what is optimal & in accordance with the “Biological Blueprint”.
    And there ain’t many of them Peta !!!
    No need to worry ’bout them NOT being widely respected.
    The cooped Doula is alive & well & NOT makin’ ANY waves !!!

  15. wisewarriror February 9, 2009 / 2:02 pm

    Misspelled “employ”.
    I mistakenly wrote “Imploy”.

  16. talkbirth February 18, 2009 / 2:41 pm

    This quote from your post jumped out at me: “For me, it’s a form of activism, a way to support and accompany women through their labor.” DONA seems to specifically define a doula a NOT an activist (leave activism outside the birth room, etc.) I have an activist’s heart and cannot change that. I’m a birth educator and I do not do doula work and do not really ever plan to (mostly because I cannot stand to lend witness to hospital birth 😦 ), but I’ve trained as a doula (ALACE) and as a postpartum doula (DONA and I’m a long time member of DONA. My observation is that DONA definitely has an overtone of making sure you “toe the party line” and defer to the medical staff (or refer women to their health care provider when they ask you questions perinatally). It isn’t an overall “match” with me.

    Anyway, interesting post!

  17. Mel May 30, 2009 / 4:44 pm

    this blog (in totality) is air to me. thank you.

    i just found the blog a few days ago, and getting to this post is right on time…as i’m preparing for DONA workshops and certification starting tomorrow.

    i’m not a doula, yet. i’m a partnered queer woman of color (qwoc) and worry about finding a doula and midwife that get us. my partner and i are planning our first baby, and in figuring out my own birth plan…a natural-at-home-in-the-water-orgasmic-birth…i thought, “dang, if i knew about this ten years ago i would’ve gone to midwifery school!” i talked to a co-worker about my feelings and she said, “why not become a doula.” my research began and i made my decision.

    i do not intend to quit my job (teaching) to become a full-time doula. i recognize that quitting my job would force me to charge high fees for support, which would make it so that white upper-class women make up the bulk of clients. i want to be really clear…i’m neither anti-white, nor anti-wealth. however, the reality is that options are already abound in these communities. many american born/cultivated Q/WOC don’t even know what doulas are, or have no idea of the benefits of having a doula assist birth (in addition to having no idea how dangerous it is giving birth in a hospital!)…i want to work with qwoc, because historically we have fewer resources, less access and higher statistics.

    so you can pretty much guess that reading about how DONA ignores issues of race, class, gender, etc…comes as a bummer. HOWEVER…i wonder if abstaining from being DONA certified is the best response to this issue. wouldn’t it be beneficial to become certified…become a trainer…and give affordable or free workshops in our communities to empower doulas of the future? or do the same and provide workshops outside of our communities that force folks to look at and grapple with these issues?

    perhaps it’s my inexperience in the birthing community coming to the surface in my response…but in having dealt with other types of “fucking with the system”…i see that this may be an instance where you need to be in the system, if only for a minute, to fuck up the system. who knows, in 3 sundays i may have a different view 😉

  18. smiledoula July 5, 2009 / 10:28 am

    I appreciate all that you have written. I feel sorry that most of you were trained by woman interested in the business side of things from DONA. I am in the process of my DONA certification and was trained by and amazing Doula. She did discuss in great detail that we as doula’s need to accept any woman, regardless of their race, religion or social class. She encouraged us to do to do volenteer work and to lower or waive our fee’s if a client could not afford them. I am a better doula because of her workshop and learned things from her that I would have not learned in a book.

    As in almost every situation, there is always another side. I feel 100% confident in my certification through DONA because of who I was trained by.

  19. Lesley January 22, 2010 / 8:23 pm


    Great post! I am a doula of 16 years of experience, and I too have never certified. I have been very turned off books that literally say doulas must have birthed vaginally. Who says you even need to have birthed at all?! Also, what if you’ve needed a C-section for complete placenta previa? You’re excluded from the club?! It’s messed up.

    I have been training doulas for around 7 years, and my students are absolutely required, in order to certify, to volunteer for an organization which provides volunteer doulas to incarcerated women, women in hiding, refugees, women of financial need, etc. But they don’t need to BE certified in order to do this. and many of them just continue this volunteer work, because they love it. We teach about different cultures, ages, races, sizes, and gender identifications (or non identification). They need to be ready, willing, and able to support whatever arises, and whatever choices a woman makes.

    I do, however, teach active non-violence. Doulas who are in aggressive verbal opposition to medical staff tend to not be respected themselves, for better or for worse, and in my experience that gives us less ability to get in there and make real changes. That’s just my two cents. I’ve attended around 400 hospital births and have experimented with both approaches. I get better overall results with diplomacy, and I’m looking for real change, not just an opportunity in the here and now to speak up.

    Keep up the great work, Doula Sister,

    Lesley Everest,

  20. peacefulbeginnings October 30, 2011 / 11:18 am

    Fascinating post and so much food for thought. Thank you!

  21. Jill Herendeen September 16, 2013 / 7:38 am

    Yes–, too, took the DONA certification class and then refused to sign the contract promising never to contradict an O.B. (Knowing full well their skill at prevaricating.)

    Yes, it’d be great it women didn’t have to PAY for a doula, but then, it’d be great if they didn’t have to PAY for ANY assistance in childbirth. IN MOST OTHER DEVELOPED COUNTRIES, THEY DON’T HAVE TO, AND MIDWIVES ARE WHAT THEY AUTOMATICALLY GET, UNLESS THEY HAVE ACTUAL MEDICAL COMPLICATIONS. We are mostly suffering from the third-world-style “Pay-Or-Die” health non-care system. Seems to me that we’d be far better off with single-payer health care–at least we wouldn’t be tripping over the issue of money; and if care were free to all, we’d most likely have a little cash for extras if we felt the need…

  22. Kami August 5, 2016 / 10:08 pm

    Can I work as a doula if I not certified ?
    I did the course , 3 years ago ..

    • DrDoula September 11, 2016 / 9:08 am

      There are no regulations surrounding doula work. If you desire to serve women during their childbearing year, you can freely do so.

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