Oftentimes when I tell people I am a doula they ask how I trained, and if the training was similar to midwifery. They are surprised when I tell them that doula care is actually unregulated, meaning anyone can say they are a doula and work as one. This kind of sounds like a nightmare, especially when thinking about the uprising in anti-vax anti-science ideologies. And, you really don't want someone at your birth making baseless claims about the choices you should be making or arguing with a care provider that you really trust. But, what I like about the openness of certification is that doula care has us rethinking what it means to be an expert, and whether you really want an expert at your birth, or another human who really cares about what's happening. 

When I first became a doula, I was drawn to this work because our profession relates to certification differently than other perinatal care providers and many healthcare providers in general. Doula support is not a clinical practice, and while clinical knowledge is core to effective, evidence based support, doulas are also spiritual care practitioners, support people, harm reduction workers, mediators, and counsellors. We kind of fill this role of sponge in the birth space, melding together the visible and invisible players in the process of birth. And, on the practical side of things, not needing to be certified right away was helpful to me as someone who needed to be working another full time job to get doula experience at first. 

What I will say about certification is that it helps clients get money back from insurance, and that is undeniably important when it comes to accessibility for care. And, as I mentioned above, it does help to prevent the spread of misinformation and pseudoscience that exists so rampantly in the perinatal world. This is what made me decide to certify. But, the thing is, people are taught culturally to value experience and expertise over care and attention. And maybe while you want to look for expertise and experience from your clinical care provider, care and attention from your doula isn't something that comes from a certification necessarily. You might want a doula who exists close to your experience and is able to show up for you. Incarcerated birthers deserve access to doulas with lived experience of incarceration. Birthers who do sex work deserve doulas who are sex workers or have a respectful understanding of that work and its relationship to perinatal care. Queer and trans birthers deserve queer and trans doulas. Religious and spiritual birthers deserve doulas who can show up for the ceremony of birth. And the list goes on. Thus, certification might not be accessible to the doula who is best suited for a client. And even for families who are not marginalized by the healthcare system, the doula that might be best might not look the most impressive on paper but may just be a compatible and caring person to you. Attention and care are skills developed over lifetimes, not over a training period with DONA. 

So, when thinking about hiring a doula, while the question of "are you certified" and "how many births have you attended" may be on your mind, what I hope this post might also bring to mind is the questions of, "what is important to you" and "how will you care for me"? 

A very common query for families when looking for doula care is around OHIP coverage. Whether you choose to hire a doula for birth support or postpartum, care can come at a cost and money can cause barriers to accessing care. Doula care is currently not covered by OHIP, but that doesn't mean you have no coverage for care! It is becoming increasingly popular for insurance companies such as SunLife to offer some coverage for birth and postpartum doulas who are certified through a regulated body such as DONA, CAPPA, and Doula Canada. The best course of action is to reach out to your insurance provider to ask about doula coverage. 

Questions you can ask your doula when interviewing surrounding insurance coverage: 
- Are you certified in birth and postpartum or only birth/only postpartum? 
- Do you issue a receipt for services? 

If your provider currently does not offer coverage, there are a few options: 
- Request employer support: If you employer builds your care package, consider speaking to them about offering coverage for doula care!
- Request a doctor's recommendation for doula care: You may be able to secure insurance coverage if a doctor recommends doula care as a medical necessity for you. 

If cost is still a concern after taking these steps to investigate insurance coverage, speak with your doula about creating a payment plan or sliding scale offerings.