Dear Governor Cuomo,
On June 18, 2019, the doula profession became aware of that New York Legislators approved the House Bill A00364B and its counterpart in the Senate S03344-B.
While the doula profession commends New York state for attempting to address the serious impact our poor maternal and fetal health outcomes, especially in relation to racial disparities, has on our society, we have major concerns about some of the chosen language in the bill.
We would like to invite you, Governor Cuomo and all sponsors of this bill, into a conversation about how to achieve these important goals and how doulas can be a part of this, without inadvertently having an adverse effect on doulas and the community that you are trying to help.
There was a time where all women were simply supported from the start of labor through the postpartum period by other women. Eventually, modern obstetrics became the norm and giving birth in a hospital with only the support of staff became the social norm for birth. In just a few generations, women lost continuous labor support. Our current maternal health statistics reflect the lack of proper and continuous support for laboring and postpartum women.
Doulas, professional labor support, have sought to be part of the solution to poor maternal health outcomes and increased risks related to racial disparities.
We strongly believe every woman who desires a doula for continuous labor support be given access to one. Unfortunately, there are many circumstances which funds simply aren’t available.
Once again, we commend the effort to find a solution to grant more access to doula support, which is proven to improve outcomes, but we must address some concerns. Concerns which we feel could further limit access to doula care.
Our concerns include:
The Concerning Definition of ‘Certified Doula’ – The current language is concerning. It reads: “It provides the definitions of certified doulas and certified doula services and states that only a doula certified under this article shall be authorized to use the title of certified doula.”
Currently, doulas are not regulated in the United States. Several training and certification agencies exist to help bring a level of professionalism and education to the doula community.
Women certified by training organizations regularly refer to themselves as certified doulas as they have completed professional, peer-approved requirements.
Doulas provide non-medical support and thus to date, there have been no certification requirements in order to provide doula services. While this means consumers should do their due diligence during the hiring process, it means those with skills to provide continuous labor support are able to provide such services regardless of access to state certification programs.
While providing an opportunity to become state certified is a great step towards professionalism, will this language set the stage for potentially criminalizing doulas who do not pursue certification under the state of NY?
We feel different language provides more protection from unnecessary requirements to provide labor support. Perhaps, ‘State Certified Doula’ while allowing other certified doulas to continue referring to themselves appropriately as they have completed peer-recognized certifications.
The Potential to Further Disparities Among Minorities – It is proven that there are severe disparities in birth outcomes for women of color, especially African American women.
Regardless of their education, employment and age, African American women have the highest maternal mortality rate and at no fault to them.
It is well known that a level of systematic racism plays a role in these outcomes. While we aren’t certain exactly how and why, nor do we know the exact solution to end this, we do know changes need to be made.
It is imperative that more women of color be able to provide professional labor support for other women of color.
The language in this bill currently reads: “being of good moral character as defined by the department.” How is good moral character defined? Will the board deciding who is approved be diverse and reduce the risk for discrimination or biases?
Will this exclude anyone with a previous criminal history? We know for a fact that women of color are disproportionally criminalized putting them at a disadvantage in building a career. Women of color are best suited to support other women of color in an effort to reduce disparities in maternity care.
What negative impact will this have on the very population we need to improve outcomes for?
The Impact on Those in Poverty and With Other Disadvantages – Exam and fee requirements to become certified through the state should this bill pass. Will these requirements reduce the number of women in poverty able to pursue certification? What will happen to the community doulas already serving women if they’re unable to afford exams and fees?
Doulas are non-medical providers. While many certification agencies require submitting proof of knowledge regarding evidenced based birth practices and clear understanding of scope of practice, none currently require a supervised, formal exam.
Will a well skilled doula who is not a native speaker be intimated by the exam requirement? Will this exclude an extremely qualified and skilled doula who happens to have a learning disability?
Adjusting these requirements could be vital to ensuring adequately skilled doulas can continue to practice, especially within their own communities, to be part of the solution to our poor maternity care outcomes.
The Bill Is Modeled After Struggling Pilot Programs – Several community doula and Medicaid covered doula programs have attempted to provide continuous labor support to as many women as possible regardless of a mother’s personal ability to pay. Unfortunately, many of these programs are not sustainable.
This bill is modeled with the idea these pilot programs have been successful. However, if they are not sustainable, is modeling this bill after that style program a benefit to anyone?
While many doulas enter the profession as a calling and with a desire to help, they cannot continue to practice long term without proper compensation. The nominal reimbursement of many pilot Medicaid programs became a hurdle to these programs lasting long-term. Modeling this bill after such programs may set up the entire doula profession in the state of NY to struggle.
The bill does attempt to address the need for continuous labor support for women. However, we feel very strongly that changes need to be made.
Any bill which leaves the opportunity for further racial disparities, socioeconomic discrimination and poor compensation for doulas, is not a bill which can have a positive impact on maternity care.
We ask that you, Governor Cuomo, and the New York State Legislators consider the importance of the language of this bill and how we can protect birthing women, women in all communities, and doulas.
On behalf of all of our New York Members,
Aliza Bancoff, Director,
International Doula Institute