The threat of Doula Regulation in the U.S

Why Doula Regulation Was Inevitable

For years, doulas have been positioned as powerful birth companions; supportive, nurturing, and intuitively tuned in to a mother’s emotional, physical, and spiritual needs. But today, doulas face a new challenge: regulation. What led to this sudden shift? Why now? And what does it mean for the future of birth support?

How We Got Here

Over the last decade, doulas slowly evolved from calm birth-side support to front-line medical advocates. The role of “doula as a witness” has been increasingly replaced with “doula as a protector”, stepping between patient and provider, challenging clinical decisions, and interpreting medical actions on behalf of the birthing person.

While intentions were pure, the consequences were complex. Doulas began standing in spaces meant for licensed professionals, navigating consent, disputing medical protocols, and speaking for individuals in vulnerable or unconscious states.

This wasn’t advocacy. This became legal interference.

What’s Happening Now

As a result, hospitals, medical boards, and state governments are responding. Doulas, once seen as companions, are now being viewed as liabilities. More and more hospitals are requiring formal agreements, certifications, or even banning doulas altogether.

What we’re witnessing is not oppression. It is correction.

Correction of the confusion between advocacy and authority.

Where We’re Headed

If doulas continue to blur the lines between emotional support and medical interference, regulation is not only inevitable, it’s necessary.

But there’s a better way forward: doulas as educators, activists, and culture-shapers, not undercover lawyers in the birth room.

Why This Is Happening

Because doulas stepped into the role of medical advocate, rather than supportive witness.

In a hospital setting, standing between a patient and provider is a legal action.

If that doula isn’t a legal proxy, family member, or licensed medical professional, their presence and involvement become problematic.

The doula isn’t trained to medically intervene. The doula isn’t legally responsible. Yet the doula is making interpretive or confrontational decisions.

That is a legal conflict, one that hospitals must address.

What Really Led to This

Much of this stems from the way large doula organizations have trained birth workers over the past decade. Doulas have been taught to “speak up” and “advocate for their clients,” often without receiving the in-depth education required to support true informed decision-making.

Worse still, many of these organizations have separated doula training from childbirth education training.

• It’s a separate course.

• A separate cost.

• A separate certification.

This leaves doulas underprepared to fully educate their clients. And when mothers walk into birth lacking true understanding, the doula becomes the fallback.

Now the doula is expected to speak on the mother's behalf in real-time medical situations, ones she may not have been educated for, never prepared her client for, and may not even fully understand herself.

She is learning in the moment. She is reacting in the moment. And that is exactly what has led to regulation.

Parallel Examples from Other Industries

1. Real Estate: Imagine a friend showing up at a home closing to dispute contract terms, speaking for the buyer without a license. Illegal.

2. Courtroom: A well-meaning person stands up mid-trial and begins defending a friend. They are not a licensed attorney. They are removed.

3. Surgery: A nutritionist walks into an operating room and begins advising the surgeon based on wellness beliefs. Unlicensed interference.

These examples would never fly—and yet doulas have normalized this in the birthing space.

Advocacy vs. Activism

There’s a massive difference between medical advocacy and activism:

• Advocacy in the room for someone who is silent is legal only when delegated.

• Activism outside the room—teaching, policy shaping, legislative work—is where doulas have unshakable power.

Doulas should be taking this to the legislature, fighting for informed consent, respectful care, and better hospital policies at the systems level, not distracting themselves trying to be mini-medical reps in a birth room.

Most doulas right now are not childbirth educators. Many are emotionally charged individuals stepping into high-stakes medical scenarios—even into surgical settings like cesarean births.

They’re unsupported, under-trained, and overstepping.

This is not empowerment. This is confusion.

What Doulas Can Do

It’s time for doulas to:

• Get trained not only in support but education and systems-level understanding

• Stop trying to fix broken systems from within a single birth

• Lead communities through activism, storytelling, and legislative reform

• Elevate themselves through multi-certification in childbirth education and hands-on birth skills

Doulas have always been powerful. But power is only as effective as its rightful placement.

We can preserve the integrity of the birth room and shape policy for generations. But only if we stop standing in the wrong role—and start rising in the one God actually assigned us.

Where Is God in the Birth Room?

Right now, God is missing from the birth community at large, especially in the major doula organization trainings. If you are a believer, if you’ve been given discernment and are walking in the Spirit, you know what this really is.

This isn’t just a legal shift. This is a spiritual war.

The enemy is at work - twisting truth, elevating fear over faith, and distracting doulas with emotional reactions and division. He is using emotion, policy, and power to fracture the birth space and lure even good-hearted doulas away from Spirit-led service.

If we were truly led by the Holy Spirit, this would not be our focus. We would not be trying to fight people in the room. We would be preparing families in truth and peace before they ever walk in.

This is exactly why the Faith Driven Doula + Childbirth Educator + Hands-On Skills Training exists.

It sets a new standard. One rooted in faith. One focused on education. One led by the Spirit—not the system.

Want to become a Faith Driven Doula, Childbirth Educator, and Hands-On Skills Practitioner all in one?

Learn more about our 3-in-1 certification training today. The future of birth is waiting

The Real Battle in Birthwork Isn’t What You Think

Tension is rising in the birth world. Everywhere you look, on Facebook, Instagram, in forums, even among professionals; there’s outrage, division, and defensiveness. But here's what’s not being said enough, this is not just about regulation. It’s about how we’re treating one another in a space meant for healing and support.

A troubling dynamic has emerged, especially as new hospital protocols and doula agreements come to light. Rather than inviting honest reflection, the doula community at large has responded, often with hostility, blame, and chaos. And in doing so, we are missing the real opportunity: to take ownership, rise in maturity, and actually create meaningful change.

The birthing space is sacred. And instead of stewarding it with wisdom, many are fueling a war that distracts from the deeper calling: to support mothers well, to bring safety and strength, and to bring solutions, not just soundbites.

When Outrage Replaces Accountability

The open letter to MemorialCare, a Southern California health system, sparked an uproar. It challenged the system’s right to ask doulas to sign an acknowledgment form, outlining boundaries and behavior expectations. The letter claimed the form was silencing doulas, stripping birthing people of support, and reinforcing institutional control.

Many doulas shared stories of mistreatment by providers; stories that are real, valid, and deserve to be heard. But in the storm of anger that followed, a critical truth was buried:

Yes, institutions must be held accountable—but so must we.

When doulas step into a birth space, we hold influence. With that comes responsibility. And when boundaries are unclear or professionalism wavers, it’s not “oppression” to revisit those dynamics; it’s wisdom.

We need to ask:

• Are we equipping our clients to advocate for themselves, or trying to become their voice?

• Are we afraid to not be needed?

• Are we teaching true autonomy or accidentally encouraging dependency on us?

• Are we fueling unity in birth or deepening distrust between families and care providers? If we don’t wrestle with these questions honestly, we risk becoming the very thing we claim to stand against.

A Call for the Whole Birth Community

This is not about taking sides.

It’s about creating a future of birth that’s rooted in clarity, not conflict.

It’s about doulas and birth workers reclaiming the power of education, preparation and collaboration not confrontation.

No matter your background, your beliefs, or your platform, we all have a shared responsibility:

To uplift—not escalate

To prepare—not provoke

To serve—not dominate

This is not a call to passivity. This is a call to intentional, transformative action. That means being bold and wise. Clear and compassionate.

It means knowing how to hold your ground without burning down the room.

What If We Chose a Different Way?

• What if doulas were known not just for passion, but for poise?

• What if we trained our clients so well in alignment, communication, and physiological readiness that we became needed ways that actually progresses labor?

• What if we didn’t just fight for inclusion, but became indispensable through skill, grace, and emotional intelligence?

• What if, instead of leading a rebellion, we led a reformation?

The Birth World Is at a Crossroads

You don’t need to pick a fight to protect your clients.

You need to equip them.

You don’t need to rage against regulation.

You need to show what respectful, powerful, evidence-based support looks like.

Let’s not let anger or offense hijack the deeper assignment we’ve been entrusted with.

Let’s move forward with integrity.

Let’s advocate with maturity.

Let’s keep mothers at the center, not our egos, not our fear of being silenced, not our resentment toward institutions.

Let’s remember: doulas are here because there is a problem. Let’s be part of the solution.

Doula Regulation Is Happening—Right Now

This isn’t a future concern, it’s reality in multiple states and even some hospitals.

🌟 Connecticut (CT)

As of July 1, 2023, it’s illegal to use the title “certified doula” unless you are state-certified by CT’s Department of Public Health. While you can still offer doula services, you cannot legally call yourself a “certified doula” without approval. source

🌟 Virginia (VA)

Their Code § 32.1‑77.1, effective June 1, 2025, establishes a state-certified doula title and credentialing process. Only those trained and certified by state-approved entities can legally use the term “state‑certified doula.” source

🌟 Washington State (WA)

Passed ESHB 1881 in 2023, creating doula as a regulated “health profession.” While credentialing is voluntary until Jan 20, 2025, only “state‑certified birth doulas” can claim that title. New rules under WAC 246‑835‑040 will enforce it. source

Hospitals Are Requiring Contracts & Certification

• In New York, Senate Bills S5992A/S5991A mandate doula presence during labor and even cesarean births—but only if they meet “approved” credentials, charging hospitals to verify certification or deny access. source

• In Massachusetts, the Doula Initiative is actively working on introducing statewide credentialing to allow hospitals to confirm quality of care before granting access. source

Broader Medicaid & Certification Policies

• Illinois, Oregon, Minnesota, New Jersey, Maryland, Nevada, Rhode Island, California, Colorado, Delaware, Virginia, Utah, and others require certification by approved organizations in order to be Medicaid‑reimbursable or recognized by hospitals. 

Why This Matters to You

• These states are legally protecting the use of the word “doula”, not just regulating care quality.

• Hospitals are demanding contracts and credential verification, even surgical areas like C-sections require it.

• Doulas who aren’t certified by approved bodies are now at risk, restricted from calling themselves “certified”, banned from hospitals, and even excluded from birth rooms altogether.

Faith-Driven Doula Program: The Clear Answer

This is why our Faith-Driven Doula + Childbirth Educator + Hands‑On Skills Training matters now more than ever:

1. ✅ You receive state-vetted, dual certification that meets legal standards.

2. ✅ You become recognized in hospitals and reimbursable by Medicaid.

3. ✅ You stand out with thoughtful, spiritually rooted education & activisim that doesn’t overstep into medical or legal misconduct.

   
   

We are preparing doulas to step into this next era with confidence, not confusion. The regulations are here. Let’s make sure you're called, prepared, and recognized.

U.S. State Doula Certification & Legal Guidelines

This is not legal advice, but a professionally compiled resource for doulas and training program leaders.

So let's clarify, What’s Legal?

As of now, there are no states in the U.S. where it is illegal to call yourself a doula if you are not certified by a specific organization. However, some states do require certification through approved programs for doulas seeking Medicaid reimbursement or inclusion in state-funded programs.

You can legally serve as a doula without certification in all 50 states, as long as you do not claim to provide licensed medical care and you abide by relevant state consumer protection laws.

States with Voluntary Doula Certification or Registry (for Medicaid Purposes)

These states offer (or require) registration or state-recognized training in order to participate in Medicaid reimbursement — but you are not required to be certified to practice as a doula unless you seek to be reimbursed by Medicaid or public funds.

🌲 Oregon

• Doulas must register with the Traditional Health Worker (THW) Registry through the Oregon Health Authority (OHA) to be reimbursed.

• Registry requires training through an approved program (e.g., DONA, CBI, CAPPA, etc.).

• Training programs must apply and align with THW competencies.

California

• Through Medi-Cal’s Doula Benefit, doulas can receive reimbursement.

• Certification must meet California’s state standards and doulas must enroll through the CalAIM doula registration portal (under Department of Health Care Services).

✅ Faith Driven Doula Certification Qualifies for California Medi-Cal Reimbursement.Doulas trained through the Faith Driven Doula Program can submit their credentials, complete the DHCS provider application, and begin offering services to Medi-Cal clients.To qualify:

• Submit proof of training that includes the required doula competencies

• Apply for a National Provider Identifier (NPI)

• Complete the required state paperwork and orientation modules

Let us know if you'd like support with this process!

Minnesota

• Medicaid-recognized doulas must complete training through an approved doula education program, and register with DHS for reimbursement.

• Some managed care organizations have their own preferred networks.

New York

• Creating a state doula registry and pilot Medicaid reimbursement models.

• Certification must be through a recognized and approved body to be included in programs.

New Jersey

• Approved Medicaid reimbursement program for doulas certified through:

  • DONA

  • CAPPA

  • Commonsense Childbirth Institute

  • ICTC

  • And others on the official list

Rhode Island

• Doulas must be certified and registered with the Department of Health to receive Medicaid payments.

Who Are the Most Commonly Approved Certifying Bodies Approved for Medicaid?

State Medicaid programs often accept the following:

• DONA International

• CAPPA

• Commonsense Childbirth Institute

• ICTC (International Center for Traditional Childbearing)

• Childbirth International (CBI)

• Ancient Song Doula Services

• HealthConnect One

• National Black Doulas Association (NBDA)

• Faith Driven Doula Certification (California-eligible upon provider application)

What About Unlicensed Practice?

Under California’s SB 577, and similar laws in other states, you may offer holistic wellness and doula support legally without a license as long as:

• You do not claim to diagnose, treat, or cure any medical conditions

• You provide clear disclosures about your scope of practice

• You do not use titles protected by law (like “doctor,” “midwife,” or “nurse”)

This means you can legally operate your Faith Driven Doula, Childbirth Education and Hands on Skills Maternal Alignment sessions under this statute with the right disclaimers.

You Can Still Be a Doula Without Certification — BUT…

You are not required to be certified to call yourself a doula or to serve privately with clients.

However, to access state funds like Medicaid reimbursement, you must:

• Be trained by a recognized or approved body (or apply for recognition)

• Register with the appropriate state agency

• Complete any necessary background checks or documentation

🌍 International Legalities for Doula Practice & Certification

While the U.S. generally allows doulas to practice without certification (as long as no medical care is provided), each country has its own regulatory approach to non-medical birth support.

🇨🇦 Canada

• No legal requirement for certification in most provinces.

• Doulas are considered non-medical support.

• Some regions like British Columbia are exploring doula reimbursement through health authorities or insurance, which may require certification by an approved body.

• Clients often prefer doulas with certification and liability insurance, but it is not mandated by law.

🇬🇧 United Kingdom

• Doulas are not regulated by law.

• The Doula UK organization is the most widely recognized body, but certification is not required to practice.

• NHS hospitals typically allow certified or experienced doulas but may require advance notice or documentation for birth room access.

🇦🇺 Australia

• No formal licensing required.

• Doula Network Australia and Australian Doula College are well known, but independent training is legally valid.

• Like the U.S., doulas must avoid offering medical care unless appropriately licensed.

🇳🇿 New Zealand

• Doulas can practice freely without regulation.

• Most work is in private care settings.

• The country recognizes traditional Māori birth workers and is increasingly open to faith-based and culturally-aligned training programs.

🇿🇦 South Africa

• No national regulation of doulas.

• Certification is encouraged, but not legally required.

• Doulas are increasingly being recognized for reducing birth disparities in low-resource settings.

🇪🇺 European Union (varies by country)

• Germany, Sweden, and the Netherlands have growing doula movements. Certification is often preferred but not legally enforced.

• Some countries have national health programs that may only reimburse doulas trained through specific institutions.

• However, faith-based or international certifications are not banned, and many doulas operate independently.

The Faith Driven Doula Training Program qualifies doulas to serve legally and ethically across most international settings. While laws vary by country, doulas are rarely subject to strict licensing requirements, as they do not offer medical care. Our training emphasizes professional boundaries, informed consent, and legal best practices, equipping doulas globally to serve with faith and integrity. Learn more

A Hopeful Future for Faith-Driven Doulas

Despite the ongoing shifts in doula regulation across different regions, there is one thing that remains unshaken; the need for compassionate, spirit-led support during birth. As laws evolve and certification pathways expand, we believe that God is raising up a generation of birthworkers who are not only equipped in skill, but rooted in purpose.

Faith-driven doulas offer more than techniques or textbook knowledge- they carry peace into the birthing space, intercede with prayer, and hold space for miracles. As more women search for authentic, holistic, and spiritually aligned support, the presence of faith-led doulas is not only relevant, it’s critical.

Rather than fear regulation, we view this as a powerful opportunity: to be set apart in how we serve, to educate clients on their rights, and to build bridges that protect both the art and heart of doula work. No matter what state or country you're in, there is room for your calling. There is room for God's blueprint in birth.

So whether you're just beginning your journey or navigating what regulations might look like in your area, hold fast to this: the birth space still needs you. And now more than ever, faith-driven support is not only welcome, it’s being deeply sought out.

Your presence matters. Your training matters. Your calling matters.

We understand that for many doulas, this blog hits a nerve. It’s meant to. Because it challenges a narrative that has long been fed to us — that to be valuable in the birth space, a doula must be the savior, the voice, and sometimes even the fighter.

But here’s the truth, that model is not only unsustainable, it’s not the calling.

At The Positive Pregnancy Journey Organization, we don’t train doulas to be silent. We train doulas to be equipped. There is a major difference between advocating out of trauma and educating from a place of authority and peace. One is reactive, one is redemptive. One says “Let me speak for her.” The other says, “Let me remind her of her own voice and show her how to use it.”

Here’s what got us here: an epidemic of medical trauma, compounded by systemic injustice, and doulas stepping in to fill a role to try and fix the system, a role they were never meant to carry alone. We see the pain. We understand the righteous anger. But the enemy’s tactic is distraction. He wants doulas caught up in battles they were never meant to fight, burned out, reactive, and disconnected from the real calling, to equip, educate, and edify.

The doula model we teach is faith-driven, not fear-fueled. We are reclaiming birthwork not as warfare, but as worship; where the doula doesn’t interfere, doesn’t perform, but stands grounded in truth, posture, presence, and peace. A doula who knows that true progress in labor often happens in silence, in surrender, in the sacred, not in shouting matches with staff.

That’s why the blog feels ground-shaking. Because it is. It shakes loose the savior complex. It calls us higher, to be doulas who move in the Spirit, not in ego, and who believe that God's design doesn't need our defense — it needs our agreement.

We fully agree that the state of maternal care is broken. But we believe the answer isn’t always louder doulas, it’s more educated mothers. More doulas rooted in truth. More birthworkers who model Kingdom values and let that be the standard that shifts the room.

We know this message isn’t for everyone. But it is for the ones who are ready to stop striving and start serving in divine authority.

To every doula called to more, we see you, and you’re not alone.