Doula Regulation in New York State
I am honored to be included in the Oakland Better Birth Foundation's efforts to respond to public policy and narratives affecting family and community health. Here's what I wrote at the Board's request in response to to NY Senate/Assembly Bill S3344B/A364, which was passed in the summer of 2019. A signed copy of this was sent to NY elected officials in solidarity with other doulas and the families we serve. Learn more about the context of this process and how "well-intentioned" legislation can have a negative impact here.
The Honorable Andrew M. Coumo
Governor of New York State
NYS Capitol Building
Albany, NY 12224
Re: Senate Bill S3344B via Assembly Bill A364
Dear Governor Coumo,
While this legislation is well-intentioned, it will actually counteract the goals of benefiting maternal and infant health, by limiting Doulas who are already in practice, restricting the demographics of who can be a Doula, and delegitimizing people who have already been in practice supporting pregnant, birthing and postpartum individuals and families for many years. The term "Certified Doula" has been in use for years, across the United States, and is not something that New York can claim for its own - many certification programs who have served thousands of families through their training of Doulas, already use this title. The trainings and ongoing education of Doulas worldwide is augmented by cooperation and collaboration across programs, teachers, and communities, not by the singular authority of any one state or legislative body.
As non-clinical care providers, the Doula role need not be regulated by the state - indeed it is this very process that has criminalized the work of women and those who support them throughout our history, including the purposeful disenfranchisement of elder black midwives who practiced for decades in the southeast, with incredible statistics of successful birth outcomes, despite the factors of poverty, malnourishment, and stress that affect a population recently liberated from state-sanctioned enslavement. When Doulas started to appear, as we understand them today, decades ago, it was again to advocate for a population, this time wealthier white women, who found that their rights to informed consent, bodily sovereignty, and self-determined parenting, were neither upheld nor respected by the institutions providing their medical care. Today, Doulas step in where doctors and midwives usually cannot, providing continuous emotional support, subjectively appropriate cultural care, client-centered advocacy, hands-on comfort, and emotional and mental encouragement to overcome decades of pervasive misogynist thinking that teaches women their bodies are dysfunctional, broken, incapable, weak and pathological. How does one regulate the power to inspire? The impact of the Doula, however well-documented in the statistics, cannot be codified.
We believe the subjective nature of this work, in which one-on-one care is provided as culturally appropriate per the birthing person, makes it impossible to justly standardize in a way that will truly serve all women. The formal justification for this legislation notes ethnic and racial disparities that affect maternal health outcomes - indeed black American women are three times more likely to die in childbirth than their white peers - as much as 8-10 times more likely in some areas. These gaps will only be widened by legislation that restricts Doula certification via additional fees, a smaller selection of training options (by standards yet to be defined), and a very vaguely stated judgment of moral character, as of yet undefined and inherently prone to human bias and institutional bigotry. Parents and babies in low-income and racially or otherwise marginalized communities rely on Doulas to be there as informed choice advocates and liaisons, as do clients in higher-income communities of all races and backgrounds. All women and birthing people deserve to have the option to choose a Doula from within their own community, who understands their needs and values in a way that only solidarity of experience can; the implication of this legislation, that the state is equipped to assign an appropriate Doula for every client, let alone to distinguish morality of character, erases the realities of institutionalized racism and sexism within the state, and illustrates a lack of understanding of the boundaries and processes between Doula and client. In making "Doula" a state-controlled profession, the role of advocate is inherently weakened, while limitations to access will restrict otherwise excellent doulas from serving their communities legally, thereby criminalizing an entire demographic of people who either cannot afford or do not appear to fit a majority-white, wealthy Senate's concept of "good".
Finally, by potentially linking the State's certification guidelines to a process of determining fees considered acceptable for reimbursement by the State, this legislation lays the groundwork to economically disenfranchise thousands of community birth workers by assigning a budget-based value to the priceless work of supporting families, and forcing birth workers to pay to participate in a more restrictive marketplace. Attempting to delegitimize otherwise capable service providers who do not or cannot comply with new requirements may lead to a loss of services in other areas that often overlap with doula work, such as nanny care, as many birth workers are experienced in multiple realms and the loss of one kind of work may threaten their financial stability, health, access to clients, and right to choose their own work balance and schedule. On the other side of this delegitimization will be an essential whitewashing of doulas who do comply, meaning a less diverse professional population, both in identity and skill. The end result is that families will have fewer choices in hiring quality doulas, thereby negatively impacting their long-term satisfaction, health outcomes, and future participation in the family care services economy.
For these reasons, as well as the apparent lack of integrated input by actual community doulas in the creation of this legislation, we of the Oakland Better Birth Foundation stand with our sister doula and birthworker organizations, stand with all birthing people, and stand with all birthworkers of all affiliations in recommending that Senate Bill S3344B is thoroughly rejected in recognition of its disservice to the citizens of New York and beyond.
Jessalyn Ballerano, BA, CD, CCCE, Communications Administrator
On Behalf of The Oakland Better Birth Foundation,
Samsarah T Morgan, CD CHT DD, Executive Director & Founder
Advisory Board Members Endorsing This Statement:
Tora Spigner, RN
Liberdad Rivera, RN, BSN, CLE
Laura Cox, BA, CLEC
Cristina Urista, RN
CC: Assemblywoman Amy Paulin, Sponsor Senator Jessica Ramos, Sponsor Assemblyman Richard Gottfried, Co-Sponsor Assemblywoman Galef, Co-Sponsor Assemblywoman Jaffee, Co-Sponsor Assemblywoman Rosenthal, Co-Sponsor Assemblywoman Cook, Co-Sponsor Assemblywoman Seawright, Co-Sponsor Assemblywoman Arroyo, Co-Sponsor Assemblyman Blake, Co-Sponsor Assemblywoman Dickens, Co-Sponsor Assemblyman Pichardo, Co-Sponsor Assemblyman Thiele, Co-Sponsor Assemblyman McDonough, Co-Sponsor Assemblywoman Solages, Co-Sponsor Senator Biaggi, Co-Sponsor Senator Kaplan, Co-Sponsor Senator Gaughran, Co-Sponsor Senator Krueger, Co-Sponsor Senator Rivera, Co-Sponsor