Frequently Asked Questions - Birth Doulas | Washington State Department of Health

Infographic of competencies according to WAC (PDF).

What do state-certified birth doulas do?

A person that is a nonmedical birth coach or support person trained to provide physical, emotional, and informational support to birthing persons during pregnancy, antepartum, labor, birth, and the postpartum periods. Birth doulas do not provide medical care.

See table for competencies to rule (PDF).

How do I meet the education requirement for the birth doula certification?

There are three pathways to obtain birth doula certification in Washington state.

Pathway A: Training Program Pathway
Complete an approved program defined in WAC 246-835-020

And

(2)(a) Culturally congruent ancestral practices, training, and education defined in WAC 246-835-025, which includes culturally congruent care in the birthing client’s community.
Pathway B: Ancestral or Legacy Pathway
Complete ancestral pathway competencies defined in WAC 246-835-022

And

(2)(a) Culturally congruent ancestral practices, training, and education defined in WAC 246-835-025, which includes culturally congruent care in the birthing client’s community.
Pathway C: Out of State Pathway
Completed certification requirements in another state or territory of the US. Which includes culturally congruent ancestral practices, training and education defined in WAC 246-835-025, which includes culturally congruent care in the birthing client’s community.

And

Ten (10) hours of continuing education (CE) for applicants who have been certified in another jurisdiction for two years or more as defined in WAC 246-835-040 which includes culturally congruent care in the birthing client’s community. CE is not required for applicants who have been certified in another jurisdiction for less than two years.

What is the difference between culturally congruent care, which is separate from culturally congruent ancestral practices?

Culturally Congruent Care: Every birth doula, regardless of their identity, has a duty to learn respect for and uphold their client’s cultural practices around birth. Birth doulas should be able to use community resources and networks to help families access other doulas from the same background, religion, culture, and community as them.

Culturally Congruent Ancestral Practices: Birth doulas who gained their experience outside of traditional training/workshops/programs which could include, but are not limited to mentorship, apprenticeship, or experience through practice. Practices may include, but are not limited to:

Spiritual and cultural rituals for birth (i.e., rebozo use, belly binding, placenta burial, placenta encapsulation, cord burning, lotus birth, etc.)
Development of intuitive practices during birth (following intuition).

How do I satisfy culturally congruent ancestral practices, training, and education from WAC 246-835-025?

Culturally congruent ancestral practices, training, and education includes culturally congruent care. A birth doula certification applicant may complete an attestation stating they have completed practices, training, and education in any areas listed in WAC 246-835-025, examples include:

Birth Justice and Advocacy (History of Obstetrics)
Erasure of Granny Midwives and Indigenous birthwork
LGBTQ+/Gender Inclusive care
Black and Indigenous perinatal health crisis
Trauma-informed care
Social determinants of health
Adverse childhood experiences (ACES)
Ancestral Pathway only: Other training and education that enhances knowledge of culturally ancestral practices.

WAC 246-835-025 provides examples; this is not an all-inclusive list. Many other examples may be appropriate.

How many hours of culturally congruent ancestral practices, training, and education are required?

The is no defined number of hours required. Culturally congruent ancestral practices, training, and education completed must include culturally congruent care in the birthing client’s community.

What are the requirements to apply for certification?

State certification requirements can be found in WAC 246-835-030. Also, depending on your route to certification, other requirements are likely needed. See the section above for specific laws relevant to becoming state certified.

What materials do I include with my application?

Please see the application for complete instructions. You must submit:

Any fees required in WAC 246-835-990
Proof of successful completion of the culturally congruent ancestral practices requirements in WAC 246-835-025; and one of the following:
- Proof of successful completion of core curricula training through a program, or courses that collectively meet the requirements in WAC 246-835-020(1)
- Proof of successful completion in training requirements from an approved program through WAC 246-835-020(2); or
- Proof of successful completion education requirements through completion of the ancestral pathway competencies in WAC 246-835-022.

Once my initial, state certification is issued, when does it need to be renewed?

Your initial credential cycle is less than one year. Your initial certification expires on your next birthday after your initial credential is issued, per WAC 246-12-020. After that initial credential cycle, you are required to renew every two years on your birthday and attest to meeting the requirements of 10 hours of continuing education (CE) per WAC 246-835-060.

Ten hours of CE every renewal cycle:

A minimum of eight hours of CE and leadership development activities must be obtained through one of the activities listed (a) through (f) in WAC 246-835-060.

A minimum of five hours must directly relate to the practice of a birth doula.

You shall complete two hours of health equity CE every four years per chapter 43.70 RCW and in compliance with WAC 246-12-800 through 246-12-830.

You shall obtain CE hours in one or more of the categories listed in WAC 246-835-060. Documentation for all activities must include your, date of activity, and number of hours.

What happens if I’m audited for my 10 hours of continuing education?

If you’re audited, you’ll receive a letter from the Department of Health. You must reply and send documentation of all courses for the continuing education cycle.

How do I apply for a state-certification of a birth doula?

Application and forms will be posted on our website on October 1, 2023.

How much does it cost to become a state-certified birth doula?

Information about the fee schedule is in this notice of certification fees.

Is there an exam I need to take?

No, there is no examination requirement for state-certified birth doula.

How long do I have to keep proof of my continuing education courses?

Per WAC 246-12 Part 7, you must keep documentation for four years.

How do I change my name or update my contact information?

We must have your current mailing address in our system. This is especially important because we mail your courtesy renewal notice. The U.S. Postal Service does not forward Department of Health mail so it’s your responsibility to inform our Customer Service Office of a change in name or address.

If your contact information is not current in our system, complete and submit the contact information change form.

After completing the form, submit it to the Department of Health by doing one of the following:

Email: select the “Email” button on the contact information change form, it will be sent automatically
Fax: 360-236-4818
Mail: see the address at the bottom of the form.

How can I be involved and stay informed?

To get important information about state-certified birth doulas, subscribe for email updates at the bottom of the page.

Can a person practice as a birth doula without obtaining certification?

Nothing in chapter 18.47 RCW prohibits a person from practicing as a birth doula without obtaining certification. However, no person may use the title “state-certified birth doula” in connection with the person’s name to indicate or imply, directly or indirectly without state-certification from the Department of Health.

Can a state-certified birth doula perform birth rituals, such as cord burning and lotus birth, in hospitals and other settings?

Some hospitals are not able to perform cording burning and lotus birth rituals in their settings due to regulations concerning open flames and recommended practices from obstetric and pediatric professional societies. Please check the policies of each organization or setting where you plan to perform birth rituals.

How long does the application process take?

The required documentation may take several weeks to receive. Routine applications may be issued within two weeks following receipt of all required information. Applications requiring additional background information or review may take longer.

How do personal data questions affect my application?

A “yes” answer to a personal data question or the existence of a criminal conviction does not automatically prohibit the department from issuing a credential. If you answer “yes” on any of the personal data questions or if a criminal history appears on a criminal background check, your file will be evaluated on an individual basis. Your application would then become an exception file, and the normal application processing time does not apply.

Does Apple Health (Medicaid) reimburse for birth doula services?

Not currently. Apple Health (Medicaid) is managed by the Washington State Health Care Authority (HCA), not the Department of Health. HCA is actively partnering with stakeholders to establish a doula benefit for Apple Health clients. HCA is targeting early 2025 to implement the benefit. SB 5950 Sec 211 (34) (PDF) directed and funded the HCA to implement a Medicaid doula benefit in WA, requiring first that the Centers for Medicare & Medicaid Services (CMS) to approve a State Plan Amendment. If you're interested in updates or being involved with this work, sign up for the HCA doula listserv (scroll to the subheading of “reproductive health providers” and then “doulas”).